Intraductal papilloma
Benign papillary tumour within a breast duct
Overview
A benign papillary tumour growing within a (usually subareolar) breast duct — the commonest cause of BLOODY single-duct nipple discharge, typically in women 40–50. Usually no palpable lump. Diagnosed by triple assessment/ductography and treated by microdochectomy (duct excision), partly to exclude an underlying malignancy.
Recognise
- BLOODY (or serous) discharge from a SINGLE duct, often spontaneous; usually no mass (or a small subareolar nodule)
- Women ~40–50; solitary (central) papillomas are benign; multiple peripheral papillomas carry a small cancer risk
- Distinguish from duct ectasia (multi-duct, green/creamy) and carcinoma
Red flags
- Bloody single-duct discharge → refer (exclude carcinoma) and excise
- An associated mass or atypia on biopsy
Differentials & how to tell them apart
Investigations
Triple assessment; ductography/ultrasound; biopsy. Microdochectomy provides histology.
Management
Triple assessment → microdochectomy (duct excision)
- 1Refer single-duct bloody discharge for triple assessment; localise and excise the duct (microdochectomy).Gate: Bloody SINGLE-duct discharge needs excision to obtain histology and EXCLUDE an underlying carcinoma — not just reassurance
- 2Histology guides further management; multiple peripheral papillomas/atypia warrant closer surveillance.
Key points
Bloody single-duct discharge with no lump = intraductal papilloma (commonest cause) → excise to confirm and exclude cancer. Multi-duct green discharge = duct ectasia instead.
Monitor & prognosis
Histology; surveillance if atypia/multiple.
Benign (solitary); small risk with multiple/atypia.
Source: NICE NG101