Diagnostic dilemmas in Intraductal papillomas of the breast - Experience at Sultan Qaboos University Hospital in the Sultanate of Oman.

Adil Al Jarrah Al Ajmi,Sukhpal Sawhney,Husam Jamil,Ritu Lakhtakia,Zoheb Jaffer,Kamran Ahmad Malik

doi:10.12669/pjms.312.6476

Abstract

Objectives:The aim of this retrospective study was to correlate the significance and accuracy of the colour of nipple discharge and breast ultrasound imaging in the diagnosis of intraductal papilloma.Methods:This is a retrospective study of 34 patients who underwent 36 microdochectomies in Sultan Qaboos University Hospital (SQUH) in the Sultanate of Oman, over a 4 year period of January 2009 till December 2012. The confounders considered were patient age, physical examination findings, nipple discharge cytology result, ultrasound results and biopsy report following microdochectomy. Comparisons analysis, charts and graphs were made using the SPSS software (version 20).Results:The mean age of the patients was 44(27-73) years old. Twenty-seven out 36 (75%) patients had presented with nipple discharge, 14 out 27 (52%) had blood stained nipple discharge and 13(48%) with coloured discharge (yellow, brown and green), 9 patients had no discharge. The final histopathology showed intraductal papilloma 13 (36%), duct ectasia 18(50%), DCIS 1 (2.7%), fibrocystic disease 3(8.3%) and LCIS 1(2.7%). Thirteen out of 36 had intraductal papilloma on final histopathology. The correlation between blood stained discharge and final histopathology of intraductal papilloma was insignificant (p=0.44).Conclusion:Nipple discharge is irrelevant to the diagnosis of intraductal papilloma. Spontaneous nipple discharge regardless of color is to be referred to breast surgeon and to be assessed with triple assessment. Surgery remains the mainstay of treatment.

Highlights

There is a vast variety of clinical and radiologic manifestations of intraductal papillomatous lesions of the breast
The blood stained nipple discharge is thought to be due to twisting of papilloma on its fibro vascular pedicle leading to necrosis, ischemia and intraductal bleeding.[4]
We conducted a retrospective study of 34 patients who underwent 36 microdochectomies in Sultan Qaboos University Hospital (SQUH) in the Sultanate of Oman, over a 4 year period of January 2009 till December 2012

Summary

Introduction

There is a vast variety of clinical and radiologic manifestations of intraductal papillomatous lesions of the breast. The lesion presents as an oval or roundish mass located within a dilated. Histological analysis reveals proliferation of the ductal epithelium surrounded by myoepithelial cells and a fibro vascular stroma.[1] these lesions are benign, there is controversy about their diagnosis, mainly because of diversity in their clinical presentation and histopathology.[2] Clinically, they present most commonly as nipple discharge, known as pathological nipple discharge, which can be either blood stained, serous or coloured.[3] Blood stained or clear nipple discharge, usually of less than 6 months duration. The blood stained nipple discharge is thought to be due to twisting of papilloma on its fibro vascular pedicle leading to necrosis, ischemia and intraductal bleeding.[4] Management is multidisciplinary, requiring triple assessment with detailed history and clinical examination, imaging with mammogram or Ultrasonography, cytology of the discharge and biopsies followed by surgical intervention

Objectives

Methods

Results