Intraductal papilloma with bloody discharge from Montgomery's areolar tubercle examined by ductoscopy from the areola

A retrospective observational study of intraductal breast papilloma and its coexisting lesions: A real-world experience

Background

Breast intraductal papilloma is a heterogeneous group. The aim of the study is to investigate the intraductal breast papilloma and its coexisting lesions retrospectively in real‐world practice.

Methods

We retrospectively identified 4450 intraductal breast papilloma and its coexisting lesions.

Results

About 18.36% of intraductal papilloma coexisted with malignant lesions of the breast, 37.33% coexisted with atypia hyperplasia (AH), 25.24% coexisted with benign lesions, and only 19.10% coexisted without concomitant lesions. In addition, 36.80% of intraductal breast papilloma had nipple discharge, 51.46% had a palpable breast mass, and 16.45% had both nipple discharge and a palpable breast mass. About 28.18% experienced discomfort or were asymptomatic. Furthermore, 98.99% had ultrasound abnormalities, and 53.06% had intraductal hypoechogenicity upon ultrasound. 31.89% had mammographic distortion, and 14.45% had microcalcification upon mammography. Intraductal breast papilloma with malignancy had significant correlations with clinical manifestations.

Conclusion

Coexisting malignancy was also related to ultrasound abnormality (BIRADS 4C and 5), mammographic distortion, and microcalcification upon mammography but was not related to the intraductal hypoechoic upon ultrasound. Coexisting atypical hyperplasia correlated with nipple discharge but not palpable mass, mammographic distortion, or intraductal hypoechoic upon ultrasound. The coexisting AH was also related to abnormality upon ultrasound or microcalcification compared with the benign lesions. The intraductal papilloma coexists with malignancy or AH accounted for more than 50%, and the clinical information on papilloma and its coexisting lesions is nonspecific. We recommended surgical treatment for benign intraductal papillary lesions.

Neglected aspect of the strategy for human breast diseases: trans-areolar drug delivery

Breast cancer is the most common malignancy in women worldwide. Oncoplastic surgery and partial-breast reconstruction have already developed to improve cosmetic outcomes. However, new strategies for breast diseases are still needed. The principles of evolutionary biology and phylogeny can help solve specific medical problems. But the phylogeny of human breast areola had not been researched ever since proposed. The breast areola has a unique phylogeny, it has all different types of skin glands and includes a few hairs towards the periphery. These skin appendages, including Montgomery's glands - whose miniature mammary acini are in the subcutaneous tissue - make the dermal microvascular "sink" phenomenon imperfect, resulting in that more drug molecules can penetrate into deeper tissue. Meanwhile, the wrinkled skin of the areola increases the total delivery area. Here, we emphasize that the human breast areola has the potential to increase transdermal drug delivery to the breast. We anticipate that our hypothesis may help to provide new, optimized therapeutic and prophylactic strategies for the human breast diseases.