Department of Surgery, Bács-Kiskun County Teaching Hospital, Nyíri út 38, Kecskemét 6000, Hungary.
Pathol Oncol Res. 2013 Jul;19(3):589-95. doi: 10.1007/s12253-013-9622-4. Epub 2013 Mar 24.
Solitary ductal papilloma of the breast, although considered a benign disorder has a potential association with carcinomas. We studied and analyzed the role of selective ductectomy (SD) for the diagnosis and treatment of intraductal lesions presenting with single duct discharge and ductography suggestive of intraductal (papillary) lesions. During a ten-year-period, files of patients presenting with single (or rarely dual) duct discharge were retrospectively reviewed. The examinations included mammography, ductography and ultrasonography and cytology of the fluid discharged from the duct in all patients. Patients treated with SD were considered further and their histological diagnosis and treatment were analyzed. The series included 100 patients. In 6 cases malignancy was found in the specimen consisting of four in situ and two invasive ductal carcinomas. These 6 patients had a second operation and this was followed by adjuvant treatment. Nine further patients had atypical ductal hyperplasia in or around papillomas and one patient had lobular neoplasia around her papilloma. In the present series, the incidence of carcinoma associated with the clinical suspicion of papillary lesions was 6%, and further 10% had low grade neoplastic proliferations resulting in the diagnosis of atypical papillomas or atypical ductal hyperplasia or lobular neoplasia around the papilloma, indicating that single duct discharge may be a symptom a malignancy, and that ductal papillomas have malignant potential. For such a low risk and grade of malignancy simple follow-up could be one option, but in some cases SD could be applied to relieve the patients from symptoms and establish a diagnosis.
乳腺单纯性导管内乳头状瘤虽然被认为是一种良性疾病，但与癌有潜在的关联。我们研究和分析了选择性导管切除术（SD）在诊断和治疗以单导管溢液和导管造影提示导管内（乳头状）病变为特征的导管内病变中的作用。在十年期间，回顾性分析了以单导管（或罕见的双导管）溢液就诊的患者的病历。检查包括乳腺 X 线摄影、导管造影和超声以及所有患者导管溢液的细胞学检查。对接受 SD 治疗的患者进行进一步考虑，并分析其组织学诊断和治疗。该系列包括 100 例患者。在 6 例标本中发现恶性肿瘤，包括 4 例原位癌和 2 例浸润性导管癌。这 6 例患者进行了第二次手术，并随后进行了辅助治疗。9 例患者在乳头状瘤周围或附近存在不典型导管增生，1 例患者在乳头状瘤周围存在小叶肿瘤。在本系列中，与乳头状病变临床怀疑相关的癌的发生率为 6%，进一步有 10%的低度肿瘤性增生导致不典型乳头状瘤或不典型导管增生或乳头状瘤周围小叶肿瘤的诊断，表明单导管溢液可能是恶性肿瘤的症状，并且导管内乳头状瘤具有恶性潜能。对于如此低风险和低级别恶性肿瘤，单纯随访可能是一种选择，但在某些情况下，SD 可用于缓解患者的症状并做出诊断。
