DUCT PAPILLOMA BREAST [ An ultrasound & color doppler diagnosis ]

Clinically duct pailloma causes nipple discharge  , which is usually blood stained in nature .

On ultrasound  often  a duct is seen dilated  with  a soft tissue  density intraductal mass [ echogenic mass or filling defect ] noted within it .  Some times  associated intraductal fluid with internal echos also present . Duct papilloma may be of varying size , but usually small  , solitary or multiple , and nonmobile mural adherent lesion with internal vascularity of Doppler [ suggests soft tissue nature ] . This  should be differentiated  from intraductal  infected slough debris or other nonviable matter . Duct papillomas are common in subareolar  & juxtaareolar areas , with some times dilated  duct is seen extending into nipple  . Biopsy is advised to detect any desmoplastic / neoplastic change.

Case – A 55 yrs old  female presented with H/O blood stained nipple discharge . Ultrasound scan showed  a dilated duct  extending from nipple to subareolar and adjacent area ,with a small soft tissue density / echogenic intraductal , mural adherent , nonmobile mass  seen as a filling defect [ Fig 1, 2 ] . The intraductal mass showed  internal vascularity on color and spectral Doppler  , suggesting viable soft tissue nature of the lesion  [ Fig 3 and 4 ]. 

Fig 1 - Nipple US scan shows elongated curved tubular ductal area [arrows]

Fig 2 - Subareolar US scan shows conti..dilated duct with a small echogenic intraductal mass[M], seen  as filling defect 

Fig 3-   The intraductal mass shows internal vascularity on power doppler

Fig 4 - Arterial waveform  signals depicted within vessel of intrductal mass[papilloma]