Der Pathologe

, Volume 27, Issue 5, pp 350–357 | Cite as

Papilläre Tumoren der Mamma

  • D. Hungermann
  • T. Decker
  • H. Bürger
  • C. Kersting
  • W. Böcker
Schwerpunkt: Mammapathologie

Zusammenfassung

Papillom bezeichnet eine benigne Läsion des Mammagewebes, welche ein verzweigtes Stromagerüst mit einer durch eine Basalmembran abgetrennte glandulär/myoepitheliale Überkleidung aufweist. Papillome können in jedem Teil des Milchgangsystems entstehen und werden nach ihrer Lokalisation in solitäre, zentrale Papillome der großen subareolären Milchgänge und in multiple, periphere Papillome in den dilatierten terminalen duktulolobulären Einheiten des peripheren Drüsengewebes unterteilt. Sowohl Veränderungen des Stromas als auch epitheliale Meta- und Hyperplasien können ein Papillom modifizieren und die Diagnose erschweren. In einer signifikanten Anzahl von Papillomen können Atypien identifiziert werden, die überwiegend vom duktalen Typ sind. Diese Läsionen müssen vom papillären Typ des duktalen Carcinoma in situ (DCIS) differenziert werden. 17% aller Papillome sind mit synchronen In-situ- oder invasiven Karzinomen assoziiert, aber sie stellen zusätzlich eine Indikatorläsion dar, die ohne bzw. mit Atypien ein 1,8- bzw. 3,5-fach erhöhtes Risiko anzeigen, ein (metachrones) Karzinom zu entwickeln. Als Konsequenz werden Papillome in der minimalinvasiven Biopsie als B3 klassifiziert und sind in der Regel chirurgisch zu exzidieren.

Schlüsselwörter

Papillom Atypie Duktales Carcinoma in situ (DCIS) Indikatorläsion 

Papillary tumors of the breast

Abstract

The term papilloma applies to benign proliferative epithelial breast lesions with a papillary architecture. The papillae in such lesions contain an arborizing fibrovascular core, glandular surface epithelium and a basal myoepithelial layer. A basement membrane encloses these structures. Papilloma may occur at any site in the ductal lobular system and according to its localization is subdivided into two types: solitary (central) papilloma which are located in the major nipple/subareolar ducts or large segmental ducts and multiple (peripheral) papillomas in cystically dilated terminal ductal lobular units (TDLU). Stromal changes, epithelial metaplasia and/or proliferations and neoplasia may alter the prototypical architecture. In a significant number of papillomas atypia can be identified which have to be classified as atypical proliferates of the ductal type. These lesions must be distinguished from the papillary type of ductal carcinoma in situ. Some 17% of all papilloma are associated with (synchronous) intraductal or invasive carcinoma, but these also act as an indicator for subsequent (metachronous) carcinoma. As a consequence, in minimally invasive biopsy papilloma has to be classified as B3 and usually has to be followed by surgical excision.

Keywords

Papilloma Atypia Ductal carcinoma in situ Risk indicator 

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Copyright information

© Springer Medizin Verlag 2006

Authors and Affiliations

  • D. Hungermann
    • 1
  • T. Decker
    • 1
  • H. Bürger
    • 1
  • C. Kersting
    • 1
  • W. Böcker
    • 1
  1. 1.Institut für PathologieUniversitätsklinikumMünster

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