Intraductal papilloma This disease is most commonly seen in women aged 40-50 years, with a trend toward younger age in only a few years. 3/4 of the cases occur in the enlarged part of the large milk duct near the nipple. The tumor is very small, tipped and with many villi, richly vascularized and with a thin, brittle wall that bleeds easily. The clinical features are a bloody nipple discharge, usually bright red, and a mass that is not easily palpable. The diagnosis can be established if a soft, pushable lump of several millimeters in size is found in the areola area, and if the lump can be discharged from the nipple with gentle pressure (most patients do not have a palpable lump). The affected breast is usually painless. Occasionally, pain may occur due to tumor obstruction of the milk duct, and once the blood is discharged, the pain may disappear, which may recur. It is usually believed that intraductal papilloma is benign, but malignancy can occur in 6-8% of cases, so it should be treated by early surgery. In postmenopausal patients, simple excision of the affected breast may be considered because of the increased likelihood of malignancy. The excised specimen should be sent for pathological examination, and if malignant changes are seen, it should be treated as breast cancer.