The term “papillary excrescences” is a descriptive phrase used in pathology and imaging reports to characterize a specific shape or growth pattern found within a body cavity or on a surface. It is a morphological description, similar to calling a growth “round” or “flat,” and does not inherently define whether the lesion is harmless or cancerous. The significance of an excrescence depends entirely on its location and what the cells that form it look like under a microscope.
Defining Papillary Excrescences
The word “papillary” refers to a structure shaped like a small nipple, finger, or frond. In a biological context, this describes a finger-like projection of tissue that extends outward from a surface, often having a central core composed of connective tissue and small blood vessels. This morphology is sometimes compared to the structure of coral or small tree branches due to its branching nature.
The second part of the term, “excrescence,” simply means an abnormal outgrowth or bump on an organ or tissue. Therefore, a papillary excrescence is literally a projecting, finger-shaped bump. This shape can be found in a wide variety of tissues throughout the body and is a common feature of both noncancerous growths and malignant tumors.
Common Locations and Clinical Context
Papillary excrescences are most frequently discussed in the context of ovarian masses, where their presence is a specific feature noted during ultrasound imaging. They often project inward from the wall of a fluid-filled ovarian cyst, indicating a complex cyst structure rather than a simple, typically benign, fluid sac. Excrescences can also be found on the outer surface of the ovary, which may raise suspicion for certain types of tumors.
These growths are also found in other anatomical areas, including the urinary tract, where they characterize conditions like papillary urothelial tumors in the bladder or renal cell carcinoma in the kidney. A type of growth called a papillary fibroelastoma is the most common benign tumor found on the valves of the heart, particularly the aortic and mitral valves. While these cardiac growths are noncancerous, they are clinically important because fragments can break off and travel through the bloodstream, potentially causing a stroke or other embolic event.
Assessing Malignancy Risk
The question of whether a papillary excrescence is cancerous requires a thorough examination of the cells that make up the structure. The risk level is established through pathological analysis, usually after the lesion has been surgically removed or biopsied. In the ovary, the finding of excrescences on a cyst wall shifts the lesion into the “complex” category, increasing the likelihood of a tumor requiring surgical removal.
Ovarian tumors with papillary architecture are broadly categorized into three groups based on their cellular behavior. Benign growths, such as cystadenomas, show papillary projections but are lined by normal-appearing cells. The second classification is “borderline” or tumors of low malignant potential, which show cellular proliferation and abnormal-looking cells (atypia) but have not clearly invaded the surrounding tissue. These borderline tumors often feature prominent papillary excrescences and have an excellent prognosis.
The third classification is malignant carcinoma, where the cells show uncontrolled growth and clear invasion into adjacent structures. The presence of multiple, large, or highly vascularized papillary projections seen on imaging correlates with a higher risk of malignancy. The final classification is made by the pathologist who examines the cellular structure and the pattern of growth to confirm the presence or absence of invasion.
Detection and Management Strategies
The initial detection of a papillary excrescence often occurs through medical imaging, with ultrasound being the most common first-line tool for pelvic masses. Sonographers look for the presence, size, and number of excrescences, as well as the blood flow within them, which is assessed using Doppler technology. Increased blood flow (vascularity) within the papillary structure suggests a higher risk of malignancy.
If an excrescence is identified, further imaging, such as CT or MRI, may be ordered to provide detailed information, especially for surgical planning and to check for spread. Management is dictated by the risk assessment derived from imaging and clinical factors like patient age. Lesions with clearly benign characteristics may be managed with careful surveillance, involving repeat imaging over time. However, lesions that are large, rapidly growing, or classified as highly suspicious or borderline usually require surgical intervention for definitive diagnosis and treatment.