Complaining of a spontaneous serous discharge from right nipple. Clinical examination detected that the secretion was serous and coming from a single duct.
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Ultrasounds show a solid mural nodule of 5 mm within a dilated retroareolar duct
Ultrasounds show a solid mural nodule of 5 mm within a dilated retroareolar duct and nipple discharge cytology detected papillary aggregates of normal duct cells, without red blood cells.
The patient was operated for an ultrasound guided microdochectomy (selective ductectomy), under general anesthesia. Histological examination of the specimen confirmed the diagnosis of a solitary intraductal benign papilloma without atypia.
In young patients with secreting breast but without lump, cytological analysis in addition to ultrasounds are the indicated.
If ultrasound clearly shows a solid mural nodule within a dilated retroareolar duct, galactography can be avoided, especially in a young woman.
Microdochectomy, and not the resection of all the milk ducts (Urban operation), must be considered in young women, to preserve breastfeeding. Microdochectomy is made by a small periareolar incision and the resulting scar can be nearly undetectable.
A study by the Mayo clinic estimated that patients with a solitary papilloma without atypia have a 2 fold increase risk of breast cancer 1.
- 1 Mulligan AM, O'Malley FP. Papillary lesions of the breast - a review. Adv Anat Path 2007; 14: 108 - 119.