Unique case of multiple ductal papillomatosis

31 year old  nulliparous lady presented with serous nipple discharge from right breast since 3 months. She had no co-morbid conditions and no family history of cancer.

o/e – she had serous nipple discharge from 3-4 ducts (3,8,10 o clock). There were no palpable lumps in either of the breasts or axillae.

Nipple discharge cytology as negative for malignancy

On USG a very interesting finding was observed – there were ductal papillomas seen in ducts present at 3,8 and 10 ‘o clock position and the 3’o clock duct showed multiple ductal papillomas (3 can be seen in the USG image)

 

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Considering the age of the patient, a decision was taken to carry out three microdochectomies and the HPE revealed benign papillomas in all ducts.

 

Reasons for highlighting this case:

  1. Ductal papillomas are the most common cause of bloody nipple discharge and they arise from the terminal duct lobular units. This patient presented with serous nipple discharge.
  2. Usually ductal papillomas are solitary. Only 10% of intra-ductal papillomas tend to be multiple. This patient had at least 4 papillomas on final HPE.
  3. Multiple papillomatosis are more frequently associated with hyperplasia, atypia, DCIS, sclerosing adenosis, and radial scar but in this case none of the findings were present.

 

 

 

Case by:

Dr. Rohan Khandelwal & Dr. Savita Chopra

Department of Breast Diseases & Cancer Care

W Pratiksha Hospital, Gurgaon

 

 

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