Nipple discharge is a common problem with which ladies present to our Breast Clinic. Nipple discharge can be of many types ranging from clear fluid to frank blood.
Greenish nipple discharge is commonly seen in ladies between the ages of 40-55 years. It is common in ladies who smoke and those are suffering from diabetes.
Breast Cancer should be ruled out in all these patients by doing a triple assessment, i.e. clinical examination, imaging & biopsy. Once cancer has been ruled out, patient should be re-assured and if there is any inflammation, antibiotics can be given. In case of persistent discharge and a lump, the implicated ducts can be surgically removed.
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)
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:
- 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.
- 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.
- 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.
Dr. Rohan Khandelwal & Dr. Savita Chopra
Department of Breast Diseases & Cancer Care
W Pratiksha Hospital, Gurgaon