A 52-year-old woman presents with spontaneous bloody nipple discharge from one duct opening. Ultrasound shows a 6 mm intraductal lesion. The most likely diagnosis and recommended surgical procedure are:

• A Duct ectasia; microdochectomy
• B Carcinoma; total duct excision (Adair's operation)
• C Fibrocystic disease; wedge excision
• D Intraductal papilloma; microdochectomy (Hadfield's operation) ✓

Explanation

Unilateral, spontaneous, single-duct bloody nipple discharge in a middle-aged woman is the classic presentation of a solitary intraductal papilloma. Microdochectomy (Hadfield's operation) excises the responsible duct and the lesion, providing both diagnosis and treatment. Total duct excision (Adair's) is reserved for multiple-duct discharge or duct ectasia.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.