A 35-year-old woman presents with bloody nipple discharge from a single duct opening in the left breast. There is no palpable mass and mammogram is normal. The MOST likely diagnosis and the appropriate investigation are:
- A Ductal carcinoma in situ; immediate mastectomy
- B Intraductal papilloma; microdochectomy is both diagnostic and therapeutic ✓
- C Galactocoele; reassurance and observation
- D Paget's disease of the nipple; punch biopsy of nipple skin
Explanation
Bloody single-duct nipple discharge in a woman under 50 with a normal mammogram is most commonly caused by an intraductal papilloma — a benign papillary lesion of the large lactiferous ducts near the nipple. Microdochectomy (excision of the affected duct and its papilloma) is both diagnostic and therapeutic. However, malignancy must be excluded — DCIS and invasive carcinoma can also present with bloody nipple discharge; ductoscopy and duct excision provide histological certainty. Galactocoele is a milk-retention cyst in lactating women. Paget's disease presents with nipple eczema/ulceration, not discharge.
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.