A 45-year-old woman reports intermittent blood-stained discharge from a single duct of the left nipple for 2 months. There is no palpable lump and the discharge is reproducible from one pinpoint orifice. Cytology of the discharge shows benign ductal cells. What is the most common cause of this presentation?

• A Fibrocystic change with apocrine metaplasia
• B Duct ectasia
• C Intraduct papilloma ✓
• D Invasive ductal carcinoma

Explanation

C solitary duct producing spontaneous blood-stained or serous discharge without a mass is the classical presentation of a solitary intraduct papilloma, the commonest cause of bloody nipple discharge. Duct ectasia typically causes multiduct, green-brown, cheesy discharge in perimenopausal women and is often associated with a subareolar mass or nipple retraction. Carcinoma must be excluded by imaging and biopsy, but it accounts for a smaller proportion of blood-stained discharge cases than papilloma.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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