A 48-year-old woman presents with a 3-month history of bloody nipple discharge from the left breast. On examination no discrete lump is palpable. Mammography is normal. Ductoscopy and cytology of the discharge confirms the presence of atypical ductal cells. What is the most likely diagnosis and the definitive management?
- A Duct ectasia; total duct excision (Hadfield's procedure)
- B Galactorrhoea due to hyperprolactinaemia; bromocriptine therapy
- C Paget's disease of the nipple; punch biopsy and mastectomy
- D Intraductal papilloma; microdochectomy (excision of the involved duct) ✓
Explanation
Bloody (serosanguinous) nipple discharge from a single duct in a perimenopausal woman is the classic presentation of an intraductal papilloma, the most common benign cause of such discharge. Atypical ductal cells on cytology may be seen with papilloma; definitive management is microdochectomy (excision of the responsible duct and papilloma) which also provides histological diagnosis. Duct ectasia typically causes green/brown discharge from multiple ducts. Galactorrhoea is milky, bilateral, and associated with elevated prolactin. Paget's disease presents with nipple eczema and may have an underlying carcinoma but would show Paget cells on nipple scrape/biopsy.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.