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Case number:	092
Age:	68
Clinical presentation:	Postmenopausal woman with average risk of developing breast cancer presented with nipple discharge from the right nipple of duration 1 year. Examination revealed right breast nodularity with tenderness felt along the axillary tail. There was clear watery discharge form the nipple.

Mammography:

Breast composition:	ACR category a (the breasts are almost entirely fatty)
Mammography features:
‣ Location of the lesion:	Right breast, central portion of the breast, upper inner quadrant at 12–1 o’clock, anterior third
‣ Mass:
• Number:	1
• Size:	None
• Shape:	Linear dilated duct
• Margins:	Circumscribed
• Density:	Equal
‣ Calcifications:
• Typically benign:	None
• Suspicious:	None
• Distribution:	None
‣ Architectural distortion:	None
‣ Asymmetry:	None
‣ Intramammary node:	None
‣ Skin lesion:	None
‣ Solitary dilated duct:	None
‣ Associated features:	Dilated duct in subareolar region

Ultrasound:

Ultrasound features: Right breast, central portion of the breast
‣ Mass
• Location:	Right breast, central portion of the breast
• Number:	1
• Size:	0.5 cm in the dilated duct
• Shape:	Irregular
• Orientation:	None
• Margins:	None
• Echo pattern:	Isoechoic
• Posterior features:	No posterior features
‣ Calcifications:	None
‣ Associated features:	Duct changes
‣ Special cases:	Solitary dilated duct

BI-RADS:

BI-RADS Category: 4A (low level of suspicion for malignancy)

Further assessment:

Further assessment advised: Referral for cytology

Cytology:

Cytology features:
‣ Type of sample:	Nipple discharge
‣ Site of biopsy:
• Laterality:	Right
• Quadrant:
• Localization technique:
• Nature of aspirate:	Clear serous fluid discharge from the nipple
‣ Cytological description:	Smears show only thin proteinaceous material. Cellular material not seen
‣ Reporting category:	Benign
‣ Diagnosis:	Benign, negative for malignant cells
‣ Comments:	None

Cytology features:
‣ Type of sample:	FNAC (solid lesion)
‣ Site of biopsy:
• Laterality:	Right
• Quadrant:	Subareolar
• Localization technique:	Ultrasound-guided FNAC
• Nature of aspirate:	Scant brownish fluid
‣ Cytological description:	Smears show plenty of foamy histiocytes and a few ductal epithelial cells, some of which show apocrine change
‣ Reporting category:	Benign
‣ Diagnosis:	Benign, proliferative fibrocystic change
‣ Comments:	None

Case summary:

Postmenopausal woman presented with right breast clear watery nipple discharge. Diagnosed as right breast subareolar solitary dilated duct with intraductal echoes, BI-RADS 4A on imaging and as benign proliferative fibrocystic change on cytology.

Learning points:

The discharge in fibrocystic changes can be clear, greenish or brownish in colour. Frankly blood-stained discharges occur with intraductal papilloma and intraductal carcinoma.