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Atlas of breast cancer early detection

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Case number:092
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.


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

Further assessment:

Further assessment advised: Referral for 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.

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