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Case number:	145
Age:	39
Clinical presentation:	Premenopausal woman with average risk of developing breast cancer presented with right nipple itching. Examination did not reveal any lump or palpable lesion.

Mammography:

Breast composition:	ACR category d (the breasts are extremely dense, which lowers the sensitivity of mammography)
Mammography features:
‣ Location of the lesion:	None
‣ Mass:
• Number:	0
• Size:	None
• Shape:	None
• Margins:	None
• Density:	None
‣ 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:	None

Ultrasound:

Ultrasound features: None
‣ Mass
• Location:	None
• Number:	0
• Size:	None
• Shape:	None
• Orientation:	None
• Margins:	None
• Echo pattern:	None
• Posterior features:	No posterior features
‣ Calcifications:	None
‣ Associated features:	None
‣ Special cases:	None

BI-RADS:

BI-RADS Category: 1 (negative)

Case summary:

Premenopausal woman presented with right nipple itching. Diagnosed as BI-RADS 1 on imaging.

Learning points:

Breast imaging is performed to exclude breast parenchymal findings causing nipple–areolar complex symptoms, commonly Paget disease. Absence of underlying disease allays anxiety and management of dermatological causes, as in this case, can be done.