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Subject Area

Orthopedic Surgery

Article Type

Case Report

Abstract

Detection of intraductal papilloma can be difficult; however, conventional ductography, MRI, ultrasound, and ductoscopy play important roles in the diagnostic process. Intraductal papilloma is usually benign in nature, with a small parentage being malignant. When evaluating the average size of a papilloma, which is between 1 and 3 cm, both conventional ductography and MRI have high sensitivity in detection. However, MRI has slightly better sensitivity and less invasiveness in comparison with conventional ductography and is considered the state of art in evaluation of normal-size intraductal papilloma. A 40-year-old female patient presented with a history of clear nipple discharge from the left breast. Left breast had no palpable mass, and there were no skin changes. From the center part of the nipple, there was watery clear discharge (serous) from a single duct. No bloody nipple discharge was expressed from either nipple. Mammography was negative for masses or nipple retraction. Ultrasound demonstrated dilated duct with no intraductal mass. Conventional ductogram demonstrated dilated duct with abrupt cutoff and no filling defect. MRI did not demonstrate any mass except dilated duct. Owing to concavity seen in the ductogram, mammography-guided wire placement was done for the dilated duct and then surgically removed. Pathology revealed 2-mm intraductal papilloma, with no atypia or carcinoma in situ. Neither the conventional ductogram nor the MRI ductography proves to be a better method of diagnosing miniscule intraductal papilloma. Individually, both methods have the potential to emphasize various aspects of the ducts in a way that would be valuable to the reader.

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