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Incidental Treatment of Nipple Discharge Caused by Benign Intraductal Papilloma Through Diagnostic Mammotome Biopsy

Mark A. Dennis1, Steve Parker, Terese I. Kaske, A. Thomas Stavros and Joan Camp

1 All authors: Radiology Imaging Associates, Sally Jobe Breast Diagnostic and Counseling Center, 8200 E. Belleview Ave., Ste. 102, Englewood, CO 80111



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  		Fig. 1A. —65-year-old woman with serous nipple discharge. Sonogram oriented radially with reference to nipple shows periareolar mass (arrows).

 


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  		Fig. 1B. —65-year-old woman with serous nipple discharge. Sonogram obtained during saline injection through ductography needle reveals offending duct (thin arrows) extending to papilloma (short thick arrow) and verifies intraductal mass as cause of discharge. Subsequent mammotomy removed lesion and ended discharge.

 


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  		Fig. 2. —48-year-old woman with no discharge. Sonogram with color flow in papillary excrescence (arrow) distinguishes this palpable intracystic papilloma from debris or avascular septation in nonneoplastic complex cyst.

 


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  		Fig. 3. —37-year-old woman with clear nipple discharge. Radially oriented sonogram shows duct partially filled with indeterminate material (short solid arrows). Flow shown within (long arrow) duct confirms presence of neoplasm. Ectatic duct segment leading to nipple is shown for orientation (open arrows). Mammotome (Biopsys/Ethicon Endo-surgery, Cincinnati, OH) biopsy showed benign papilloma.

 


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  		Fig. 4A. —76-year-old woman with dark bloody nipple discharge. Sonogram shows well-defined intraductal mass (curved arrows) within ectatic duct (straight arrows).

 


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  		Fig. 4B. —76-year-old woman with dark bloody nipple discharge. Sonogram shows mammotome probe in ideal position; elongated papilloma (short black arrows) is within upward-directed mammotome (Biopsys/Ethicon Endo-surgery, Cincinnati, OH) aperture. Acoustic "ring-down" from vacuum ports is seen deep in relation to aperture (long back arrows). Small white arrows represent superior surface of probe proximal to aperture.

 


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  		Fig. 4C. —76-year-old woman with dark bloody nipple discharge. Sonogram (right and left orientation reversed) reveals absence of papilloma after probe removal from biopsy site (arrow). On follow-up physical examination no discharge was seen.

 


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  		Fig. 5A. —41-year-old woman with clear nipple discharge. Ductogram shows injection cannula (curved arrow) and occlusive filling defect (straight arrow).

 


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  		Fig. 5B. —41-year-old woman with clear nipple discharge. Sonogram shows intraductal mass (thin arrows), nipple (short solid arrow), and duct (curved arrow).

 


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  		Fig. 5C. —41-year-old woman with clear nipple discharge. Intraprocedural sonogram shows compressed lesion (curved arrow) and distorted ectatic duct (short arrow) positioned above and in close proximity to mammotome (Biopsys/Ethicon Endo-surgery, Cincinnati, OH) aperture. Borders of aperture and distal "ring-down" confirm excellent probe position for tissue acquisition (long arrows).

 


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  		Fig. 5D. —41-year-old woman with clear nipple discharge. Sonogram after biopsy shows small hypoechoic cavity caused by complete excision (arrow). No discharge was seen on follow-up.

 


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  		Fig. 6A. —52-year-old woman with serous bloody nipple discharge. Digital mammogram after ductogram shows lobulated filling defect within dilated duct in nipple (arrow).

 


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  		Fig. 6B. —52-year-old woman with serous bloody nipple discharge. Sonogram of nipple—areolar complex shows gel stand-off (short solid arrows), nipple (curved arrows), and lesion in nipple (short thick arrow). External fragment of tissue was removed with forceps, and pathology showed papilloma. Patient was not offered percutaneous biopsy because of position of lesion in nipple.

 

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