A 45-year-old woman presents to the breast clinic with a complaint of unilateral bloody nipple discharge from her right breast. The discharge is spontaneous and originates from a single duct orifice. She has no palpable breast masses, skin changes, or associated pain. Mammography and ultrasound show no evidence of masses or other abnormalities. A duct excision is performed, and histopathology confirms the diagnosis.
Which of the following pathologic conditions is most commonly associated with unilateral bloody nipple discharge from a single duct orifice, after intraductal papilloma?
A. Paget’s disease of the nipple
B. Intraductal carcinoma
C. Inflammatory carcinoma
D. Subareolar mastitis
Answer:
The correct answer is B. Intraductal carcinoma.
Explanation:
Intraductal carcinoma (B):
- After intraductal papilloma, the most common cause of unilateral bloody nipple discharge from a single duct orifice is intraductal carcinoma (ductal carcinoma in situ or DCIS). DCIS may involve the ducts and lead to nipple discharge, especially if the tumor is located near the nipple. Although it is a non-invasive cancer, early detection and management are critical to prevent progression to invasive carcinoma.
Explanation of Incorrect Options:
Paget’s disease of the nipple (A):
- Paget’s disease of the nipple typically presents with eczematous changes of the nipple and areola, including crusting, erythema, and ulceration. Bloody nipple discharge is not a characteristic feature of Paget’s disease, which is often associated with underlying breast carcinoma, particularly DCIS or invasive carcinoma.
Inflammatory carcinoma (C):
- Inflammatory carcinoma is a rare and aggressive form of breast cancer that presents with rapid breast swelling, skin redness, and a “peau d’orange” appearance due to lymphatic involvement. Bloody nipple discharge is not a typical feature of inflammatory carcinoma.
Subareolar mastitis (D):
- Subareolar mastitis refers to infection or inflammation of the ducts beneath the areola, often associated with pain, swelling, and abscess formation. While this condition can cause nipple discharge, it is usually not bloody and tends to present with purulent or serous discharge.
In conclusion, intraductal carcinoma (B) is the most common pathologic condition associated with unilateral bloody nipple discharge after intraductal papilloma, making it the correct answer.