Intraductal papilloma of the male breast: a case report and review of the literature

Unusual presentation of intraductal papilloma on the nipple: A case report

INTRODUCTION AND SIGNIFICANCE

Intraductal papilloma (IDP) is a benign breast lesion characterized by a small, delicate wart-like growth found within the milk ducts. Typically located centrally behind the nipple, IDP often presents with a serous, serosanguinous, or bloody discharge from the nipple, making it a common cause of abnormal nipple discharge. Differential diagnosis is crucial as it can be mistaken for other conditions such as pigmented Paget's disease and pigmented basal cell carcinoma.

CASE PRESENTATION

This case study depicts a 35-year-old female with a painless, pigmented mass on the nipple of her right breast that had been present for four months. Physical examination revealed a well-defined blue nodule measuring 13 × 8 mm. Although mammography and ultrasound did not detect any abnormalities in the breast tissue, a biopsy confirmed the diagnosis of intraductal papilloma. The lesion was surgically excised under local anesthesia without complications.

CLINICAL DISCUSSION

In this case, IDP presented as a blue nodule near the nipple. Despite the patient's young age and unique presentation, the diagnosis of intraductal papilloma was made based on the identified risk factors for breast tumors. Differential diagnoses considered included mammary Paget disease, nipple duct adenoma, and erosive adenomatosis of the nipple.

CONCLUSION

This case report underscores the uncommon occurrence of IDP manifesting on the nipple. A thorough evaluation incorporating medical history, physical examination, imaging studies, and cytological analysis is essential for an accurate diagnosis and to exclude malignancy. Surgical excision was successful in removing the lesion.

Mammographic and Sonographic Findings of Intraductal Papilloma of the Right Breast: A Case Report

Intraductal papillomas are tumors that arise in the epithelial cells of the mammary duct. Common presenting symptoms for intraductal papilloma include serous or serosanguinous nipple discharge or a palpable mass. We present a case of a 48-year-old woman who presented with spontaneous right breast nipple discharge and a palpable mass. Diagnostic imaging for the patient included mammography and ultrasound with color doppler imaging that revealed a mass at eight o'clock in the right breast at a distance of 2 cm from the nipple and that corresponded to the area of palpable concern. Percutaneous ultrasound-guided biopsy of the mass confirmed a diagnosis of intraductal papilloma. Surgical excision may be required in many cases of an intraductal papilloma due to the variety of diagnoses that can be included on the differential, the increased risk for cellular atypia, and the treatment for spontaneous nipple discharge.

Male Breast Cancer Review. A Rare Case of Pure DCIS: Imaging Protocol, Radiomics and Management

Ductal carcinoma in situ (DCIS) of male breast is a rare lesion, often associated with invasive carcinoma. When the in situ component is present in pure form, histological grade is usually low or intermediate. Imaging is difficult as gynaecomastia is often present and can mask underlying findings. We report a rare case of pure high-grade DCIS in a young male patient, with associated intraductal papilloma and atypical ductal hyperplasia. Digital breast tomosynthesis (DBT) showed an area of architectural distortion at the union of outer quadrants of the left breast without gynaecomastia. Triple assessment suggested performing a nipple-sparing mastectomy, which revealed the presence of a focal area of high-grade DCIS of 2 mm. DCIS, even of high grade, is difficult to detect with mammography and even more rare, especially when associated with other proliferative lesions. DBT with 2D synthetic reconstruction is useful as the imaging step of a triple assessment and it should be performed in both symptomatic and asymptomatic high-risk men to differentiate between malignant and benign lesions. We propose a diagnostic model to early detect breast cancer in men, optimizing resources according to efficiency, effectiveness and economy, and look forward to radiomics as a powerful tool to help radiologists.

A rare case of intraductal papilloma with atypical ductal hyperplasia in a male breast: A pathological diagnosis

Male breast cancer is itself a very rare condition and represents 0.5%–1% of all breast cancers diagnosed. Atypical ductal hyperplasia (ADH), intraductal papilloma (IP), and ductal carcinoma in situ are also very rare in a male breast. Only a few cases of ADH with gynecomastia have been reported in English literature until now. Here, we report a rare case of an IP with ADH associated with gynecomastia in an elderly male, who complained of right nipple pain, discharge, and tiny retroareolar mass. Mammography showed a subareolar nodule graded as the Breast Imaging-Reporting and Data System 4B. It is difficult to differentiate, both clinically and radiologically, between benign and malignant papillary lesions and invasive carcinoma, because of the similarity of findings. Hence, any male with palpable unilateral hard fixed lesions in the retroareolar region with complaints of nipple discharge, skin changes, or axillary lymphadenopathy should have a histopathological evaluation.

Imaging of male breast disease: the good, the bad and the ugly - A pictorial review

The male breast is affected by a broad spectrum of conditions, ranging from benign to malignant, many of which are similar to those occurring in its female counterpart. Despite the challenge motivated by different imaging characteristic features, correct imaging interpretation in male breast disease may aid at differentiation between benign and suspected conditions, narrow the differential diagnosis and guide subsequent management. The purpose of this review is to showcase a wide array of male breast diseases, discuss their imaging presentations and key features for diagnosis.