72 year old with bloody left nipple discharge started 2 days ago. Biopsy proven left papilloma. History of breast cancer in mother diagnosed at age 56 and sister diagnosed at age 63. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. The left breast demonstrates stable dilated ductal system extending to the mid breast at the level of the biopsy clip. Stable benign calcifications are present adjacent to the clip. No new masses, suspicious microcalcifications or areas of architectural distortion are present in either breast. Note is made that bloody discharge was seen from left nipple when left breast was compressed with mammographic plate.Left breast ultrasound was performed. In the retroareolar region, there are dilated ducts, without intraductal lesion detected. At left 3:00 position, 3 cm from nipple, there is an intraductal solid lesion with a marker clip and calcifications, measuring 11 x 6 mm, consistent with a biopsy proven papilloma. Increased blood flow is detected within this lesion. Compared to the prior MRI (8/15/11), the size of the papilloma is not significantly changed.
Stable biopsy proven papilloma in the left breast. No mammographic or sonographic evidence for malignancy.Breast MRI would be useful for follow-up of the papilloma and to rule out new breast lesion. If the known papilloma is confirmed as a cause of bloody discharge, a vacuum assisted large core biopsy might be an option to reduce the symptom.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed.