Monthly Archives: July 2012

Cytology Quiz N°13 – Mediastinal Adenopathy

Click HERE to enjoy the new Quiz case

Primary epithelioid angiosarcoma of the breast

Click here to enjoy case report N^22

Cytology of Benign Nipple Discharge

Possible causes of benign nipple discharge are:

Intraductal Papillomas:

  1. Solitary intraductal papillomas – one lump, usually near a nipple
  2. Multiple papillomas – groups of lumps, farther away from a nipple
  3. Papillomatosis – very small groups of cells inside the ducts, a type of hyperplasia, more scattered than multiple papillomas

An intraductal papilloma is a tiny wart-like growth in breast tissue that sometimes punctures a duct. Solitary intraductal papillomas usually occur in the large milk ducts near your nipple, and it may feel like a small lump. When one of these breaks a duct, it can cause a little clear or bloody nipple discharge, which is usually not worrisome. Multiple papillomas usually occur deeper inside the breast, and can’t easily be felt, a group of papillomas like this won’t cause nipple discharge.

Intraductal papillomas can be surgically removed. A small incision is made along the edge of your areola, then the papilloma and its duct are removed. The resulting scar can be nearly undetectable.

Cytological images & diagnosis





Descriptive diagnosis:  A-D) Papillary aggregates of epithelial cells, macrophages,  amorphous material &  numerous red blood cells.

Final diagnosis: Papillary lesion, NOS.

Duct Ectasia:

 In some women who are nearing menopause, milk ducts may become swollen and clogged. These ducts are just beneath the nipple, and the swelling can cause nipple to feel tender or irritated, and may cause nipple discharge. Mammary duct ectasia can cause grey to green discharge that is thick and sticky. It is possible to give relief from this condition by using warm packs. If the ducts become infected it is possible to use antibiotics. In cases when the ducts will not return to normal size, they can be surgically removed, without causing a great change in the appearance of the breast.

Cytological images & diagnosis



Descriptive diagnosis:  A,B) Scattered & isolated epithelial cells , some macrophages,  amorphous material &  red blood cells.

Final diagnosis: Negative for malignancy

Mastitis/Breast abscess:

Breast may turn pink and might feel tender and lumpy. It is possible to see pus discharge from the nipple. For example mastitis may occour in the patient who are breast-feeding, and a milk duct becomes clogged. Milk will collect behind a clogged duct, building up pressure and causing swelling. This can lead to infection, as bacteria may grow in the trapped milk.

Cytological images & diagnosis




Descriptive diagnosis:  A-C) Lymphocytes, granulocytes, multinucleated giant cells & red blood cells.

Final diagnosis: Inflammatory.

Scratchy clothing:

 continually rubbing or compressed the breast, may cause nipple discharge.

Thyroid malfunction

may cause nipple discharge


Cytological analysis of the nipple discharge is useful to discriminate papillary lesions from all other lesions; in fact, on the basis of cytological examination only, is not possible to identify which of the types of papilloma the patient is suffering. What is known is that in all other types of conditions in which we are in presence of a nipple discharge, the papillary aggregates of epithelial cells should not be present, so when have almost one (ore few) of these papillary aggregates the final cytological report shoul be: papillary lesions, NOS.

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