Snapshot A 32-year-old woman presents to her primary care physician with one day of painless, bloody discharge from the right nipple. She reports that she has otherwise been in good health. She is nulliparous. Examination of the right breast reveals no palpable mass, but blood is expressed from the nipple. There is no lymphadenopathy in the axilla. Introduction Overview login to view 3 more bullets Epidemiology Makes up 48% of cases of pathologic nipple discharge Presentation Symptoms login to view 1 more bullet Physical exam login to view 3 more bullets Imaging Ultrasound login to view 4 more bullets Mammography login to view 4 more bullets Studies Serum TSH, prolactin, hCG levels login to view 2 more bullets Core needle biospy login to view 4 more bullets Excisional biopsy login to view 4 more bullets Differential Intraductal papillary carcinoma login to view 2 more bullets Galactorrhea login to view 3 more bullets Nipple fissure login to view 3 more bullets Breast mastitis login to view 4 more bullets Treatment Surgical login to view 3 more bullets Complications Risk of DCIS found within papilloma Prognosis 1.5-2x risk of breast cancer compared to general population Typically does not convert to carcinoma but can hide DCIS within the papilloma