Intraductal Carcinoma Presenting as Enlarging Nipple

A 67-year-old woman presented with the chief complaint of an enlarging left nipple. Neither nipple discharge nor spontaneous pain was noted.

Key point: The affected nipple appeared irregularly enlarged and was firm to palpation. Manipulation of the nipple elicited mild tenderness. No breast masses were detected. Because the differential diagnosis included mammary Paget disease, however, a mammogram was obtained. It showed an underlying a dense mass which, on fine-needle aspiration biopsy, demonstrated intraductal carcinoma.

Treatment: The patient was referred to a breast cancer clinic and offered the various appropriate therapeutic options. She chose mastectomy as monotherapy.

Note: Mastitis would be expected to be more painful/tender and is often associated with significant nipple discharge.