Cytological evaluation in males presenting with bloody nipple discharge, with or without breast mass: Report of two cases depicting two poles of the disease spectrum

Abstract

Nipple discharge (ND) either in the presence or in the absence of underlying mass is a very uncommon presentation in males and its bloody nature is still rarer. ND cytology in males has not been reported much in the literature. Spontaneous and expressed ND, however, can be very useful in establishing the diagnosis. Two males with bloody ND, one, without any palpable mass and another with underlying mass, were evaluated on ND cytology. The presence of loose papillaroid clusters and cell sheets with mild atypia was seen in ND smears itself in case 1. The discharge was more copious in case 2, but the ND smears were paucicellular. The presence of tall columnar cells in ND smears as well as in the FNA from underlying mass with clear features of malignancy was helpful in reaching the diagnosis of papillary carcinoma in case 2. Histopathology in case 1 was a spectrum of ADH to DCIS, whereas in case 2, was tubulopapillary carcinoma.Following two cases highlight the importance of the cytological evaluation of ND smears. K E Y W O R D S carcinoma, nipple discharge, papillaroid, papillary DCIS 1 | INTRODUCTION Males presenting with nipple discharge (ND) is very uncommon. There are very few reports describing ND, as a presenting feature, in cases of male breast cancer (MBC). 1,2 Other causes of ND can be duct papilloma, duct ectasia, fibrocystic change, gynaecomastia, and even skin adnexal tumors. 1 Evaluation of ND can be very helpful, especially when positive. 3,4 As there is limited data available on ND evaluation, in males, any new cases need to be recorded and added to the literature for a better understanding of this subject. 2 | CASE REPORTS 2.1 | Case 1 A 70-year-old male presented with unilateral bloody ND off and on. On examination, it was spontaneous and appeared to come from the central duct of left nipple. No mass lesion was found. The smears from the spontaneous ND showed papillaroid clusters of epithelial cells, without significant atypia, in a haemorrhagic background. Further squeesing yielded very cellular smears, comprising of monolayered sheets of epithelial cells and tiny papillaroid clusters with focal moderate atypia. Dyscohesive atypical epithelial cells were also present (Figure 1). It was reported as papillary lesion with atypical ductal hyperplasia and was advised radiological examination, and guided trucut biopsy. However, the surgeons performed a microdochotomy and the specimen showed four tiny foci of grey-white areas, ranging from 3 to 6 mm. No grossly dilated duct could be identified. Sections showed multiple foci of spectrum of ADH to DCIS (cribriform, solid, and papillary) and were ER, PR positive (Figure 2). No invasive carcinoma could be identified. Subsequently, the patient underwent mastectomy, which showed only benign rudimentary ducts embedded in adipose tissue and scant stroma without any significant proliferation. | Case 2A 62-year-old male presented with copious bloody ND off and on with painless enlargement of right breast. On examination, it was spontaneous and appeared to be multi...