Little Speck in the Brassire

Catherine Winnipeg (42) has noted secretions coming out of her right nipple lately. For the time being she has put a little panty liner in her bra. The fluid appears dark. Whether it was also bloody she cannot say. Her left breast never gave her any trouble. After she had breastfed her three children, both breasts kept on secreting for quite a while but she did not really attribute any relevance to it. Now she worries. Her mammogram shows nothing abnormal. During the clinical examina-

I The Case of Catherine Winnipeg

I The Case of Catherine Winnipeg

Fig. 12.22 One of the mamillary ducts is quite dilated and obstructed. A filling defect is visible: the papilloma has been located. Have you seen the two calcifications in the immediate neighborhood? You should be able to make that diagnosis by now! -sjsojDau jej

tion, Hannah is able to gently squeeze some more dark fluid out of the right breast. Together with Dr. Skywang, Hannah calms Mrs. Winnipeg. The reason for these secretions is most likely papillomas, she tells her, and these hardly ever turn malignant. She advises the patient to have a galactography done. For this procedure, the glandular duct in question is cannulated from the nipple with a fine blunt needle and a little contrast is given. Subsequently, a mammogram is performed. In Figure 12.21 you can see what a normal galactogram looks like. Mrs. Winnipeg's galactography shows a typical filling defect in the affected duct, compatible with a papilloma (Fig. 12.22). Dr. Skywang suggests having it removed surgically. Apart from getting rid of the annoying secretions, the histological work-up would end any uncertainty about the benign or malignant nature of the lesion.

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