Imagerie du papillome intra canalaire mammaire à propos d’un cas et revue de la littérature

Abstract

Intraductal papilloma of the breast is a benign tumor that develops within a milk duct, commonly located near the nipple. It can cause symptoms such as spontaneous nipple discharge, which may sometimes be bloody. Imaging plays a crucial role in the diagnosis, characterization, and monitoring of intraductal papillomas. This report presents the case of a 49-year-old patient with no history of breast cancer who presented with recent onset of serosanguinous nipple discharge. Clinical examination revealed spontaneous, multifocal discharge without palpable mass or axillary lymphadenopathy.

Initial mammography identified clustered coarse calcifications in the retroareolar region, and ultrasound showed ductal ectasia with thickened walls but no vascularization. The case was classified as BI-RADS 3. A follow-up ultrasound performed four months later, due to recurrent bloody discharge, identified an intraductal hypoechoic mass with a vascular axis, suggestive of a solitary papilloma. Subsequent MRI showed a homogenous nodular enhancement consistent with an intraductal papilloma, which was later confirmed by biopsy. The patient underwent surgical excision, and histopathology revealed an intraductal papilloma with associated in situ ductal carcinoma.

This case highlights the importance of a multimodal imaging approach—mammography, ultrasound, and MRI—in the detection and characterization of intraductal papillomas, as well as the need for histopathological confirmation to guide patient management.

RÉSUMÉ

Le papillome intra-canalaire mammaire est une tumeur bénigne rare qui présente des aspects radiologiques variés selon les techniques utilisées. Nous rapportons le cas d'une femme de 49 ans qui a consulté pour un écoulement séro-sanglant du mamelon. La mammographie a montré des calcifications rétros-aréolaires de nature indéterminée et l’échographie a révélé un nodule intra-canalaire échogène, vascularisé au Doppler. Une micro-biopsie a confirmé le diagnostic de papillome intra-canalaire. À travers cette observation et une revue de la littérature, nous discuterons les modalités diagnostiques et thérapeutiques du papillome intra-canalaire mammaire