a 31-year - old female patient consulted to our outpatient clinic because of a mass protruding from her right nipple . on her breast examination , an 8 mm prolapsed mass was seen on the right breast areola ( figure 1 ) . during physical examination
any abnormality was not detected on other parts of the breast , and her left breast . from her personal and family medical history
her breast ultrasonographic ( us ) examination demonstrated an avascular , hypoechoic prolapsed solid mass measuring 8x5 mm which filled the areolar region completely .
based on physical , and us examination findings surgery was planned with the initial diagnosis of intraductal papilloma .
the prolapsed mass , minimal portion of the overlying areolar skin and communicating ductus were totally excised under local anesthesia .
histopathological examination of the specimen revealed intraductal papilloma without atypical dysplasia ( figure 2 ) .
any postoperative complication did not develop , and any recurrence was not seen during 2 years of follow - up .
intraductal papillomas ( ip ) are benign tumours which develop as a result of papillary proliferation of the ductal epithelium .
its incidence is 2 - 3% , and it is seen between 30 , and 77 years of age .
central type is a solitary ip which settles in the subareaolar region , and it is observed in perimenauposal women .
peripheral type is situated on the proximal parts of the laciferous ducts of young female patients and tends to be multiple .
however , the patient consulted to the physician at an earlier stage because of the protruding characteristics of the mass .
although it is generally localized in the breast tissue , and subareolar region , in our case , it protruded from the nipple of the patient .
intramammary masses are detected by us , and the diagnosis is conclusively confirmed by biopsy .
radiological imaging techniques are helpful in establishing the diagnosis , however for the discrimination between benign , and malign lesions core needle biopsy should be performed .
treatment of intraductal papillomas consists of total excision . since the mass lesion of our patient was protruding , total excision was performed both for diagnosis , and treatment . if intramammary ip lesion can be located using radiological techniques , then excision , without needle biopsy is recommended .
core biopsy is recommended for cases with radiologically suspect malignancy or in the presence of microcalcification , and distorted tissue ultrastructure . if small papillary lesions can be totally excised , and histopathologic examination does not reveal any evidence of atypia , then the patient can be followed up with us , and mammographic monitorization . in the differential diagnosis , nipple adenoma , and papillary lesion , paget s disease , eczematous dermatitis , and pyogenic granuloma
histopathological differentiaton of the excised mass can be achieved . if untreated , papillary lesion of the nipple also protrudes .
paget s disease , and eczema can be discriminated from other lesions with their characteristic cutaneous incrustrations .
ip prolapsed from the nipple is a rarely seen abnormality . for its diagnosis , and treatment ,
 intraductal papillomas ( ip ) are benign papillary lesions caused by proliferation of mammary ductal epithelium . 
 ip occurs in the breast tissue . 
 prolapse of ip from nipple can be rarely seen . 
 ips are generally treated with total excision . 
 a 31-year - old female patient was admitted to our clinic because of a protruded lesion from the nipple of her right breast . on her breast examination , 
 an 8 mm- prolapsed mass was seen on the areola of her right breast . 
 breast ultrasonography showed no other lesions in the breast . 
 the patient was operated with initial diagnosis of ip . 
 the prolapsed mass , the overlying nipple skin and related ductus were totally excised under local anesthesia . 
 histopathological examination of the specimen revealed intraductal papilloma without atypical dysplasia . 
 herein , we are presenting a rarely encountered case of ip prolapsed from the nipple of a female patient . 
CASE REPORT
DISCUSSION