Classic invasive lobular carcinoma is usually described as consisting of small, uniform cells with round nuclei and inconspicuous nucleoli. A variable proportion of cells have intracytoplasmic lumina containing sialomucins demonstrable with the mucicarmine and Alcian blue stains [5, 6]. When the secretion is prominent, the cells have a signet ring configuration. Most so-called signet ring cell carcinomas are forms of invasive lobular carcinoma [[5–7], and ].
Intraductal papilloma is a discrete benign papillary epithelial tumor that arises in the mammary ducts. Although most common in subareolar lactiferous ducts, they may occur elsewhere in the breast, occasionally in cystically dilated ducts.
Solitary subareolar or intracystic intraductal papillomas are benign; however, for many years there has been a debate as to whether they may be precursors of papillary carcinoma, or whether they predispose the breast to an increased risk of carcinoma. Most follow-up studies have failed to demonstrate an increased carcinoma risk associated with these lesions.
Solitary papillomas lack implication for an increased risk of subsequent carcinoma in the remainder of the breast and may be safely treated by local excision .
On the other hand, multiple intraductal papillomas, which produce a mass in the periphery of the breast, are more often associated with concurrent or subsequent carcinoma. Two of the six patients reported by Carter developed carcinoma, and a similar incidence of associated carcinoma has been noted by others [10, 11].
Fine-needle aspiration cytological examination of papillary lesions is increasingly performed, especially for intracystic lesions in the periphery of the breast. The procedure holds little value for subareolar papillomas which should be surgically excised and assessed by conventional histopathology techniques.
Cytological examination of material from a nipple discharge may be diagnostic if carcinoma cells are identified, but cannot be relied upon to rule out carcinoma if the cellular composition is benign .
Since infiltrating lobular breast carcinoma is less common than infiltrating ductal carcinoma, especially the variant with signet ring cells, and since its clinical presentation, mammography and ultrasound appearance are non-specific (meaning that they can be overseen even in the later stages of the disease), only multidisciplinary approach to the treatment of the slightest symptoms of the breast lesions can help establish the correct diagnosis.
Spontaneous breast discharge can present the only symptom (when palpable and non-palpable lesions for aspiration biopsy and histopathologycal examination are absent); therefore, exfoliative cytodiagnostic emerges as an inevitable and relevant method in explaining its etiology [13–18]. However, because of its high frequency, the breast discharge is a serious problem in everyday practice both for women (fear of cancer) and for clinical and diagnostic experts.
Complementary methods used in revealing, observation and final diagnosis of secerning breast-clinical examination, mammography, ultrasound examination, cytodiagnosis, galactography, histopathology – have different characteristics and diagnostic possibilities, but behave as supplementary and contribute individually to setting the correct diagnosis of the disease.
In the case presented in this paper the only symptom of the disease – breast discharge – initiated several diagnostic procedures that discovered pathological lesions in the breast.
Cytological diagnostics of the discharge revealed the presence of intraductal papilloma and the patient underwent surgery. This was followed by histological examination of the breast tissue which not only pointed at the intraductal papilloma, but also at the tumor cells dispersed in the surrounding stroma. Although the cytological smear of the discharge was tumor cells negative (only the cells of intraductal papilloma were found), a surgical procedure which included pathohistological examination of the surrounding breast tissue was performed and individual tumor cells, hardly visible by clinical examination, were revealed. An extended surgical procedure was undertaken – a total mastectomy including axillary lymph nodes removal.
Pathohistological examination of the total breast tissue resulted in the finding of diffuse signet ring cells spread with no involved the regional lymph nodes.
In conclusion: intraductal papilloma could be the first symptom of the breast carcinoma and should require a serious approach.