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Abstract: Intraductal papilloma is a common breast disease in women, usually with a high incidence in the age group of 40-50 years. In this article, 45-year-old Ms. Li, who had a history of breast nodules, was diagnosed with intraductal papilloma of the left breast by ultrasound and pathological biopsy.
Basic information】Female, 45 years old
Disease Type】Left intraductal papilloma of the breast
Hospital】Harbin First Hospital
Date of consultation】January 2022
Treatment plan】Surgical treatment (breast nodule puncture biopsy, left breast tumor resection)
Treatment period】5 days of hospitalization
Treatment effect】The patient’s breast incision healed well, no redness, no exudation, and was discharged from the hospital in good condition.
I. Initial consultation
Patient Ms. Li, 45 years old, walked into the consultation room with an anxious look, suspecting that she had breast cancer. (BI-RADS category 3), bilateral bilateral breast hyperplasia (BI-RADS category 2) with multiple nodular occupations (BI-RADS category 3). The patient had previously had a category 3 ultrasound of a 2-point and 5-point nodule in the left breast, but the ultrasound was repeated a few days ago with a category 4a change and a higher probability of malignancy, and the patient became anxious, and the family described that sleep and life were now affected.
The patient was given a physical examination: the patient’s breasts were symmetrical, the nipples were not depressed, the nipples were not overflowing, the nodules were small and could not be palpated significantly, and the patient was explained that the nodules tended to be benign from the ultrasound point of view, and further examination was feasible with puncture biopsy, and the patient expressed understanding.
II. Treatment process
The pathology of the nodule at the 2-point site showed: left breast puncture biopsy tissue, consistent with adenopathy with intraductal papilloma. The pathology of the patient’s breast nodules showed that the intraductal papilloma was benign, but there was a certain chance of cancer, and the patient was anxious.
After the patient was admitted to the hospital, the patient was given relevant examinations, and after excluding contraindications to surgery, the patient was given a left breast tumor resection under local anesthesia, and two intraoperative pathology nodes, both of which were intraductal papillary tumors, were treated with paraffin and immunohistochemistry, and the incision was sutured closed.
III. Treatment effect
The general status of the patient was good after surgery. The patient was hospitalized for a total of 5 days and was discharged on the 4th postoperative day, and the incision was closed with cosmetic sutures without suture removal. The patient’s left breast incision healed well at the time of discharge, with no redness or swelling, no exudation, and the patient could eat and drink without fever or other complaints.
IV. Notes
I am very pleased that the patient’s condition has improved, but I need to remind the patient that the following points should be noted after discharge.
1. Avoid getting wet until the surgical incision is completely healed to avoid infection and do not squeeze the breast area.
2, pay attention to rest and avoid strenuous exercise in the short term to avoid tearing the incision.
3, pay attention to a light diet, avoid stimulating foods, such as chili, pepper, garlic, etc., can be appropriate to increase the intake of protein and meat.
4.After discharge, other breast nodes still need to be followed up regularly for review to understand the changes of other nodes.
V. Personal insight
Although intraductal papilloma is a benign tumor, it has a malignant tendency and should be treated mainly by surgical excision when detected at an early stage. Most of the intraductal papillomas only appear as nodules in the initial stage. Routine examinations include ultrasound and mammography, which usually have some significance for the nature of the nodules, but for some nodules that are difficult to identify, ultrasound-guided puncture biopsy or direct excision of the nodules for pathological examination can be chosen.
In combination with the patient in this case, the presence of breast nodules for more than 1 year and the final qualitative diagnosis of left breast intraductal papilloma was taken by pathological biopsy. At present, pathological examination is the most effective means of nodule characterization. It is important for women to have regular breast examinations, and if there is difficulty in diagnosing a nodule, further pathological examination is recommended.