Juvenile papillomatosis in a young child: a case of infantil
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In contrast to milky nipple discharge – a phenomenon frequently occurring within the first months of life and most commonly ascribed to infantile hormonal adaption – isolated bloody nipple discharge is a rather rare finding that can be distressing for parents as well as consulting physicians. Although, in adults, bloody nipple discharge may be a clinical sign of underlying malignancy, pediatric causes are usually benign and related to normal breast development. Given the distinctive etiological spectrum, bloody nipple discharge and breast lesions in a pediatric population call for a different approach than in adult patients. This includes the differential diagnostic considerations, imaging algorithms and appropriateness of biopsy as a means of further characterization, since it can damage the developing breast.

A healthy 11-month-old girl presents with a newly developed swelling in the right breast region with intermittent ipsilateral bloody nipple discharge. The patient was breastfed up until 3 months prior, reports no medication use or ingestion of medicinal herbs and displays normal growth and neurological development. She has no significant medical history, nor is there a family history of breast cancer. Upon clinical examination a hard, painless lesion with a diameter of roughly
centimeters is palpated in the right breast with peripheral blue discoloration. It appears to be mobile with no adhesion to the skin or underlying muscle tissue.

After manual examination and stimulation of the lesion, droplets of clear blood appear at the nipple. Further examination is without peculiarities. Routine laboratory workup and coagulation tests are normal. Hormonal tests, such as serum estradiol (<5.00 ng/L), thyrotropin (1.22 mU/L), and prolactin (16.8 ng/L) show normal, prepubertal levels. Ultrasound imaging demonstrates a polymorphic lesion, measuring 2.8 by 2.1 centimeters, with a solid iso-reflective and well-vascularized component as well as some ductal ectasia. Additional core biopsy with pathological examination confirms the diagnosis of juvenile papillomatosis without evidence of current coexisting malignancy. Surgical excision is performed successfully and 6-month follow-up shows no recurrence.

Source: https://www.jpagonline.org/article/S1083-3188(20)30285-0/fulltext?rss=yes
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