Galactorrhoea is non-lactational milk production and it may or may not be associated with prolactinemia1. It causes embarrassment and distress to a schizophrenic patient, especially, if the patient is male. One study in Germany reported that incidence and prevalence of galactorrhoea in schizophrenia are 14% and 19%, respectively2. Although galactorrhoea is not rare in schizophrenic patients, managing and understanding the a etiology can be problematic. In psychiatric patients, antipsychotics can be a cause but other causes need to be ruled out. Galactorrhoea also needs to be differentiated from pathologic nipple discharge which can be due to breast tumours. Usually, galactorrhoea is bilateral, multiductal, and milky, but discharge can be yellow, green or brown3. This case report describes a 32-year old patient with schizophrenia who visited a government psychiatric hospital in Kota Kinabalu, Sabah, Malaysia. This report highlights the clinical challenges to determine the aetiology of galactorrhoea and to manage it in schizophrenics. It raises the following clinical questions: Why a psychiatric patient develops galactorrhoea? How a schizophrenic patient presents with galactorrhoea? What hormonal imbalances are associated with this psychiatric disorder? How should a doctor handle a schizophrenic patient complaining of galactorrhoea? What is the danger of having galactorrhoea in a male?
A 32-year-old woman presented with a 3 cm×3 cm left breast lump associated with bloody nipple discharge during her early pregnancy. Examination and ultrasonography showed benign features, whereas core needle biopsies revealed a benign papilloma. Six months after her delivery, a 6 cm×6 cm benign papilloma was completely excised via circumareolar incision. The majority of intraductal papillomas are small; however, they can also present as a large mass rarely. We should be wary of a malignant papillary lesion when there is the presence of atypia on core needle biopsy or imaging-histology discordance. A concordant benign papilloma with benign imaging findings is otherwise reassuring. Clinicians need to be aware of this uncommon presentation of large intraductal papilloma as a complete curative excision can be achieved through a cosmetically placed incision.
To evaluate the clinical and imaging findings of papillary breast neoplasm and review the pathologic correlation at a tertiary center.Retrospective study of patients diagnosed with benign and malignant papillary lesions between 2008 to 2018. 147 patients were identified with histology diagnosis of papillary lesions. The clinical, imaging, and pathological characteristics were reviewed.Patient cohort included 147 women diagnosed with papillary lesions (mean age at diagnosis 53.8 years) and were divided into 3 histology groups (benign, atypical, and malignant). Common clinical presentations were breast lump (n = 60) and nipple discharge (n = 29), 48 patients were asymptomatic.Only 37 were detected as a mass lesion on mammogram. The presence of mass lesion on mammogram was the most common feature in all 3 papillary lesion groups, and with the presence of asymmetric density, were the 2 mammographic features significantly associated (P