 Hello everybody, my name is Dr. Resham Khanna. Today I will be presenting a short video on breast imaging case. Hope you all find this video informative. A 48 year old woman came with history of brownish discharge from left nipple since one week. She had no family history of breast diseases. On palpation there was no lump felt. Ultrason examination revealed a dilated duct measuring 5 millimeters in diameter showing a 12 x 8 x 5 mm sized heterogeneously hypoechoic mass within. On color Doppler mode a vascular stalk is seen. Based on these findings a diagnosis of inter ductile papilloma was made. Mammography images appeared unremarkable. One guided sampling was done for this patient. She underwent surgery with wide excision of the lump. Her histopathology report revealed radial scar complex sclerosing lesion along with papillomas. Introductal papillomas are the most common masses within the milk ducts of the breast. They are benign tumors but may contain areas of atypia or carcinoma. Most common symptom is nipple discharge. They occur commonly during 40 to 50 years of age. Clinical presentation, patients may be often asymptomatic or present with nipple discharge if it is especially unilateral, spontaneous and persistent. Papillomas are proliferative tumors originating from the walls of milk ducts typically growing within the duct and tending to cause local ductile obstruction. The central question and assessment of breast papilloma is whether there is any evidence of cellular atypia. Any findings suggestive of more than merely benign proliferation are generally grounds for surgical excision of the entire lesion. In addition papillomas have been reported occurring adjacent to other significant lesions such as atypical ductile hyperplasia or DCIS. Papillomas may be solitary or multiple. Multiple papillomas especially more than five are considered papillomatosis. There may be a higher rate of associated malignancy with multiple papillomas. They may be central or peripheral. Mammograms are frequently normal with small intraductile papillomas. When imaging findings are present they include a circumscribed benign appearing mass of insubarular in location, a cluster of calcifications. Galactography usually reveals a filling defect or other ductile abnormalities such as ectasia, obstruction or irregularity. However, these findings are non-specific. Breast ultrasound papilloma may be seen as a well-defined solid nodule or intraductile mass which may either fill a duct or be partially outlined by fluid either within a duct or by forming a cyst. Colour Doppler will demonstrate a vascular stalk. A dilated duct can be frequently visible sonographically. MRI, these lesions most commonly appear as T2 bright circumscribed solid enhancing lesions. Morphological characteristics may be quite variable. They may be oval, round or irregular in shape, have smooth or irregular margins. They may be solid, cystic or complex cystic. T1, the lesion usually appears isointense to slightly hypointense relative to the breast glandular tissue. On T2, hyperintense to the glandular tissue, but less bright than cysts. Host contrast, rapid early enhancement, absolute enhancement rate may be somewhat less than DCIS. It may show a homogenous or heterogeneous pattern of enhancement or a peripheral rim-like enhancement on delayed images. Diffusion weighted images, it shows restricted diffusion, high DWI and low ADC values. The differential includes other solid tumours that can occur in large ducts, specifically DCIS, invasive ductile carcinoma with an in-situ component. Papillary carcinoma of the breast can mimic intraductile papilloma, particularly on ultrasound. For ultrasound appearances also consider inspisated secretions within a dilated duct, but they have no associated vascularity. Complex breast abscess with debris will show a solid component and fat necrosis will show no Doppler vascularity. Most centres treat solitary intraductile papillomas with surgical excision even after benign biopsy to exclude components of atypia or neoclasia. Given the increased risk of malignancy over a woman's lifetime when this lesion is diagnosed, compliance with screening recommendations for such patients are strongly advisable. Women with this lesion have a relative risk of 1.5 to 2 times for developing invasive breast carcinoma in their lifetime. Thank you.