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An uncommon presentation of ductal carcinoma in situ

A 47-year-old woman presented with 6 weeks history of non-blood-stained nipple discharge. Two separate nipple cytology assessments revealed malignant cells despite normal clinical examination and radiological investigation (mammogram, ultrasound and MRI). The patient elected for a central segmentectomy which revealed a 1.8 cm area of high-grade comedo ductal carcinoma in situ in the subareolar region. The patient made a good postoperative recovery. 6 months follow-up revealed a 5 mm area of new calcification, core biopsy revealed atypical cells. After counselling, the patient elected for bilateral mastectomy which revealed fibrocystic tissue only.