Breast enlargement is considered a physiologic event in male and female neonates. However, it is rarely encountered in infancy and is deemed unusual in young children beyond the first year of life.1,2 Breast enlargement along with bloody nipple discharge, first reported in 1983 3 appears to be even more uncommon in children. We report a case of a 4-year-old boy with a 2-week history of left breast enlargement with serosanguinous nipple discharge and ipsilateral palpable axillary lymph nodes. Case ReportA 4-year-old boy was referred to the pediatric surgical service after the mother presented her child with a history of bloody nipple discharge of one week duration to the emergency room physician. The mother noted blood stains initially on the boy's underwear and later saw blood coming out of the left nipple. There was no history of breast enlargement, pain or fever. Trauma and drug ingestion were denied. Physical examination revealed a healthy child with normal findings except for an ovoid mass measuring 2.5 x 1.5 centimeters above the left nipple. It was mobile, not attached to underlying structures or skin, firm, and not tender or hot. There was no erythema. Slight pressure on the mass instigated bloody discharge from the nipple (Figure 1). The left axilla revealed two enlarged lymph nodes, one measuring 0.5 centimeter, the other 2.0 centimeters in diameter. The right breast and axilla were normal. The testes were of normal size, configuration and consistency. The complete blood count, prothrombin time and partial thromboplastin time were normal. The breast mass, including the small nipple, were excised. Both axillary lymph nodes were removed as well.The frozen section proved to be a benign lesion. The paraffin section demonstrated many dilated ducts containing granular eosinophilic material and red blood cells. In some, there were many macrophages containing foamy granular material within the lumen and pronounced periductal fibrosis with a moderate chronic inflammatory reaction in the adjacent wall (Figure 2). An occasional dilated duct proved that focal ulceration was present. A section from the left nipple showed a few dilated ducts with similar microscopic changes. A section from the axillary lymph nodes illustrated sinus histiocytosis.