Materiały źródłowe

• #1 Nipple Discharge – Clinical Methods – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK284/

  Nipple discharge is the passage of liquid material through the nipple either spontaneously or with manipulation of breast tissue. […] True discharge comes through mammary ducts out the nipple and may be noted to drain spontaneously and stain clothing, or may be elicited by segmental palpation of breast tissue. […] Differentiation of the seven basic types of nipple discharge can be determined by observation of the color of discharge, palpation of discharge to determine texture, and smear examination of discharge with Wright’s stain to see if pus or blood is present. […] Discharge from the breast is an abnormal finding except in late pregnancy or the postpartum period. There are seven basic types of nipple discharge, each of which can be associated with specific clinical conditions. […] The etiology of galactorrhea can be classified in terms of prolactin abnormalities.

• #1 Nipple Discharge – Radiology | UCLA Health

  https://www.uclahealth.org/departments/radiology/education/breast-imaging-teaching-resources/how-work-up-patient-with/nipple-discharge

  Nipple discharge is the third leading breast complaint after lumps and pain, with a prevalence of 5-10% in women. […] Nipple discharge in women is usually due to benign pathologies including ductal ectasia in 6-59% of cases, and papillomas in 35-56% of cases. […] Nipple discharge is associated with a 5-23% risk of malignancy in women, typically DCIS. […] Any discharge in a man is suspicious and associated with breast cancer in 25-57% of cases. […] Ductal ectasia, defined as a diameter 3mm, is one of the most common findings. Ductal ectasia which is peripheral, with irregular ductal margins, thickening of the wall, and hypoechoic adjacent tissues are suggestive of malignancy. […] Non-mass enhancement is the most common finding in patients with suspicious nipple discharge. […] Galactography or ductography had previously been considered the gold standard for evaluation of nipple discharge, however in recent years this modality is falling out of favor, as there are several disadvantages, such as difficulty with duct catheterization resulting in procedure failure, and procedural risks including contrast extravasation, iodinated contrast allergy, and mastitis.

• #1 Breast Nipple Discharge – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK430938/

  Nipple discharge is fluid that leaks from one or both nipples of non-pregnant and non-breastfeeding women. Nipple discharge can at times be a complex diagnostic challenge for clinicians since it can be completely benign and due to excessive nipple stimulation, or can be a manifestation of a wide variety of diseases. […] The most important consideration in a patient with nipple discharge for both the patient and the physician is the possible association of this condition with underlying breast cancer. […] Nipple discharge is not an uncommon complaint in the emergency department and can be benign (physiologic discharge) or a sign of a pathologic process. […] The majority of all nipple discharges are benign in etiology (97%). […] Pathologic discharge is usually unilateral, spontaneous, varied in appearance, and depending on the cause, involves a single duct.

• #1 Nipple discharge – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/nipple-discharge/

  Nipple discharge can be physiological or pathological. Physiological discharge is typically bilateral, multiductal, with a milky appearance; causes include lactation and galactorrhea. Pathological discharge is typically unilateral, uniductal, nonmilky, and spontaneous. Although most causes of pathological nonmilky nipple discharge are benign (e.g., intraductal papilloma, mammary duct ectasia), malignancy is an important consideration. The diagnostic approach to nipple discharge is based on clinical evaluation findings, including characteristics of the discharge and patient age. Further evaluation with imaging is required for all patients with red flags in nipple discharge. Treatment depends on the underlying cause. […] Pathological nipple discharge is associated with benign breast conditions such as intraductal papilloma, mammary duct ectasia, fibrocystic breast changes, and breast abscess.

• #1 Nipple Discharge

  https://fpnotebook.com/Gyn/Sx/NplDschrg.htm

  Galactorrhea is normal during pregnancy and for up to one year after cessation of Lactation. […] Bloody Nipple Discharge is NOT synonymous with cancer. However bloody Nipple Discharge carries a higher risk of cancer. […] Pathologic discharge is spontaneous, unilateral from a single duct opening at the nipple. Discharge may be bloody, serous, serosanguinous or watery. […] Bloody Nipple Discharge Etiologies include Intraductal Papilloma (most common), Duct ectasia (Benign Breast duct tortuosity), and Breast Cancer (represents 3%). […] Management for BI-RADS 1 to 3 involves surgically excising the involved ductal system and sending for pathology.

• #1 Nipple Discharge – Women’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/women-s-health-issues/breast-disorders/nipple-discharge

  Nipple discharge is usually caused by intraductal carcinoma or invasive ductal carcinoma. […] Prolactin is a hormone that stimulates production of breast milk. […] Several disorders can cause an abnormal discharge. […] A discharge from one milk duct or from one breast is likely to be caused by a problem with that breast, such as a noncancerous (benign) tumor or, less commonly, a cancerous (malignant) breast tumor. […] A discharge from both breasts or from several milk ducts in one breast is more likely to be caused by a problem outside the breast, such as a hormonal disorder or use of certain medications. […] Certain disorders stimulate the production of breast milk in women who are not pregnant or breastfeeding. […] In most of these disorders, the level of prolactin (a hormone that stimulates production of breast milk) is elevated. […] Cancer causes fewer than 10% of cases.

• #1 Do hormones cause breast discharge? Possible causes

  https://www.medicalnewstoday.com/articles/do-hormones-cause-breast-discharge

  Breast discharge usually happens when a person is pregnant or nursing, and it can also occur shortly after childbirth or a pregnancy loss. Hormones play a key role in the production of this discharge. […] Hormonal changes are responsible for this colostrum production. […] However, hormonal changes unrelated to pregnancy may also cause breast discharge. […] Normal discharge does not usually signal a problem. However, if the pattern of discharge changes, or discharge appears without any stimulation, it could indicate an infection or another serious issue. […] Doctors use the term galactorrhea to refer to the production of breast milk or milky discharge outside of pregnancy and breastfeeding or chestfeeding. […] Some causes of galactorrhea other than nipple stimulation include: conditions that affect the pituitary gland in the brain, such as a benign tumor; medications that affect the hormones, such as birth control pills or estrogen supplements; hormonal imbalances.

• #1 Hormones and Breast Discharge: Causes of Different Colors

  https://www.verywellhealth.com/benign-nipple-discharge-430412

  Hormones can cause normal breast discharge thats related or unrelated to pregnancy. Common hormonal causes of nipple discharge include: […] Normal fluctuations in estrogen levels throughout the menstrual cycle can lead to breast tissue changes and nipple discharge. […] Galactorrhea is a milky nipple discharge that happens when there are high levels of prolactin in the body (hyperprolactinemia). Prolactin is a hormone that is normally involved with breast growth and breastfeeding. […] Some health conditions can change the levels of certain hormones in your body. […] Hypothyroidism (underactive thyroid) and non-cancerous growths on the pituitary gland can both cause nipple discharge because they can change how much prolactin is in your body. […] Medications such as hormonal contraceptives (e.g., birth control pills) and hormone-replacement therapy (HRT) can have a milky nipple discharge as a side effect since they change the levels of hormones (like estrogen) in your body.

• #1 Nipple Discharge Fact Sheet | Westmead BCI

  https://www.bci.org.au/breast-cancer-information/fact-sheets/nipple-discharge/

  A duct papilloma is a growth within a milk duct in the breast, usually near the nipple. […] Eczema or dermatitis which affects the skin of the nipple, particularly if it becomes infected, can cause a weeping, crusty nipple discharge. […] Breast cancer is an uncommon cause of nipple discharge. […] Pagets disease is a particular type of breast cancer which involves the nipple. […] Galactorrhoea is milky nipple discharge not related to pregnancy or breast feeding. It is caused by the abnormal production of a hormone called prolactin. […] Abnormally high prolactin levels can also be caused by some drugs. […] Nipple discharge diagnosed as physiological discharge requires no treatment. […] Nipple discharge that is spontaneous, blood-stained, persistent, and unrelated to pregnancy or breast feeding needs to be investigated further. […] If any abnormality is found on these tests, a biopsy may be recommended. […] Surgery for nipple discharge is sometimes warranted. This is usually reserved for cases where a significant abnormality, such as a papilloma or breast cancer is suspected.

• #1 Nipple Discharge – Clinical Methods – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK284/

  Lesions in the hypothalamus, pituitary stalk section or drugs that influence the central nervous system can decrease the inhibitory dopaminergic control of prolactin. […] A physiologic enhancement of prolactin release is caused by thyrotropin releasing hormone (TRH). […] Three types of pituitary tumors may be associated with galactorrhea: pure prolactin-secreting tumors (micro- or macroadenoma), mixed tumors that secrete both growth hormone and prolactin, and chromophobe adenomas. […] The majority of patients with galactorrhea will have normal prolactins. […] Duct ectasia or comedomastitis can produce a multicolored, sticky discharge that is commonly bilateral in the perimenopausal woman. […] If the disease progresses, a mass can develop (plasma cell mastitis) that can mimic cancer.

• #1 Galactorrhea | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/galactorrhea?content_id=CON-20154794

  Galactorrhea often results from having too much of the hormone that makes milk when you have a baby. This is called prolactin. Your pituitary gland, a small bean-shaped gland at the base of your brain involved with several hormones, makes prolactin. […] Sometimes healthcare professionals can’t find a cause for galactorrhea. This is called idiopathic galactorrhea. This may mean that the breast tissue is very sensitive to the milk-making hormone prolactin. If so, even typical prolactin levels can lead to galactorrhea. […] In people assigned male at birth, galactorrhea may be linked with too little of the hormone testosterone. Called male hypogonadism, this most often also causes breasts that are enlarged or tender, called gynecomastia. Not being able to get and keep an erection, called erectile dysfunction, and not wanting to have sex also are linked with too little testosterone.

• #1 Surgical management of pathologic nipple discharge – UpToDate

  https://www.uptodate.com/contents/surgical-management-of-pathologic-nipple-discharge

  Nipple discharge is categorized as normal milk production (lactation), physiologic nipple discharge (galactorrhea), or pathologic (suspicious) nipple discharge. The most common causes of pathologic nipple discharge are benign intraductal papilloma (35 to 48 percent), ductal ectasia (17 to 36 percent), and carcinoma (5 to 21 percent). […] Pathologic nipple discharge, defined as secretory production of fluids other than milk due to pathological process in the breast, should be suspected by the presence of one or more of the following: Unilateral nipple discharge.

• #1

  http://www.journalononcology.org/articles/joo-v3-1112.html

  Nipple discharge is recognized as the third most common breast symptom, following breast pain and lumps. Although it is related to benign diseases mainly, an incidence of 5% to 12% associated with breast carcinoma still occurs. […] The dominating etiology of incurring Pathologic Nipple Discharge (PND) is a benign papilloma, with an incidence of 52%-57%. Duct ectasia is another of the most common benign causes of PND, representing approximately 14%- 33% of the cases, while breast cancers such as Ductal Carcinoma in Situ (DCIS) take up 5%-15% of cases of pathologic nipple discharge. […] Due to its possible relevance for breast cancer, PND has posed significant attention regarding its significance of excluding deterioration if immediate diagnostic modalities and operative treatment are performed accurately and efficiently.

• #1

  http://www.journalononcology.org/articles/joo-v3-1112.html

  The common etiologies with which it correlates are described below: Intraductal Papilloma (IDP): The benign papillary tumor is the most common cause of PND, especially for non-pregnant or nonpuerperal females with the apparent indications of presenting sanguineous discharge without the palpable mass. This lesion is growing intraductal and adherent to the mammary duct wall localizing near the nipple orifice, occasionally concealing the malice existence of atypia or Ductal Carcinoma in Situ (DCIS). […] Duct ectasia: Mammary duct ectasia (MDE) is the second most common benign etiology causing PND, which can be present in 15% to 20% of the patients who have suffered from nipple discharge. […] This is a non-proliferative and non-invasive inflammatory disease characterized by focal dilatation of endoluminal lactiferous ducts filled with keratin obstructions or thick clogged secretions, as well as changes in duct wall elastin.

• #1 Nipple discharge – Wikipedia

  https://en.wikipedia.org/wiki/Nipple_discharge

  Nipple discharge can arise from any one or more of the 15 to 20 milk ducts that each breast contains, and its causes can be divided into normal (physiological) and abnormal (pathological). […] Spontaneous nipple discharge unrelated to pregnancy or lactation is considered abnormal, but mostly have a non-serious cause. […] Discharge from nipples is also more likely to be abnormal (pathological) if it is crystal clear or blood-stained, is from only one breast, or is associated with a breast lump, swelling, redness or overlying skin changes. […] A blocked or enlarged milk duct can result in nipple discharge. […] Intraductal papillomas are non-cancerous lesions and commonest in women age 30 to 50. […] Up to half of women with intraductal papillomas may present with bloody nipple discharge, but it can also be straw-coloured.

• #1 Nipple discharge

  https://www.mayoclinic.org/symptoms/nipple-discharge/basics/causes/sym-20050946?p=1

  Nipple discharge means any fluid that comes out of a breast nipple. […] Discharge can come from one or both breasts nipples. It might happen from squeezing the nipples or breasts. Or it might happen on its own, called spontaneous. The discharge comes through one or more of the ducts that carry milk. […] A papilloma is a noncancerous, also called benign, tumor in a milk duct. A papilloma can be linked to bloody discharge. The discharge linked with a papilloma often happens spontaneously and involves a single duct. […] Often, a harmless condition causes nipple discharge. However, the discharge might mean breast cancer, especially if: […] Nipple discharge is rarely a sign of breast cancer. But it might be a sign of a condition that needs treatment. […] In the meantime, don’t massage your nipples or handle your breasts, even to check for discharge. Handling your nipples or friction from clothing can cause ongoing discharge.

• #1 Nipple Discharge Fact Sheet | Westmead BCI

  https://www.bci.org.au/breast-cancer-information/fact-sheets/nipple-discharge/

  Nipple discharge is the release of fluid from the nipple. […] Nipple discharge alone (without a lump or other nipple change) is a very uncommon symptom of breast cancer. […] Spontaneous nipple discharge unrelated to pregnancy or breast feeding is considered abnormal. In most cases it has a non-cancerous (benign) cause. Spontaneous nipple discharge that is caused by disease (pathology) in the breast is more likely to be from one breast only (unilateral), confined to a single duct, and clear or blood-stained in appearance. […] Nipple discharge that is associated with other symptoms such as a lump in the breast or ulceration or inversion of the nipple needs prompt investigation, even if it is not spontaneous or blood-stained. […] There are many causes of nipple discharge. […] Duct ectasia is a non-cancerous (benign) condition in which the milk ducts under the nipple enlarge and there is inflammation in the walls of the ducts.

• #1 Analyzing Nipple Discharge: A Surgeon’s Perspective

  https://www.endosurgeries.com/abstractArticleContentBrowse/IJESR/31259/JPJ/fullText

  Nipple discharge is the third most common complaint of a woman visiting a breast clinic. […] Most ND is benign in origin (97%); however, it can be the presenting feature of breast cancer in 5-12% of women. […] Various hormones like estrogen, progesterone, prolactin, insulin, thyrotropin-releasing hormone, etc., are involved in the production of milk and hence contribute to ND. […] It has been hypothesized that breast cancer development involves a cascade of sequential molecular and morphological changes in the ductal epithelium. […] Most pathological ND is due to benign etiologies like papillomas (35-56%) and duct ectasias (65-99%), and the risk of malignancy is 5-23%. […] Papillomas are the most frequent causes of pathological ND. […] Duct ectasia refers to the dilation of ducts, greater than 3 mm in diameter, with loss of elastin and presence of chronic inflammatory cells around the duct walls. […] Duct ectasia does not predispose to cancer. […] Several drugs can cause galactorrhea due to their antidopaminergic effects. […] The mainstay in the treatment of hyperprolactinemia is bromocriptine and cabergoline.

• #1

  http://www.journalononcology.org/articles/joo-v3-1112.html

  Breast carcinoma: DCIS is a heterogeneous group of intraductal tumors forming neoplastic lesions from the lining of breast mammary ducts and lobules. […] However, it is the least likely incurring cause among the three primary etiologies for PND, and particularly concomitant with a palpable mass, PND may thus be regarded as an alarm sign which is of significance in cancer detection. […] MRI has been mostly recommended in recent studies as an emerging and preferred diagnosis instrument for screening high-risk patients with PND or detecting the primary origin of carcinoma due to its strengths of being less invasive and no radiation especially when the findings of first-line imaging modalities of mammography and ultrasound are normal but the PND symptoms are not in resolution. […] According to Filipe et al. study of collecting 36 studies with 3764 patients in a meta-analysis regarding the detection of malignancy in patients with PND with diagnostic imaging techniques, MRI has shown the highest average sensitivity among others such as ductoscopy, ultrasound, cytology, and mammography of 83%.

• #1 Dr Chantel Thornton > Symptoms & Conditions > Nipple Changes

  https://www.breastcancerspecialist.com.au/symptoms-conditions/nipple-changes

  Spontaneous nipple discharge is the third most common reason women present to a breast surgeon. Nipple discharge can be physiological or pathological. It can be associated with benign or malignant pathology. It can cause significant anxiety; however, fortunately it is the presenting symptom for breast cancer in less than 12% of all cases. […] The most worrying discharge is a spontaneous single duct unilateral persistent discharge. The consistency and colour of the discharge does not decrease the suspicion for breast cancer. […] Discharge due to breast cancer can be clear, sero-sanguineous or bloodstained. […] Spontaneous nipple discharge confirmed to a single duct which is unilateral is more likely to be associated with underlying pathology such as cancer or DCIS. […] Nipple discharge associated with a breast lump ulceration of the nipple and areolar inversion/retraction of the nipple even if it is not spontaneous or blood stained requires urgent investigation.

• #1 Nipple discharge and the role of ductoscopy in breast diseases | Clinical Gate

  https://clinicalgate.com/nipple-discharge-and-the-role-of-ductoscopy-in-breast-diseases/

  The causes of nipple discharge are wide ranging. The majority of discharge is physiological, hormone related or results from benign breast change. […] Duct ectasia and benign breast change are common causes of multiduct discharge. In duct ectasia, the breast ducts become tortuous and dilated, predisposing to fluid accumulation. […] Persistent spontaneous discharge from a single nipple orifice is usually indicative of specific pathology involving that duct. […] Benign intraductal papillomas account for about 80% of single-duct bloodstained nipple discharges. […] Invasive breast cancer is an uncommon cause of spontaneous nipple discharge as the proliferating mass usually obliterates the duct lumen. […] The risk of an underlying malignancy is increased if the nipple discharge is spontaneous, single duct, persistent (occurs more than twice per week), bloody, age 50 years and associated with a palpable abnormality.

• #1 Nipple Discharge – Clinical Methods – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK284/

  In patients with acute puerperal mastitis, chronic lactation mastitis, central breast abscesses, or plasma cell mastitis, pus can be discharged, usually unilaterally. […] The most common cause of these discharges is intraductal papillomas, but fibrocystic disease, advanced duct ectasia, cancer of the breast, and vascular engorgement in near-term pregnancy can also be causative. […] In patients over the age of 50, malignancy becomes increasingly common, especially if the discharge is unilateral and associated with a mass.

• #1 Galactorrhea: Symptoms, Causes in Men and Women, and Treatment

  https://www.healthline.com/health/galactorrhea

  Galactorrhea is often caused by a prolactinoma. This is a tumor that forms in your pituitary gland. It can press on your pituitary gland, stimulating it to produce more prolactin. Prolactin is the hormone that’s largely responsible for lactation. […] If you aren’t producing enough dopamine, your pituitary gland may produce too much prolactin, resulting in nipple discharge. […] Many other conditions can cause you to have too much prolactin. These include: hypothyroidism, which happens when the thyroid gland doesn’t work to full capacity; taking certain high blood pressure medications, such as methyldopa (Aldomet); long-term kidney conditions; liver disorders, such as cirrhosis; some types of lung cancer; taking opioid medications, such as oxycodone (Percocet) and fentanyl (Actiq); taking certain antidepressants, such as paroxetine (Paxil) or selective serotonin reuptake inhibitors (SSRIs), such as citalopram (Celexa); using cocaine or marijuana; taking certain herbal supplements, including fennel or anise seed; taking prokinetics for gastrointestinal conditions; using phenothiazines to get rid of parasites. […] Male hypogonadism refers to having low testosterone. This is one of the more common causes of galactorrhea in males. It can also cause gynecomastia, which enlarges the breasts.

• #1 Causes of Breast Discharge – Women’s Health Network

  https://www.womenshealthnetwork.com/breast-health/causes-of-breast-discharge/

  Its a revelation to many to learn how common breast discharge is in women, not to mention the many different forms it can take clear, milky-white, greenish, yellowish, brown, sticky, or bloody! […] And though were far from fully understanding the body chemistry that leads to one form of nipple discharge or another, we are aware of a wide spectrum of lifestyle, dietary, environmental and drug factors at play. […] Nipple discharge caused by duct ectasia can be thick, green, black, opalescent, or clear. This is actually a fancy medical term to cover a large category of discharge for which we dont really understand the etiology! […] And though a full explanation for these various forms of breast discharge still eludes us, we can pretty safely conclude that the underlying cause is imbalance in the system. […] Remember, fluid discharge from the breast is only rarely an indication of something serious, but if you have some type of nipple discharge, we encourage you to seek evaluation with your healthcare provider to be on the safe side.

• #1 Nipple Discharge: Color, Causes, What It Means & Treatment

  https://my.clevelandclinic.org/health/symptoms/21014-nipple-discharge

  Yes. There are studies that show stress causes nipple discharge. This is due to increases in the hormone prolactin, which is responsible for lactation. […] Nipple discharge is concerning when: You’re male, The discharge is bloody, It only comes from one nipple and not from both, It comes out even when you don’t touch or squeeze it, You also have a lump, breast pain or other unusual symptoms. […] Nipple discharge is usually not a cause for worry, but it’s a good idea to get it checked out. Symptoms like the color of the discharge, frequency of discharge and if it comes from one or both breasts can help a healthcare provider determine a cause. A healthcare provider will examine your breasts and run any imaging tests that may be necessary. It’s rarely a sign of breast cancer, but it can be a sign of an underlying medical condition. In most cases, nipple discharge in women happens due to hormones, a blocked milk duct or a noncancerous lump or tumor. Nipple discharge in men is almost always abnormal.

• #1 Nipple discharge – Wikipedia

  https://en.wikipedia.org/wiki/Nipple_discharge

  15-20% of people with nipple discharge are found to have duct ectasia. […] Ductal carcinoma in situ (DCIS) usually presents with abnormal findings on mammography, but can less frequently present with a lump or nipple discharge in women, whereas in men with DCIS, nipple discharge is the common presentation. […] Infection in a breast, either mastitis or breast abscess may cause a discharge. […] Nipple discharge may be due to breast cancer, particularly if there is an accompanying breast lump. […] Some condition that cause a raised prolactin can result in a milky liquid appearing from nipples. […] The evaluation of milky nipple discharge in a non-pregnant, not breast feeding women is different to the assessment of other abnormal nipple discharge. […] Initially, an evaluation for cancer is indicated. Treatment will depend on the cause found, and may involve changing medication, having a lump removed, applying a cream to treat a skin condition or being given medication to treat the condition causing the discharge.

• #1 Do hormones cause breast discharge? Possible causes

  https://www.medicalnewstoday.com/articles/do-hormones-cause-breast-discharge

  Green discharge may sometimes mean that there is an infection in the breast. Infections are more common following an injury to the breast or when breastfeeding or chestfeeding. […] In many cases, an infection happens when the milk duct becomes clogged. […] If the red discharge continues, however, it is advisable to see a doctor. The blood might indicate an infection or injury. […] A breast growth called a benign papilloma may also cause red discharge. […] A papilloma is not cancer, and a single papilloma does not increase the risk of breast cancer.

• #1 Nipple discharge – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/nipple-discharge/

  Malignancy; (515% of cases): most commonly ductal carcinoma in situ. […] Intraductal papilloma is the most common cause of pathological nipple discharge accounting for up to 58% of cases. […] The following are red flag features for malignancy: Characteristics of pathological nipple discharge include unilateral, uniductal, persistent, spontaneous, and clear, bloody, or serosanguineous. […] Biopsy is necessary if imaging findings are concerning for malignancy (e.g., BI-RADS 4 or 5). […] Treatment is based on the underlying cause; see Common causes of nipple discharge.

• #1 Predictors of Malignancy for Female Patients with Suspicious Nipple Discharge: A Retrospective Study | Anticancer Research

  https://ar.iiarjournals.org/content/37/8/4655

  In our study, 18% of all cases (60/344) were confirmed to have malignancy. In the 163 patients without suspicious lumps, 15 (9.2%) had malignancy. The risks of breast cancer in patients with and without suspicious lumps found here were similar to those of previous reports. […] Patients with older age were more likely to have malignancy, as shown in our study. This is consistent with previous studies, indicating that the incidences of breast cancer were generally higher in elderly women. However, previous studies did not suggest any association between the color of the ND (serous, serosanguinous or colored discharge) and the presence of malignancy. Additionally, the association between bloody discharge and an increased risk of breast cancer was also controversial. In our study, we did not observe any association between bloody ND and an increased risk of having breast cancer, which is not consistent with previous studies. Some studies suggest that breast lesions other than breast cancer may also lead to bloody ND. We suggest that for patients with bloody ND, caution is required and surgical treatment is indicated. Additionally, we noted that the presence of suspicious lumps were associated with malignancy. Patients with suspicious lumps larger than 1 cm had significantly higher risk of breast malignancy than those with smaller suspicious lumps. […] In conclusion, a total of 18% of female patients with suspicious ND in this study had malignant disease. Older age and the presence of suspicious lumps, rather than the presence of bloody discharge, were significantly associated with malignancy.

• #1 Breast Nipple Discharge – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK430938/

  The primary goal of evaluation of the nipple discharge in a general outpatient setting or the emergency department is to distinguish patients with benign discharge from those with underlying breast cancer, infection/abscess, or those patients who are at high risk of developing pathologic processes. […] Physiological discharge is bilateral and is clear or milky. Pathological discharge is always unilateral and may be bloody. […] The treatment of breast discharge depends on the etiology. A physiological discharge does not require any treatment. Systemic causes of nipple discharge require specific medications. Benign causes of breast discharge like duct ectasia requires microdochectomy (removal of one duct) or total duct excision (removal of all ducts). […] Most nipple discharge is due to an intraductal papilloma and these patients have an excellent outcome when the lesion is excised.

• #1 MRI for assessment of pathologic nipple discharge: is it mandatory? | Egyptian Journal of Radiology and Nuclear Medicine | Full Text

  https://ejrnm.springeropen.com/articles/10.1186/s43055-019-0105-9

  Benign breast lesions is the most common cause of nipple discharge; however, a rare but major cause is breast cancer. This study assesses the superadded value of MRI in diagnosing causes of pathologic nipple discharge. […] A rare but major cause of spontaneous pathologic nipple discharge (SPND) is breast cancer which accounts for 733% of the cases. […] Magnetic resonance imaging (MRI) is a valuable adjunctive means of detecting and diagnosing papillomas and malignancies especially invasive ductal carcinoma and ductal carcinoma in situ (DCIS), especially in cases when the other two modalities are normal. […] Our aim in this study was to determine the added value of dynamic contrast-enhanced MRI in diagnosis of different causes of pathologic nipple discharge. […] Simply dilated ducts and presence of a mass on US examination were of statistically significant probability in differentiation between benign and malignant causes of pathological nipple discharge (p value=0.017 and 0.001). Non-mass enhancement and STIR signal changes on MRI were of high statistically significant probability in differentiation between benign and malignant causes of pathological nipple discharge (p value 0.001).

• #1 MRI for assessment of pathologic nipple discharge: is it mandatory? | Egyptian Journal of Radiology and Nuclear Medicine | Full Text

  https://ejrnm.springeropen.com/articles/10.1186/s43055-019-0105-9

  Sensitivity and specificity of mammogram and ultrasound in differentiation between benign and malignant causes of pathologic nipple discharge were 71.4% and 54.2% respectively with positive predictive value of 31.2%, negative predictive value of 86.7%, and accuracy of 58.1%, while sensitivity and specificity of 100% and 83.3% with positive predictive value of 63.6%, negative predictive value of 100%, and accuracy of 87.1%. […] We can conclude that MRI add in diagnosis of different causes of pathologic nipple discharge and we believe it is mandatory in the following situations: If there is intraductal echogenicity to confirm intraductal mass lesion and exclude inspissated secretion especially in young female to preserve duct system and to differentiate between benign from suspicious lesion. […] In case of asymmetric heterogeneous breast parenchyma. […] In suspicious breast mass to determine the extent of the lesion for proper selection of patient for conservative management. […] Evaluation of residual suspicious lesion after improper operation.

• #1 Nipple Discharge and Breast Cancer: Understanding the Facts and Risks | Breastlink

  http://breastlink.com/breast-cancer-101/common-breast-problems/nipple-discharge

  Nipple discharge can be a concerning symptom for many women. Although it can be an early symptom of breast cancer, most cases are due to benign conditions. It’s crucial to differentiate between benign and malignant discharge to avoid any misdiagnosis or misinterpretation of the symptoms. […] If the discharge is spontaneous and originating from a single duct, we perform a ductogram, a procedure in which contrast material is placed into the duct under local anesthesia and an X-ray is taken. If an abnormality is detected, the patient is taken directly to the operating room for removal of the abnormal duct. […] It is important to note that nipple discharge can be caused by a wide range of conditions, and breast cancer is only one of them. With proper evaluation and management, the vast majority of patients with nipple discharge can be treated successfully.

• #1 Nipple discharge and the role of ductoscopy in breast diseases | Clinical Gate

  https://clinicalgate.com/nipple-discharge-and-the-role-of-ductoscopy-in-breast-diseases/

  After breast lumps and mastalgia, spontaneous nipple discharge forms the next most common symptom, comprising 38% of referrals to symptomatic breast clinics. The majority of nipple discharge is benign, with up to 20% being associated with an underlying malignancy. […] Conventional methods of investigating nipple discharge include mammography, ultrasound and smear cytology, each of which have recognised limitations. […] Standard operations such as microdochectomy and major duct excision are undirected procedures that carry a risk of leaving undiagnosed pathology in the breast. […] Mammary ductoscopy allows direct visualisation of the duct epithelium to locate the lesion precisely and to map the three-dimensional anatomy. […] The ability to visualise normal or benign ductal structures may facilitate conservative management of symptomatic nipple discharge and enable targeted excision of visualised lesions or indeterminate areas.

• #1 Common Breast Problems | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0415/p505.html

  Nipple discharge is classified as pathologic if it is spontaneous, bloody, unilateral, or associated with a breast mass. […] Pathologic discharge is generally spontaneous and unilateral, and originates from a single duct opening on a nipple. It may be bloody, serous, serosanguineous, or watery. […] If discharge is deemed pathologic, age-appropriate diagnostic imaging with mammography and/or ultrasonography is indicated. […] Studies have shown a low risk of malignancy when diagnostic studies are negative. […] The clinical utility of cytology is limited because of its high rate of false-negative findings. […] Imaging results of BI-RADS 4 or 5 require tissue biopsy. […] Duct excision, potentially localized by ultrasonography, magnetic resonance imaging, or ductography, is preferred to rule out malignancy.

• #1 Discharges and Secretions of the Nipple | Oncohema Key

  https://oncohemakey.com/discharges-and-secretions-of-the-nipple/

  NAF is a simple, minimally invasive method of sampling histologic alterations within the breast. […] Cytologic examination of the breast fluid has long been considered a potential aid in the detection of breast disease. […] The diagnosis of cancer was made in only 21% of the cases. […] NAF was proposed as a novel approach to study breast cancer precursors but was not considered a diagnostic tool. […] Factors that affect NAF production in nonlactating women include age, existing proliferative breast disease, previous breast biopsy, and family history of breast cancer. […] The study concluded that women with cytologic diagnosis of atypical hyperplasia experienced a significant increase in risk of developing breast cancer. […] The noncellular component of the NAF has been studied for a number of biochemical substances and biomarkers.

• #1 Dr Chantel Thornton > Symptoms & Conditions > Nipple Changes

  https://www.breastcancerspecialist.com.au/symptoms-conditions/nipple-changes

  Breast Cancer – approximately 5% of women with breast cancer will have nipple discharge and some of these will also have other symptoms such as a retracted nipple or a breast lump. […] Microdochectomy (single duct excision) is the only procedure that will confirm a definitive histological diagnosis in a patient that presents with single duct discharge. […] Spontaneous single duct or bloodstained discharge requires a full set of breast imaging in the form of ultrasound and mammogram (for patients over age of 35). A sample of the nipple discharge may be sent for cytological examination by the pathologist and any mass or lump beneath nipple or areola may be subjected to a biopsy (fine needle aspiration or core biopsy). If there is ongoing single duct spontaneous nipple discharge, a microdochectomy, or single duct excision is usually required. The offending duct will be removed in order to explore the duct under the microscope to rule out any significant abnormality/pathology and to correct the problem.

• #2 Nipple Discharge: Causes and Treatment

  https://www.healthline.com/health/womens-health/nipple-discharge

  Nipple discharge is common and usually not serious, but it may be a symptom of an underlying condition. […] Discharge is usually not serious. Still, it can be a sign of breast cancer, so its worth talking about with a doctor. […] The causes listed are only suggestions. If you notice nipple discharge of any color, you should contact a doctor for a proper diagnosis. […] When youre pregnant or lactating, small amounts of milk might leak out. […] However, you may have discharge even if youre not pregnant or lactating. Other causes of nipple discharge include: birth control pills, breast infection or abscess, duct papilloma, a harmless wart-like growth in your milk duct, drugs that increase levels of the milk-producing hormone prolactin, such as antidepressants and tranquilizers, excess stimulation of the breast or nipple, fibrocystic breasts, hormone changes during your period or menopause, injury to the breast, mammary duct ectasia, known as a blocked milk duct, prolactinoma, a noncancerous tumor of the pituitary gland, underactive thyroid gland, breast cancer.

• #2

  http://www.journalononcology.org/articles/joo-v3-1112.html

  Nipple discharge is recognized as the third most common breast symptom, following breast pain and lumps. Although it is related to benign diseases mainly, an incidence of 5% to 12% associated with breast carcinoma still occurs. […] The dominating etiology of incurring Pathologic Nipple Discharge (PND) is a benign papilloma, with an incidence of 52%-57%. Duct ectasia is another of the most common benign causes of PND, representing approximately 14%- 33% of the cases, while breast cancers such as Ductal Carcinoma in Situ (DCIS) take up 5%-15% of cases of pathologic nipple discharge. […] Due to its possible relevance for breast cancer, PND has posed significant attention regarding its significance of excluding deterioration if immediate diagnostic modalities and operative treatment are performed accurately and efficiently.

• #2 Breast Nipple Discharge | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/18591

  Physiological discharge is usually bilateral, with clear fluid, involves multiple ducts, and is non-sticky. Pathologic discharge is usually unilateral, spontaneous, varied in appearance, and depending on the cause, involves a single duct. […] The treatment of breast discharge depends on the etiology. A physiological discharge does not require any treatment. Systemic causes of nipple discharge require specific medications. Benign causes of breast discharge like duct ectasia requires microdochectomy (removal of one duct) or total duct excision (removal of all ducts). Duct papillomas that produce unilateral bloody discharge require microdochectomy. Breast cancer-producing bloody nipple discharge requires surgery and/or chemotherapy or radiation depending on the staging of the disease.

• #2 Galactorrhea | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/galactorrhea?content_id=CON-20154794

  Galactorrhea often results from having too much of the hormone that makes milk when you have a baby. This is called prolactin. Your pituitary gland, a small bean-shaped gland at the base of your brain involved with several hormones, makes prolactin. […] Sometimes healthcare professionals can’t find a cause for galactorrhea. This is called idiopathic galactorrhea. This may mean that the breast tissue is very sensitive to the milk-making hormone prolactin. If so, even typical prolactin levels can lead to galactorrhea. […] In people assigned male at birth, galactorrhea may be linked with too little of the hormone testosterone. Called male hypogonadism, this most often also causes breasts that are enlarged or tender, called gynecomastia. Not being able to get and keep an erection, called erectile dysfunction, and not wanting to have sex also are linked with too little testosterone.

• #2 Nipple Discharge Fact Sheet | Westmead BCI

  https://www.bci.org.au/breast-cancer-information/fact-sheets/nipple-discharge/

  A duct papilloma is a growth within a milk duct in the breast, usually near the nipple. […] Eczema or dermatitis which affects the skin of the nipple, particularly if it becomes infected, can cause a weeping, crusty nipple discharge. […] Breast cancer is an uncommon cause of nipple discharge. […] Pagets disease is a particular type of breast cancer which involves the nipple. […] Galactorrhoea is milky nipple discharge not related to pregnancy or breast feeding. It is caused by the abnormal production of a hormone called prolactin. […] Abnormally high prolactin levels can also be caused by some drugs. […] Nipple discharge diagnosed as physiological discharge requires no treatment. […] Nipple discharge that is spontaneous, blood-stained, persistent, and unrelated to pregnancy or breast feeding needs to be investigated further. […] If any abnormality is found on these tests, a biopsy may be recommended. […] Surgery for nipple discharge is sometimes warranted. This is usually reserved for cases where a significant abnormality, such as a papilloma or breast cancer is suspected.

• #2 Galactorrhea: Symptoms, Causes in Men and Women, and Treatment

  https://www.healthline.com/health/galactorrhea

  Galactorrhea is often caused by a prolactinoma. This is a tumor that forms in your pituitary gland. It can press on your pituitary gland, stimulating it to produce more prolactin. Prolactin is the hormone that’s largely responsible for lactation. […] If you aren’t producing enough dopamine, your pituitary gland may produce too much prolactin, resulting in nipple discharge. […] Many other conditions can cause you to have too much prolactin. These include: hypothyroidism, which happens when the thyroid gland doesn’t work to full capacity; taking certain high blood pressure medications, such as methyldopa (Aldomet); long-term kidney conditions; liver disorders, such as cirrhosis; some types of lung cancer; taking opioid medications, such as oxycodone (Percocet) and fentanyl (Actiq); taking certain antidepressants, such as paroxetine (Paxil) or selective serotonin reuptake inhibitors (SSRIs), such as citalopram (Celexa); using cocaine or marijuana; taking certain herbal supplements, including fennel or anise seed; taking prokinetics for gastrointestinal conditions; using phenothiazines to get rid of parasites. […] Male hypogonadism refers to having low testosterone. This is one of the more common causes of galactorrhea in males. It can also cause gynecomastia, which enlarges the breasts.

• #2 Surgical management of pathologic nipple discharge – UpToDate

  https://www.uptodate.com/contents/surgical-management-of-pathologic-nipple-discharge

  Nipple discharge is categorized as normal milk production (lactation), physiologic nipple discharge (galactorrhea), or pathologic (suspicious) nipple discharge. The most common causes of pathologic nipple discharge are benign intraductal papilloma (35 to 48 percent), ductal ectasia (17 to 36 percent), and carcinoma (5 to 21 percent). […] Pathologic nipple discharge, defined as secretory production of fluids other than milk due to pathological process in the breast, should be suspected by the presence of one or more of the following: Unilateral nipple discharge.

• #2 Analyzing Nipple Discharge: A Surgeon’s Perspective

  https://www.endosurgeries.com/abstractArticleContentBrowse/IJESR/31259/JPJ/fullText

  Nipple discharge is the third most common complaint of a woman visiting a breast clinic. […] Most ND is benign in origin (97%); however, it can be the presenting feature of breast cancer in 5-12% of women. […] Various hormones like estrogen, progesterone, prolactin, insulin, thyrotropin-releasing hormone, etc., are involved in the production of milk and hence contribute to ND. […] It has been hypothesized that breast cancer development involves a cascade of sequential molecular and morphological changes in the ductal epithelium. […] Most pathological ND is due to benign etiologies like papillomas (35-56%) and duct ectasias (65-99%), and the risk of malignancy is 5-23%. […] Papillomas are the most frequent causes of pathological ND. […] Duct ectasia refers to the dilation of ducts, greater than 3 mm in diameter, with loss of elastin and presence of chronic inflammatory cells around the duct walls. […] Duct ectasia does not predispose to cancer. […] Several drugs can cause galactorrhea due to their antidopaminergic effects. […] The mainstay in the treatment of hyperprolactinemia is bromocriptine and cabergoline.

• #2 Nipple discharge – Wikipedia

  https://en.wikipedia.org/wiki/Nipple_discharge

  Nipple discharge can arise from any one or more of the 15 to 20 milk ducts that each breast contains, and its causes can be divided into normal (physiological) and abnormal (pathological). […] Spontaneous nipple discharge unrelated to pregnancy or lactation is considered abnormal, but mostly have a non-serious cause. […] Discharge from nipples is also more likely to be abnormal (pathological) if it is crystal clear or blood-stained, is from only one breast, or is associated with a breast lump, swelling, redness or overlying skin changes. […] A blocked or enlarged milk duct can result in nipple discharge. […] Intraductal papillomas are non-cancerous lesions and commonest in women age 30 to 50. […] Up to half of women with intraductal papillomas may present with bloody nipple discharge, but it can also be straw-coloured.

• #2 Nipple Discharge – Clinical Methods – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK284/

  Lesions in the hypothalamus, pituitary stalk section or drugs that influence the central nervous system can decrease the inhibitory dopaminergic control of prolactin. […] A physiologic enhancement of prolactin release is caused by thyrotropin releasing hormone (TRH). […] Three types of pituitary tumors may be associated with galactorrhea: pure prolactin-secreting tumors (micro- or macroadenoma), mixed tumors that secrete both growth hormone and prolactin, and chromophobe adenomas. […] The majority of patients with galactorrhea will have normal prolactins. […] Duct ectasia or comedomastitis can produce a multicolored, sticky discharge that is commonly bilateral in the perimenopausal woman. […] If the disease progresses, a mass can develop (plasma cell mastitis) that can mimic cancer.

• #2 Nipple discharge – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/nipple-discharge/

  Malignancy; (515% of cases): most commonly ductal carcinoma in situ. […] Intraductal papilloma is the most common cause of pathological nipple discharge accounting for up to 58% of cases. […] The following are red flag features for malignancy: Characteristics of pathological nipple discharge include unilateral, uniductal, persistent, spontaneous, and clear, bloody, or serosanguineous. […] Biopsy is necessary if imaging findings are concerning for malignancy (e.g., BI-RADS 4 or 5). […] Treatment is based on the underlying cause; see Common causes of nipple discharge.

• #2 Nipple discharge and the role of ductoscopy in breast diseases | Clinical Gate

  https://clinicalgate.com/nipple-discharge-and-the-role-of-ductoscopy-in-breast-diseases/

  The causes of nipple discharge are wide ranging. The majority of discharge is physiological, hormone related or results from benign breast change. […] Duct ectasia and benign breast change are common causes of multiduct discharge. In duct ectasia, the breast ducts become tortuous and dilated, predisposing to fluid accumulation. […] Persistent spontaneous discharge from a single nipple orifice is usually indicative of specific pathology involving that duct. […] Benign intraductal papillomas account for about 80% of single-duct bloodstained nipple discharges. […] Invasive breast cancer is an uncommon cause of spontaneous nipple discharge as the proliferating mass usually obliterates the duct lumen. […] The risk of an underlying malignancy is increased if the nipple discharge is spontaneous, single duct, persistent (occurs more than twice per week), bloody, age 50 years and associated with a palpable abnormality.

• #2 Hormones and Breast Discharge: Causes of Different Colors

  https://www.verywellhealth.com/benign-nipple-discharge-430412

  Hormones can cause normal breast discharge thats related or unrelated to pregnancy. Common hormonal causes of nipple discharge include: […] Normal fluctuations in estrogen levels throughout the menstrual cycle can lead to breast tissue changes and nipple discharge. […] Galactorrhea is a milky nipple discharge that happens when there are high levels of prolactin in the body (hyperprolactinemia). Prolactin is a hormone that is normally involved with breast growth and breastfeeding. […] Some health conditions can change the levels of certain hormones in your body. […] Hypothyroidism (underactive thyroid) and non-cancerous growths on the pituitary gland can both cause nipple discharge because they can change how much prolactin is in your body. […] Medications such as hormonal contraceptives (e.g., birth control pills) and hormone-replacement therapy (HRT) can have a milky nipple discharge as a side effect since they change the levels of hormones (like estrogen) in your body.

• #2 Do hormones cause breast discharge? Possible causes

  https://www.medicalnewstoday.com/articles/do-hormones-cause-breast-discharge

  Green discharge may sometimes mean that there is an infection in the breast. Infections are more common following an injury to the breast or when breastfeeding or chestfeeding. […] In many cases, an infection happens when the milk duct becomes clogged. […] If the red discharge continues, however, it is advisable to see a doctor. The blood might indicate an infection or injury. […] A breast growth called a benign papilloma may also cause red discharge. […] A papilloma is not cancer, and a single papilloma does not increase the risk of breast cancer.

• #2 Nipple Discharge – Clinical Methods – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK284/

  Nipple discharge is the passage of liquid material through the nipple either spontaneously or with manipulation of breast tissue. […] True discharge comes through mammary ducts out the nipple and may be noted to drain spontaneously and stain clothing, or may be elicited by segmental palpation of breast tissue. […] Differentiation of the seven basic types of nipple discharge can be determined by observation of the color of discharge, palpation of discharge to determine texture, and smear examination of discharge with Wright’s stain to see if pus or blood is present. […] Discharge from the breast is an abnormal finding except in late pregnancy or the postpartum period. There are seven basic types of nipple discharge, each of which can be associated with specific clinical conditions. […] The etiology of galactorrhea can be classified in terms of prolactin abnormalities.

• #2 Predictors of Malignancy for Female Patients with Suspicious Nipple Discharge: A Retrospective Study | Anticancer Research

  https://ar.iiarjournals.org/content/37/8/4655

  In our study, 18% of all cases (60/344) were confirmed to have malignancy. In the 163 patients without suspicious lumps, 15 (9.2%) had malignancy. The risks of breast cancer in patients with and without suspicious lumps found here were similar to those of previous reports. […] Patients with older age were more likely to have malignancy, as shown in our study. This is consistent with previous studies, indicating that the incidences of breast cancer were generally higher in elderly women. However, previous studies did not suggest any association between the color of the ND (serous, serosanguinous or colored discharge) and the presence of malignancy. Additionally, the association between bloody discharge and an increased risk of breast cancer was also controversial. In our study, we did not observe any association between bloody ND and an increased risk of having breast cancer, which is not consistent with previous studies. Some studies suggest that breast lesions other than breast cancer may also lead to bloody ND. We suggest that for patients with bloody ND, caution is required and surgical treatment is indicated. Additionally, we noted that the presence of suspicious lumps were associated with malignancy. Patients with suspicious lumps larger than 1 cm had significantly higher risk of breast malignancy than those with smaller suspicious lumps. […] In conclusion, a total of 18% of female patients with suspicious ND in this study had malignant disease. Older age and the presence of suspicious lumps, rather than the presence of bloody discharge, were significantly associated with malignancy.

• #2 MRI for assessment of pathologic nipple discharge: is it mandatory? | Egyptian Journal of Radiology and Nuclear Medicine | Full Text

  https://ejrnm.springeropen.com/articles/10.1186/s43055-019-0105-9

  Benign breast lesions is the most common cause of nipple discharge; however, a rare but major cause is breast cancer. This study assesses the superadded value of MRI in diagnosing causes of pathologic nipple discharge. […] A rare but major cause of spontaneous pathologic nipple discharge (SPND) is breast cancer which accounts for 733% of the cases. […] Magnetic resonance imaging (MRI) is a valuable adjunctive means of detecting and diagnosing papillomas and malignancies especially invasive ductal carcinoma and ductal carcinoma in situ (DCIS), especially in cases when the other two modalities are normal. […] Our aim in this study was to determine the added value of dynamic contrast-enhanced MRI in diagnosis of different causes of pathologic nipple discharge. […] Simply dilated ducts and presence of a mass on US examination were of statistically significant probability in differentiation between benign and malignant causes of pathological nipple discharge (p value=0.017 and 0.001). Non-mass enhancement and STIR signal changes on MRI were of high statistically significant probability in differentiation between benign and malignant causes of pathological nipple discharge (p value 0.001).

• #2 Nipple Discharge – Radiology | UCLA Health

  https://www.uclahealth.org/departments/radiology/education/breast-imaging-teaching-resources/how-work-up-patient-with/nipple-discharge

  Nipple discharge is the third leading breast complaint after lumps and pain, with a prevalence of 5-10% in women. […] Nipple discharge in women is usually due to benign pathologies including ductal ectasia in 6-59% of cases, and papillomas in 35-56% of cases. […] Nipple discharge is associated with a 5-23% risk of malignancy in women, typically DCIS. […] Any discharge in a man is suspicious and associated with breast cancer in 25-57% of cases. […] Ductal ectasia, defined as a diameter 3mm, is one of the most common findings. Ductal ectasia which is peripheral, with irregular ductal margins, thickening of the wall, and hypoechoic adjacent tissues are suggestive of malignancy. […] Non-mass enhancement is the most common finding in patients with suspicious nipple discharge. […] Galactography or ductography had previously been considered the gold standard for evaluation of nipple discharge, however in recent years this modality is falling out of favor, as there are several disadvantages, such as difficulty with duct catheterization resulting in procedure failure, and procedural risks including contrast extravasation, iodinated contrast allergy, and mastitis.

• #2 Common Breast Problems | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0415/p505.html

  Nipple discharge is classified as pathologic if it is spontaneous, bloody, unilateral, or associated with a breast mass. […] Pathologic discharge is generally spontaneous and unilateral, and originates from a single duct opening on a nipple. It may be bloody, serous, serosanguineous, or watery. […] If discharge is deemed pathologic, age-appropriate diagnostic imaging with mammography and/or ultrasonography is indicated. […] Studies have shown a low risk of malignancy when diagnostic studies are negative. […] The clinical utility of cytology is limited because of its high rate of false-negative findings. […] Imaging results of BI-RADS 4 or 5 require tissue biopsy. […] Duct excision, potentially localized by ultrasonography, magnetic resonance imaging, or ductography, is preferred to rule out malignancy.

• #2 Nipple Discharge: Color, Causes, What It Means & Treatment

  https://my.clevelandclinic.org/health/symptoms/21014-nipple-discharge

  Yes. There are studies that show stress causes nipple discharge. This is due to increases in the hormone prolactin, which is responsible for lactation. […] Nipple discharge is concerning when: You’re male, The discharge is bloody, It only comes from one nipple and not from both, It comes out even when you don’t touch or squeeze it, You also have a lump, breast pain or other unusual symptoms. […] Nipple discharge is usually not a cause for worry, but it’s a good idea to get it checked out. Symptoms like the color of the discharge, frequency of discharge and if it comes from one or both breasts can help a healthcare provider determine a cause. A healthcare provider will examine your breasts and run any imaging tests that may be necessary. It’s rarely a sign of breast cancer, but it can be a sign of an underlying medical condition. In most cases, nipple discharge in women happens due to hormones, a blocked milk duct or a noncancerous lump or tumor. Nipple discharge in men is almost always abnormal.

• #2 Nipple discharge and the role of ductoscopy in breast diseases | Clinical Gate

  https://clinicalgate.com/nipple-discharge-and-the-role-of-ductoscopy-in-breast-diseases/

  Mammary ductoscopy allows direct visualisation of the ductal epithelium and can be used to direct surgical resection of target lesions while limiting resection of normal breast tissue. […] The development of microbiopsy forceps, cytology brushes and intraductal localisation wires has enhanced the role of mammary ductoscopy as an interventional diagnostic and therapeutic procedure.

• #3 Nipple Discharge – Clinical Methods – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK284/

  Nipple discharge is the passage of liquid material through the nipple either spontaneously or with manipulation of breast tissue. […] True discharge comes through mammary ducts out the nipple and may be noted to drain spontaneously and stain clothing, or may be elicited by segmental palpation of breast tissue. […] Differentiation of the seven basic types of nipple discharge can be determined by observation of the color of discharge, palpation of discharge to determine texture, and smear examination of discharge with Wright’s stain to see if pus or blood is present. […] Discharge from the breast is an abnormal finding except in late pregnancy or the postpartum period. There are seven basic types of nipple discharge, each of which can be associated with specific clinical conditions. […] The etiology of galactorrhea can be classified in terms of prolactin abnormalities.

• #3 Do hormones cause breast discharge? Possible causes

  https://www.medicalnewstoday.com/articles/do-hormones-cause-breast-discharge

  Green discharge may sometimes mean that there is an infection in the breast. Infections are more common following an injury to the breast or when breastfeeding or chestfeeding. […] In many cases, an infection happens when the milk duct becomes clogged. […] If the red discharge continues, however, it is advisable to see a doctor. The blood might indicate an infection or injury. […] A breast growth called a benign papilloma may also cause red discharge. […] A papilloma is not cancer, and a single papilloma does not increase the risk of breast cancer.

• #3 Common Breast Problems | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0415/p505.html

  Nipple discharge is classified as pathologic if it is spontaneous, bloody, unilateral, or associated with a breast mass. […] Pathologic discharge is generally spontaneous and unilateral, and originates from a single duct opening on a nipple. It may be bloody, serous, serosanguineous, or watery. […] If discharge is deemed pathologic, age-appropriate diagnostic imaging with mammography and/or ultrasonography is indicated. […] Studies have shown a low risk of malignancy when diagnostic studies are negative. […] The clinical utility of cytology is limited because of its high rate of false-negative findings. […] Imaging results of BI-RADS 4 or 5 require tissue biopsy. […] Duct excision, potentially localized by ultrasonography, magnetic resonance imaging, or ductography, is preferred to rule out malignancy.

• #3 MRI for assessment of pathologic nipple discharge: is it mandatory? | Egyptian Journal of Radiology and Nuclear Medicine | Full Text

  https://ejrnm.springeropen.com/articles/10.1186/s43055-019-0105-9

  Sensitivity and specificity of mammogram and ultrasound in differentiation between benign and malignant causes of pathologic nipple discharge were 71.4% and 54.2% respectively with positive predictive value of 31.2%, negative predictive value of 86.7%, and accuracy of 58.1%, while sensitivity and specificity of 100% and 83.3% with positive predictive value of 63.6%, negative predictive value of 100%, and accuracy of 87.1%. […] We can conclude that MRI add in diagnosis of different causes of pathologic nipple discharge and we believe it is mandatory in the following situations: If there is intraductal echogenicity to confirm intraductal mass lesion and exclude inspissated secretion especially in young female to preserve duct system and to differentiate between benign from suspicious lesion. […] In case of asymmetric heterogeneous breast parenchyma. […] In suspicious breast mass to determine the extent of the lesion for proper selection of patient for conservative management. […] Evaluation of residual suspicious lesion after improper operation.

Zobacz więcej