NIPPLE DISCHARGE

Question 1

General considerations of nipple discharge

Answer 1

(1) Characteristics of nipple discharge need to be evaluated by history and
physical examination
(a) Some characteristics include
1) Serous - most likely benign fibrocystic changes (FCC) like duct ectasia
2) Bloody- more likely neoplasticpapilloma or carcinoma
a) If there is bloody discharge, the bloody duct (and mass if present) should be excised
3) Associated mass- more likely neoplastic
4) Unilateral- neoplastic or non-neoplastic
5) Bilateral- most likely non neoplastic

Question 2

Related history of nipple discharge (TRPP)

Answer 2

1) Taking any hormones
2) Relation to menses
3) Pre vs postmenopausal
4) Persistence vs intermittent occurrence

Question 3

Common causes (in the non-lactating woman) of nipple discharge

Answer 3

(1) Duct ectasia; type of FCC
(a) Spontaneous, unilateral, serous or serosanguineous discharge from a single duct
(2) Intraductal papilloma; type of FCC
(a) Spontaneous, unilateral, serous or serosanguineous discharge from a single duct
(3) Carcinoma
(a) Bloody discharge

Question 4

Other causes of nipple discharge

Milky discharge in the non-lactating woman may occur from

Answer 4

hyperprolatinemia

(a) serum prolactin levels to rule out pituitary tumor
(b) TSH to rule out hypothyroidism
(c) Antipsychotic drugs can cause elevated prolactin levels which lead to lactation

Question 5

Other causes of nipple discharge

Oral contraceptives or estrogen replacement

Answer 5

May cause clear, serous or milky discharge

Question 6

Other causes of nipple discharge

Breast abscess

Answer 6

(a) Purulent discharge

(b) Requires removal of abscess

Question 7

Laboratory findings of nipple discharge

Answer 7

(1) Cytological evaluation of discharge
(a) May identify malignant cells
(b) Negative finding does not rule out malignancy

Question 8

Imaging of nipple discharge

Answer 8

(1) Mammography and ultrasound
(a) When localized is not possible
(b) In the absence of a palpable mass

Question 9

Treatment of nipple discharge

Answer 9

(1) Would discuss with your supervising physician and refer to a breast clinic,
OB/GYN, or General surgery depending on what type of discharge is present
(2) Dependent on underlying cause
(3) Most discharge is benign

Question 10

Follow up of nipple discharge

Answer 10

(1) Patient should be reexamined every 3 to 4 months for a year if workup does
not show malignancy