Nipple discharge

Clinical feature of pathological and physiological nipple discharge.

-Bloody or serous? ( 피가 있나 )

-spontaneous or non-spontaneous? ( 유방에 자극을 줘서 표출한것인가 )

-Single duct or multiple duct? ( 표출했을때 분비물이 여러 구멍에서 나오는가 )

Features of pathological nipple discharge:
Bloody, spontaneous, single duct discharge

Mem tip:
A: Once, again. You're reaching the end of the year without a girlfriend.
B: I'm "bloody spontaenolsly single" man.

Investigations in nipple discharge:
Subareolar U/S or Mammogram -> if normal then ductogram

if any abnormality of one or more of the above -> biopsy

if all normal chance of malignancy less than 3 %. Then follow up pt.

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"Nipple discharge alone is not usually a sign of breast cancer. Occult malignancy is rare. A period of ‘watchful waiting’ may prevent

patients undergoing unnecessary surgery.
Patients who underwent operation for nipple discharge at a district general hospital (population 460,000) over a 3-year period were

included. All had normal clinical, radiological and cytological examination. Operation and histopathology reports were reviewed.
Eighty-six patients underwent operation for nipple discharge.
Two patients had occult malignancy – DCIS (1) and LCIS (1). No invasive cancer was found."

-<Ann R Coll Surg Engl. 2007 March; 89(2): 124–126.>

"While bloody discharge is more classically associated with a neoplasm, it may also be related to an intra-ductal papilloma."

-<BMJ Best Practice>

"Paget's disease always involvees the nipple and only involves areola as secondary event,
whereas eczema involves the areola and only secondarily affects the nipple."

-<Garden - Surgery textbook>