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nipple discharge
Only spontaneous discharge as distinguished from non-spontaneous discharge or discharge requiring manipulation to elicit is clinically significant.
Nipple discharge in men or bloody discharge is cancer until proven otherwise.
Bilateral nippledischarge is generally endocrine or secondary to pharmacologic agents (see galactorrhea).
Unilateral discharge should increase clinical suspicion of malignancy.
Etiology:
1) purulent discharge: Staphylococcus
2) non-bloody discharge
- duct ectasia
- carcinoma (rare)
3) bloody discharge
- intraductal papilloma
- duct ectasia
- carcinoma until proven otherwise
Clinical manifestations:
1) purulent discharge
- generally occurs during pregnancy or lactation
- fever
- erythema
- fluctuance
- purulent discharge
2) non-bloody discharge
- green, brown or yellow heme-negative discharge
- may occur in associated with breast manipulation
- may occur in relationship to menses
3) bloody discharge
- sanguineous, serosanguineous or clear heme-positive discharge from nipple
Laboratory:
1) purulent discharge
- gram-stain & culture
- biopsy of abscess wall
2) non-bloody discharge: cytology of discharge fluid
3) bloody discharge
Radiology:
- non-bloody discharge
a) mammogram in women over 30 or strong history of breast cancer
b) galactogram not useful
Management:
1) purulent discharge
- 2nd generation penicillin
- incision & drainage of abscess
2) non-bloody discharge
a) decrease manipulation of breasts
b) surgery referral
- findings on palpation
- positive mammogram
- findings on cytology of fluid
- discharge persistent & interferes with patient's life
3) bloody discharge
- excisional biopsy of any mass
- excision of offending duct for histopathology if no mass is found
- monthly breast exam for one year
- mammograms every 6 months for 1 year
Related
galactorrhea
General
discharge (d/c)
sign/symptom
References
- Saunders Manual of Medical Practice, Rakel (ed),
WB Saunders, Philadelphia, 1996, pg 384