Nipple Discharge

by Richard Mitchell, MD, PhD

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    00:01 Welcome.

    00:02 In this talk, we're going to discuss nipple discharge.

    00:05 As part of the series on breast pathology.

    00:08 And nipple discharge is just the passage of liquid or the ability to express liquid from the breast through the nipple.

    00:15 There are several types the general consistency and color of the different liquids that can be expressed, will suggest etiology.

    00:25 If it's milky, that suggests that there are fat globules.

    00:29 And this is either in breastfeeding or galactorrhea due to a primary pituitary tumor or some medications.

    00:37 If it's yellow, or purulent, that suggests that neutrophils are present, and that we are dealing with an infection.

    00:43 If it's clear, or green, or brown, suggesting a little bit of blood, a thin discharge with varying amounts of blood is consistent with fibrocystic change a benign variation.

    00:56 And then if it's bloody, it can suggest an intraductal papilloma, most frequently, but may also suggest that there might be an underlying malignancy.

    01:05 So let's go through each of the different kinds of discharges in turn and then we'll return to a final kind of summary.

    01:12 Milky discharge is obviously normal in pregnancy and breastfeeding, but can occur with certain medications such as oral contraceptives, antidepressants, antipsychotics.

    01:22 It may also suggest a prolactinoma, a primary pituitary tumor, which is causing galactorrhea.

    01:29 A yellow or purulent discharge is suggestive of mastitis an inflammation of the breast.

    01:35 There will be a separate talk in the breast pathology series just about mastitis.

    01:40 And it may suggest a breast abscess, most commonly centrally but it may also be peripheral.

    01:47 Again, clear brown or green discharge is mostly due to cystic material within a fibrocystic change within the breast.

    01:56 And there will be a whole separate talk on fibrocystic change within the breast series.

    02:01 And then bloody discharge.

    02:03 Fortunately, most of the time it is due to benign things like intraductal papilloma or mammary duct ectasia, but can be suggestive of breast cancer.

    02:13 So a bloody discharge in particular, raises our antennas and makes us want to make sure that we are not dealing with malignancy.

    02:22 In evaluating nipple discharge, you want to get a good history from your patient about color and consistency and maybe be able to express it yourself to evaluate it and send it off for microscopy to look underneath a microscope and see what is present yourself.

    02:38 If it's unilateral versus bilateral, that also gives us some information.

    02:42 Bilateral will typically suggest a diffuse process, such as breastfeeding, or galactorrhea.

    02:52 Unilateral can be fibrocystic change or a mass.

    02:55 Associated masses, so with bilateral milky discharge, that tends to be a diffuse breast enlargement, obviously.

    03:03 Bloody unilateral discharge with a mass is going to be malignancy, in many cases.

    03:08 Evaluation of the nipple discharge, a good history, the cytology of the fluid itself.

    03:14 You want to do mammography to evaluate for particular masses.

    03:18 Alternatively, you may do an ultrasound if it's predominantly cystic in nature, and for anything that's vaguely suspicious, do a biopsy send it off to your friendly neighborhood pathologist.

    03:29 And with that, we've covered the essentials of a breast discharge.

    About the Lecture

    The lecture Nipple Discharge by Richard Mitchell, MD, PhD is from the course Breast Pathology.

    Included Quiz Questions

    1. Infection
    2. Fibrocystic disease
    3. Breastfeeding
    4. Galactorrhea
    5. Mammary duct ectasia
    1. Intraductal papilloma
    2. Fibrocystic disease
    3. Mastitis
    4. Pregnancy
    5. Galactorrhea

    Author of lecture Nipple Discharge

     Richard Mitchell, MD, PhD

    Richard Mitchell, MD, PhD

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