Category Archives: Nipple Discharge

When is a galactogram done?

Breast Cancer, Breast Imaging, Intraductal Papilloma, Mammary Duct Ectasia, Nipple Discharge, Papillary Carcinoma of the Breast

Galactogram = Ductogram

Usually done for spontaneous unilateral bloody nipple discharge.  Sometimes it is done for serous (clear) discharge.

90% of the women with unilateral bloody nipple discharge = benign intraductal papilloma, a solitary discrete intraductal mass.  However if multiple masses are discovered in the duct, the more likely the diagnosis will be ductal carcinoma in situ (DCIS).

Regardless of single mass or multiple mass, a surgical biopsy (excisional biopsy) is required for diagnosis.  Methylene blue dye can assist the surgeon in removing the duct in the OR.

Facts about Phyllodes tumors

Breast Cancer, Breast Disease, Cystosarcoma phyllodes, Nipple Discharge

Phyllodes tumors of the breast:

  • Not easily distinguished from fibroadenomas on physical exam and even challenging on radiological studies
  • Rarely involve the nipple-areolar complex
  • Most are in the upper outer quadrant
  • Central phyllodes tumors may present with bloody nipple discharge or nipple retraction
  • Few have been reported in men
  • Primary goal for treatment of phyllodes tumor is to achieve a wide negative margin with a rim of at least 1 cm of uninvolved tissue.
  • Total mastectomy may be required for lesions too big to achieve a 1 cm margin without markedly deforming the breast or for repeated local recurrences

 

Nipple Discharge

Breast Cancer, Ductal Carcinoma In Situ, Intraductal Papilloma, Mammary Duct Ectasia, Nipple Discharge, Papillary Carcinoma of the Breast

Unilateral Nipple Discharge – spontaneous and persistent

  • Associated with a increased risk of carcinoma.
  • Can be clear, serous, serosanguinous or bloody
  • Nipple aspirate cytology isn’t popular as a diagnostic
  • Most common etiologies are intraductal papilloma and mammary duct ectasia
  • Doesn’t matter what’s found on radiology, open surgical biopsy is preferred
  • Directed duct excision plus excision of the surround area after ductogram.  Rule out papillary carcinoma of the breast.
  • Central duct excision (non-directed duct excision) is not as accurate.
  • If the lesion is deep, radiologist may help with needle localization with excision
  • DCIS = Ductal Carcinoma In Situ is the malignancy most commolny found in intraductal lesions with pathological nipple discharge.
  • Papillary carcinoma of the breast is a subset of DCIS.

Intraductal Papilloma

  • Benign
  • Most common cause of bloody nipple discharge
  • A single intraductal papilloma doesn’t increase the risk of breast cancer, but multiple papillomas does increase the risk slightly.

Mammary duct ectasia

  • Milk ducts beneath the nipple become dilated, thickened, and filled with fluid and thus have some discharge
  • Benign
  • Often improves without treatment.