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.
- 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
- Often improves without treatment.