Nipple Discharge

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.