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.