Impact of Prolactin and Estrogen on Nipple Secretions: Their Significance
Pathologic nipple discharge, a fluid coming out of the nipples in women who aren't pregnant or breastfeeding, can be a cause for concern. This article aims to shed light on the common causes, diagnosis, and treatment of this condition.
Common Causes of Pathologic Nipple Discharge
Pathologic nipple discharge can stem from various benign conditions, such as mammary duct ectasia, intraductal papilloma, and fibroepithelial stromal polyps. It can also indicate more serious conditions like Paget disease and breast cancer.
- Mammary duct ectasia: A benign condition where milk ducts beneath the nipple become swollen and clogged, causing breast tenderness, redness, and sticky or thick nipple discharge.
- Intraductal papilloma: A benign tumor inside a milk duct that often causes unilateral, bloody or serous nipple discharge.
- Paget disease of the breast: A rare type of breast cancer involving the nipple and areola, presenting with erythematous, scaly rash, pruritus, nipple retraction, ulceration, and often blood-tinged nipple discharge.
- Mastitis and breast infections: Infections like mastitis can cause yellowish nipple discharge along with fever, tenderness, and swelling.
- Breast abscess: A localized infection causing painful lump and pus drainage, sometimes involving nipple discharge.
Diagnosis and Treatment
The diagnosis and treatment of pathologic nipple discharge depend on the underlying cause. For instance, mammary duct ectasia is usually managed conservatively, while intraductal papillomas require surgical excision. Paget disease is treated primarily with surgery, often followed by radiation. Mastitis and breast abscesses are treated with antibiotics and, in some cases, drainage.
When to Worry
Pathologic nipple discharge is more likely if it's spontaneous, bloody, from one duct, in women over 40, associated with a lump or skin changes, and if the patient has a medication history, missed periods, or symptoms of hormonal imbalances. Every case of non-lactational nipple discharge deserves a full clinical evaluation, starting with history-taking and physical examination.
Physiological Discharge and Galactorrhea
Physiological discharge, or galactorrhea, is not linked to pregnancy or breastfeeding and can be caused by medications, pituitary tumors, hormonal imbalances, or other medical issues. Treatment for hormone-related nipple discharge depends on its cause.
Screening and Imaging
For pathologic discharge, breast imaging is essential to check for any abnormalities in the ducts or breast tissue. Women 30-39 years should first undergo a mammogram, then ultrasound if needed. Women ≥40 years should undergo diagnostic mammography plus breast ultrasound for further diagnostic investigations.
In conclusion, pathologic nipple discharge warrants careful evaluation for benign conditions such as duct ectasia and infections, as well as malignant causes like Paget disease. Treatment ranges from conservative management and antibiotics to surgical intervention based on diagnosis confirmed by clinical, imaging, and biopsy assessments.
[1] Breast Cancer Now. (2021). Nipple discharge. Retrieved from https://www.breastcancernow.org/information-support/treatment/diagnosis/diagnostic-tests/nipple-discharge
[2] American Cancer Society. (2021). Paget disease of the breast. Retrieved from https://www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis/types-of-breast-cancer/paget-disease-of-the-breast.html
[3] National Cancer Institute. (2021). Intraductal papilloma. Retrieved from https://www.cancer.gov/types/breast/hp/intraductal-papilloma-treatment-pdq
[4] Mayo Clinic. (2021). Paget disease of the breast. Retrieved from https://www.mayoclinic.org/diseases-conditions/paget-disease-of-the-breast/symptoms-causes/syc-20375740
[5] UpToDate. (2021). Nipple discharge. Retrieved from https://www.uptodate.com/contents/nipple-discharge-in-women?search=nipple%20discharge&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
- Pathologic nipple discharge is a concern for women who aren't pregnant or breastfeeding.
- This condition can stem from various benign conditions such as mammary duct ectasia, intraductal papilloma, and fibroepithelial stromal polyps.
- It can also indicate more serious conditions like Paget disease and breast cancer.
- Mammary duct ectasia occurs when milk ducts beneath the nipple become swollen and clogged.
- Intraductal papilloma is a benign tumor inside a milk duct that often causes unilateral, bloody or serous nipple discharge.
- Paget disease is a rare type of breast cancer involving the nipple and areola.
- Mastitis and breast infections can cause yellowish nipple discharge, fever, tenderness, and swelling.
- A breast abscess can cause a painful lump and pus drainage, sometimes involving nipple discharge.
- The diagnosis and treatment of pathologic nipple discharge depend on the underlying cause.
- For instance, mammary duct ectasia is usually managed conservatively.
- Intraductal papillomas require surgical excision.
- Paget disease is treated primarily with surgery, often followed by radiation.
- Mastitis and breast abscesses are treated with antibiotics and, in some cases, drainage.
- Pathologic nipple discharge is more likely if it's spontaneous, bloody, from one duct, in women over 40.
- It's also more concerning if associated with a lump or skin changes, medication history, missed periods, or symptoms of hormonal imbalances.
- Every case of non-lactational nipple discharge deserves a full clinical evaluation.
- Physiological discharge, or galactorrhea, is not linked to pregnancy or breastfeeding.
- It can be caused by medications, pituitary tumors, hormonal imbalances, or other medical issues.
- Treatment for hormone-related nipple discharge depends on its cause.
- Screening and imaging are essential for pathologic discharge.
- Women 30-39 years should first undergo a mammogram, then ultrasound if needed.
- Women ≥40 years should undergo diagnostic mammography plus breast ultrasound for further diagnostic investigations.
- In conclusion, pathologic nipple discharge warrants careful evaluation.
- This includes assessing benign conditions, infections, and malignant causes.
- Treatment ranges from conservative management and antibiotics to surgical intervention.
- Diagnostic tests and imaging, such as mammograms and ultrasounds, are crucial.
- Breast Cancer Now provides resources on nipple discharge.
- The American Cancer Society offers information on Paget disease of the breast.
- The National Cancer Institute, Mayo Clinic, UpToDate, and other resources also offer valuable insights on intraductal papilloma, Paget disease, and nipple discharge.
