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Query: UMLS:C0849787 (nipple discharge)
 518 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Breast cancer is the most common malignant neoplasm in women, and 6% will develop it during their normal life expectancy. There is a group who have a high risk of developing breast cancer. The recent improvement in cure rates seems to be jue chiefly to earlier diagnosis rather than to improved methods of therapy. The physician, by careful periodic breast examinations and by the judicious use of diagnostic aids such as mammography and thermography, especially in the high risk group, has a golden opportunity to pick up cancer in a localized stage where the prognosis for cure with appropriate therapy is excellent. A tentative diagnosis of breast cancer (Table XI) can be made with a fair degree of accuracy by taking a careful history, utilizing and combining available statistics about the frequency, median age, characteristic symptom complexes of the common breast lesions and factors related to a high mammary carcinoma risk, and by a systematic and thorough breast examination supplemented with diagnostic aids when appropriate. However, biopsy and histologic examination is mandatory in all patients with a) true, three dimentional, dominant lumps even if diagnostic aids are negative except for cysts which can be safely aspirated under controlled conditions; b) suspicious lesions found by diagnostic aids even though there are no clinical findings; c) serous, serosanguineous, bloody, or watery nipple discharge; and d) other signs of cancer, i.e. eczema of the nipple, axillary adenopathy, etc., in order to determine with absolute accuracy whether the lesion is benign or malignant.
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PMID:Clinical diagnosis of breast cancer. 16 76

The pathologic diagnosis of 282 consecutive breast lesions seen in 255 black patients over a 3-year period (January 1975-December 1977) at Harlem Hospital Center were reviewed and analyzed. The most common lesion was fibroadenoma, accounting for 34.7% of all lesions and 48% of benign breast lesions, followed by carcinoma (28%) and fibrocystic disease (17%). Other major benign breast lesions in order of frequency were intraductal papilloma, sclerosing adenosis, chronic mastitis, and fat necrosis. One each of the following rare lesions was observed: papillomatosis, ducatal ectasia, cystosarcoma phylloides, and granular cell tumor. Multiple lesions were found in 1 or both breasts in 15% of all benign breast disease cases, with fibroadenoma being the most common lesion. 94% of the patients presented with a breast mass, 5% with nipple discharge, 5% with pain, and 2% with a history of trauma to the breast. The lesions varied in size from 0.5-10 cm, and had been present for a few days to 20 years before medical treatment was sought. The upper quadrant of the breast was the most common site for lesions. Peak age incidence for all benign breast lesions was 20-35 years; for fibroadenoma, peak age incidence was 16-25 years and for fibrocystic disease, 40-50 years. The surgical literature shows that in a predominantly white population, peak age of incidence for benign lesions is 30-49 years; this disparity in age distribution may be due to the high percentage of adolescent patients with fibroadenoma in the Harlem Hospital series. Median age of patients with breast carcinoma in this series is 61 years. 24 patients (13.7%) with benign breast disease had taken oral contraceptives before the breast biopsies were performed. However, the study population is to small and follow-up time to short to draw any conclusion regarding the relation of oral contraceptive use to the subsequent development of breast cancer. This study shows that compared to the white population, fibroadenoma is more frequent than cancer in black women while cancer is more frequent than fibroadenoma in white women.
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PMID:Analysis of benign breast lesions in blacks. 45 72

Data of the examination of 143 patients with limited forms of cancer and benign tumors of the mammary gland have been analysed. Mention is made of certain difficulties in establishing the differential diagnosis of such tumors based only on the clinical symptoms. The tumorigenesis may be established by using some accessory diagnostic methods: a cytological test of the tumor punctate and the breast nipple discharge, as well as a sectorial resection of the involved mammary gland portion with an express histological analysis of the preparation. Mammography aids to precisely determine the tumor size. Clinically, the true proliferation of the tumor is difficult to recognize, but it may be recognized after radical mastectomy and histological investigation of the whole preparation.
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PMID:[Clinical symptoms of cancer and precancerous diseases of the breast]. 69 21

A review of the histories of 1059 patients with breast problems seen consecutively in office consultation revealed an incidence of breast cancer of 13%. Patients over 50 years of age or whose mother or sister had had breast cancer had a substantially greater likelihood of having breast cancer. The finding of the problem on routine examination, a family history of breast cancer in a relative other than the mother or a sister, or prominent breast pain or nipple discharge made the diagnosis of cancer less likely. Menstrual status, a history of previous benign disease, nulliparity, current hormone therapy and duration of symptoms did not help identify the patient likely to have breast cancer. Much time could be saved for both doctor and patient in taking the history from patients with breast disorders. Only the patient's age and the history of the mother and sisters with regard to breast cancer will help identify the "high-risk" patient. Other historical findings are either valueless or should be used to reassure these usually anxious women.
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PMID:Value of the history in the office diagnosis of breast cancer. 86 61

Nipple discharge, especially the blood-stained type, is regarded as an important symptom in breast disease. In many reports the high incidence of malignancy is stressed and an active surgical approach has often been recommended. In this series of 80 women with nipple discharge the type of secretion and the result of exfoliative cytology were evaluated. Three women had cancer but the nipple discharge was important for the diagnosis in only one case. Six women had papilloma and in all the nipple discharge was essential for the diagnosis. Fibroadenosis and duct ectasia were the most common diagnoses. The blood-stained secretion was due to fibroadenosis in about half of the cases. No cancer was found in 46 women with a serous secretion. When a tumour is present nipple discharge is of little importance for the diagnosis and treatment. In the absence of a tumour and when exfoliative cytology gives no suspicion of cancer and no atypical cells or papillomatous clusters are present, an expectant attitude towards surgery seems satisfactory. With such an approach many surgical biopsies prove unnecessary, but a prerequisite is an organized follow-up.
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PMID:On the significance of nipple discharge in the diagnosis of breast disease. 103 57

As a result of health education programs that have stressed self-examination and the importance of early diagnosis and treatment, less than 5 percent of breast lesions seen in clinical practice today are malignant. Nevertheless, breast cancer is the leading cause of deaths due to cancer in women and the second most common breast lesion. Chronic cystic mastitis, the most common breast lesion seen in women, can often be treated conservatively by aspirating the cystic fluid. Close follow-up is necessary so that if carcinoma develops, it can be treated early. Carcinoma is unpredictable but not hopeless. Although controversy exists regarding treatment, radical mastectomy is still the preferred treatment in most cases. Other breast diseases include adenofibroma, a common lesion requiring excisional biopsy for positive diagnosis; nipple discharge, which should be carefully examined cytologically; and relatively rare breast lesions, including intraductal papilloma, adenosis, traumatic fat necrosis, and cystosarcoma phylloides.
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PMID:Diseases of the breast. 116 67

Estrogen and progesterone, although of a synthetic type in contraceptive pills, play a major role in the development, growth and function of the breasts. There is no statistically valid evidence to indicate that the widespread use of estrogens for contraceptive purposes and for the menopausal syndrome has increased the incidence of benign, premalignant or malignant breast lesions. However, if a cancer is present in a woman's breast, estrogen can increase its rate of growth. Furthermore, while the effect of exogenous estrogen administration to the population as a whole may be null, there may be a subgroup in which their use may have different effects, with a possible increase in breast cancer incidence in nulliparous or late parous women and a decrease in those with early parity. Patients with a dominant lump, suspicious diagnostic aid changes, serous, serosanguineous, bloody or watery nipple discharge or other adverse breast changes should not receive exogenous estrogens unless the lesion is found to be completely benign on biopsy. Even then, patients with gross cystic disease will continue to have these changes as long as estrogens are administered, and so they should avoid the use of estrogens. Patients in the high rist group for developing breast cancer should be cautioned about the potential dangers of the use of estrogens, whether in birth control pills or in other preparations for the menopause, and if they use them, these patients should be followed carefully by breast self-examinations, periodic examinations by physicians and diagnostic aids. Finally, serious consideration should be given to the inclusion of estriol in all estrogen preparations for its impeding or blocking effect against the potential carcinogenic properties of estradiol and estrone and to the addition of progesterone for its estrogen-antagonistic effect.
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PMID:The pill and the breast. 125 43

Ductal carcinoma in situ of the breast is very rare in men, representing 0-7% of all male breast cancers. We analysed 15 cases from a retrospective multicentric series of 404 patients (3.7%). It occurs earlier than infiltrating carcinoma (mean age: 55 years), sometimes before 40 years of age. The main symptoms are bloody nipple discharge or retro areolar mass. Modified radical mastectomy constitutes the basic treatment. Lower axillary dissection can eventually be indicated in comedocarcinoma or in tumors larger than 25 mm. The main histologic subgroup is papillary carcinoma, pure or intracystic. As is the case in women, local recurrence, invasive or not, rarely occurs. Theoretically, the cure rate approaches 100%. However, as in all cases of breast cancer in men, an important number of deaths due to secondary cancer or intercurrent disease have been noted. Until now, no clear etiologic factors have been found.
Bull Cancer 1992
PMID:[Breast cancer in males: a study of 15 cases of pure ductal carcinoma in situ]. 133 68

Statistics from the Connecticut Tumor Registry from 1979 to 1988 were examined, and individual medical records from 1979 to 1983 were also reviewed. Three hundred nineteen medical records were available for review, documenting 220 cases of ductal carcinoma in situ and 102 cases of lobular carcinoma in situ. In 1979, there were 33 new cases of ductal carcinoma in situ reported to the Connecticut Tumor Registry, representing 1.8% of all breast cancers. There has been a yearly increase in ductal carcinoma in situ, with 200 new cases, or 7.4% of all breast cancers, reported in 1988. Forty-eight (22%) of 217 patients with ductal carcinoma in situ had bilateral breast involvement with ductal carcinoma in situ or an invasive breast cancer. Ten (83%) of 12 mastectomy specimens from patients with ductal carcinoma in situ who presented with nipple discharge demonstrated residual tumor, suggesting a more diffuse involvement. Two of the three reported recurrences involved nipple discharge. Thirty-seven (16.8%) of the 220 patients with ductal carcinoma in situ and six (5.9%) of the 102 patients with lobular carcinoma in situ were diagnosed as having another unrelated cancer. Ongoing clinical trials will direct optimum therapy for patients increasingly diagnosed as having ductal carcinoma in situ.
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PMID:Ten-year follow-up of breast carcinoma in situ in Connecticut. 136 82

This study was aimed at determining the role of high-frequency (7.5 MHz) US combined with cytology in the diagnosis of complex breast nodules (complex cysts--cystic tumors). The study population included 60 patients presenting with complex breast nodules selected on the basis of US patterns among 3,000 cases. All patients were also submitted to US-guided fine-needle aspiration biopsy (FNAB). Cytology of nipple discharge was always performed when discharge was present (15 cases), mammography was performed in 50 cases and pneumocystography in 10. US allowed the identification of the lesion in all patients and the diagnosis of nature in 73%; with FNAB the figure reached 96.7%. Mammography identified the lesion in 95% of patients, but failed to reveal the complex nature of the nodule. In a small number of cases mammography proved to be a useful complementary tool demonstrating malignant features not recognizable on US images. On the contrary, pneumocystography yielded no further information with respect to US. Diagnostic control was obtained by means of surgery in 30 patients and of clinical-US follow-up in the extant 30 cases. On the basis of their US features the lesions were classified into two groups: I) nodules having a mainly liquid component--i.e., hemorrhagic, septic, multilocular cysts, papillary cystadenoma; II) nodules having a mainly solid component--i.e., solitary intraductal papilloma, intracystic carcinoma, mixed carcinoma, phylloid adenoma, sarcoma. As to the former group, US proved reliable in making a diagnosis in the cases with typical hemorrhagic, septic and multilocular cysts. In the atypical cases, FNAB of the solid component of the nodule was necessary to differentiate irregular clots, thick septa or inflammatory thickening from different conditions. As to the latter group, FNAB of the solid component and/or mammography proved useful in making a diagnosis, even though to this aim US revealed peculiar patterns which were highly suggestive. In our experience, combined US and FNAB are of basic importance in the diagnosis of breast lesions, thus replacing pneumocystography which has been widely employed so far. As regards mammography, its role seems limited to pointing out the peculiar characters of malignancy which could not be demonstrated otherwise.
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PMID:[The diagnostic imaging of complex breast nodules]. 141 Jun 63


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