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

In a series of 8,703 breast operations, nipple discharge was the presenting symptom in 7.4% of cases. It is even more common in the office and clinic since many discharges can be treated medically. To be significant, a discharge should be true, spontaneous, persistent, and nonlactational. Of the 7 basic types, i.e., milky, multicolored and sticky, purulent, clear (watery), yellow (serous), pink (serosanguineous), and bloody (sanguineous), the last 4 are the surgically significant ones. Of the 586 patients operated on for one of these types of discharge, the majority had a benign etiology, i.e., intraductal papillomata (48.1%) and fibrocystic changes (32.9%), but 14.3% were due to cancer and another 7.3% to precancerous mastopathy. In the 84 patients with cancers, the false-negative rate for mammography was 9.5% and was 17.8% for cytology. There was no palpable mass in 13.1% of patients. There was an increasing likelihood of the discharge being due to cancer when the discharge was, in order of increasing frequency, yellow, pink, bloody, or watery, when it was accompanied by a lump, when it was unilateral and from a single duct, when the mammogram or galactogram and the cytology were positive, and when the patient was over 50 years of age. Milky discharges are usually treated medically unless they are due to a pituitary adenoma. If the cause cannot be found and eradicated, bromocriptine is the drug of choice. Multicolored sticky discharges are also treated medically, chiefly by nipple hygiene, except when advanced. Purulent discharges are treated with appropriate antibiotics but abscesses need drainage and a biopsy of the wall. Except in women under 35 years of age or in those anxious to have children, surgically significant discharges are treated by central duct excision. Good cosmetic results can be obtained with careful technique and the danger of a recurrent discharge is eliminated.
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PMID:Management of nipple discharge. 269 28

A follow-up study of 105 patients with microdochectomy for nipple discharge during the ten year period from 1965 to 1974 revealed that cancer developed in seven of the cases. The histology of the seven cases consisted of atypical hyperplasia in the terminal duct or lobular neoplasia. Accordingly, patients with either of the above histological findings were regarded as high risks for the development of breast cancer. Twenty such high risk patients were selected from 1850 patients biopsied for benign breast disease during the eleven year period from 1975 to 1985. This follow-up study revealed that five of the 13 patients (38%) with atypical hyperplasia in the terminal duct and two of the seven patients (28%) with lobular neoplasia developed breast cancer. Microphotocytometry using TV image analyzed system showed that the mean +/- standard deviation of the nuclear area and the absorbance were, respectively, 46.79 +/- 2.84 and 0.42 +/- 0.01 in fibroadenoma, 62.93 +/- 12.15 and 0.32 +/- 0.02 in precancerous lesion and 86.16 +/- 14.38 and 0.44 +/- 0.07 in breast cancer.
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PMID:[Follow-up study of precancerous lesions of the breast]. 273 58

Microdochectomy has been the accepted treatment for single-duct nipple discharge. Review of 97 consecutive patients undergoing microdochectomy between 1980 and 1987 revealed a total of eight patients with ductal carcinoma in situ. All of these had pre-operative mammography, results of which were highly suspicious of malignancy in six patients. Tiny foci of ductal carcinoma in situ were found in the two patients with normal mammograms. We suggest an expectant policy in cases where the mammogram is normal, omitting routine microdochectomy.
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PMID:Microdochectomy for single-duct discharge from the nipple. 284 57

The authors report 5 cases of in situ intraductal breast carcinoma (IDC) revealed or complicated by a clinical inflammatory syndrome. These cases showed some common features with other IDCs, such as mammographic signs and histologic forms of epitheliamatous proliferation, but were also characterized by clinical inflammatory signs different from those of rapidly developing "inflammatory" cancer, frequent nipple discharge, frequent positive results in bacteriologic examinations of nipple discharge and the role of cytologic studies of discharge in determining a definite diagnosis of carcinoma. Some hypotheses as to etiology are also discussed.
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PMID:[An unusual clinical form of intraductal breast carcinoma: an inflammatory syndrome. Apropos of 5 cases]. 285 96

Four hundred and ten women with serous or bleeding nipple discharge without palpable mass were treated by surgery in the Curie Institute between 1970 and 1984. The cancer rate in this group was 12.2 per cent. Galactography was of anatomical interest as it showed the canal at the origin of the discharge. Malignant cells were observed at cytological examination in only 17 per cent of intragalactophoric cancers. Surgical excision is necessary if the nipple discharge is uniporous and easily reproducible by areolar pressure, particularly in the post-menopausal period when the frequency of cancer is highest (17.7 per cent).
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PMID:[Nipple discharge without palpable tumor. Experience of the Institut Curie from 1970 to 1984]. 296 63

A retrospective analysis of 52 patients with intraductal carcinoma or ductal carcinoma in situ (DCIS) and 30 patients with microinvasive DCIS was performed. All patients but one were treated by mastectomy. The average follow-up was 5 1/2 years. The clinical presentation of the patients having DCIS only included the presence of a mass in 33% (17/52), nipple discharge in 34% (18/52), or suspicious mammographic finding in 33% (17/52), whereas in those patients having DCIS with microinvasion, the initial presenting symptom was a mass in 63% (19/30) of the patients, nipple discharge in 13% (4/30), and mammographic finding in 23% (7/30). The presence of axillary lymph node metastasis was identified in one of the 52 patients with DCIS and six (20%) of the 30 patients with DCIS and microinvasion. Associated carcinomas in the mastectomy specimens of patients with DCIS were as follows: DCIS, 18% (9/51); lobular carcinoma in situ, 13% (7/51); Paget's disease, 8% (4/51); and invasive carcinoma, 2% (1/51). In the 30 patients with microinvasion, DCIS was found in other quadrants in 23% (7/51) of the patients; lobular carcinoma in situ, 7% (2/51); Paget's disease, 13% (4/51); and invasive carcinoma, 7% (2/51). There was one death due to cancer in the patients with DCIS only. Of the patients diagnosed as having DCIS with microinvasion, seven patients have developed metastasis and four have died of the disease.
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PMID:Intraductal carcinoma. Analysis of presentation, pathologic findings, and outcome of disease. 302 76

A case of squamous cell breast carcinoma is presented. The patient was 31-year old woman with a complaint of a right breast mass. The tumor was found to measure 7.0 x 8.0 cm without any inflammatory signs, and was associated with a bloody nipple discharge. Lymph-node metastases of the ipsilateral axillary and supraclavicular nodes were noted, and metastasis to the fifth lumbar vertebrae also was seen. Because of a diagnosis graded T4bN3M1, stage IV, an extended radical mastectomy was performed. Histologically, the major portion of this tumor consisted of a squamous cell carcinoma with a minimal component of adenocarcinoma and accompanying keratinization. The patient died of this cancer 5 months after the operation.
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PMID:[A case of squamous cell carcinoma of the breast]. 328 78

From January 1982 to March 1987, an exfoliative cytological examination of abnormal nipple discharge was carried out on 790 patients. Of 22 histologically confirmed mammary carcinomas, 7 cases (31.8%) were diagnosed as positive by conventional cytologic techniques. By using the concentration method, in which the nipple secretion was collected in a series of testings that lasted 3 to 5 days and stored in a glass tube containing a fixative, the diagnostic accuracy was seen to increase significantly and 9 out of 15 malignant cases (60.0%) were accurately diagnosed as having cancer. Moreover, all 5 cases without any palpable mass were found to be positive by the smears made by this procedure.
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PMID:[A cytologic diagnosis of breast secretions--application of cytology to the mass survey of breast cancer]. 334 95

The authors, in a retrospective study, have looked at the clinical and paraclinical parameters that suggest that a cancer may be present when there is a nipple discharge. By using logistic regression on these criteria a model has been able to be constructed with four variables (bloody discharge, and associated palpable tumour, a suspicious mammographic appearance and atypical or proliferating cells in cytology). The probability of a cancer being present varies between three per thousand when none of the four variables are present to 99.1% when all four are present. A first outline of the therapy that can be used is suggested.
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PMID:[Cancer and nipple discharge]. 335 Dec 5

The cytodiagnostic significance of the clinical patterns (types and sites) of nipple discharges was studied in 5,305 cytologically examined discharges from 3,687 women in a consecutive series of 50,181 self-referred women in whom 1,062 breast cancers were detected. The clinical patterns were correlated with cytologic and histologic results in both the whole series and in 119 biopsied cases, and the relative risk of association with breast cancer was calculated for each pattern. As a whole, aside from the pattern, cases with nipple discharges showed a higher relative risk (48.5) than did asymptomatic cases, but a bloody nipple discharge was by far more frequently associated with cancer than was any other pattern, being present in 70% of the cancer cases and in almost all cancer cases with suspicious cytologic findings in the discharge smear. The presence of a nipple discharge, being associated with a higher risk of breast cancer, is an indication for a careful physical examination; systematic cytologic examination should be limited only to bloody discharges. Since cancer is rare in cases with nonbloody discharges and is difficult to detect in cytologic smears of such discharges, systematic cytologic examination of all nipple discharges would not be cost-effective.
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PMID:Significance of nipple discharge clinical patterns in the selection of cases for cytologic examination. 345 80


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