nipple discharge may occur in a male or in a non-lactating female and is the symptom caused by...
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What should be performed for a patient who has nipple discharge.By: Dr. Seyed Reza Samsamshariat
Note: The present slides can be used if the reference is mentioned.
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Nipple discharge may occur in a male or in a non-lactating female and is the symptom caused by several situations. In males there is usually an endocrine abnormality and in females the etiologies are more variable.
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By the way the nipple discharge represents an abnormal symptom and the underlying
disease should be diagnosed.
Different kinds of nipple dischare
Frankly bloody Bloody Purulent
Serous( yellow &
clear )Watery Milky
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The causes of nipple discharge in women
Malignancy
Breast carcinoma
Benign lesions
Papilloma Ductectasia
Endocrine disturbance
s
Pituitary adenoma
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•Fine needle aspiration biopsy
•Open biopsy
There is a mass in the breast exam
•Fine needle aspiration biopsy
•Open biopsy
A mass is found in
mamography
•Cytologic examination of the discharge
•Measurement of prolactin level in serum
There is not any
evidence of tumor
What is the next step for evaluation of nipple discharge in a non-lactating
woman?
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How is the discharge of the nipple collected for cytopathologic
examination?With special pump With pressure on
areola
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The benign lesions causing nipple discharge :
Ductectasia Papilloma Tuberculo
sis
Others(as fungal infections)
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The prevalence of malignancy when nipple discharge is seen
• 0.83%
• 0.13%
• 3.96%
• 0.16%
Serous dischar
ge
Bloody dischar
ge
Purulent
discharge
Milky dischar
ge
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The breast cancers which induce nipple discharge:
Ductal carcinoma
Paget’s disease
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• 47%Diagnosis of cancer
• 45%Suspicious cancer
• 8%Wrong
diagnosis as a benign lesion
The sensitivity of the cytopathologic examination of the nipple discharge.
The Cytopathologic results of the nipple discharges were as below in women with breast carcinoma:
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Except the cytopatologic examination of the nipple discharge the values of the other tests ( as biochemistry or microbiology) are
Inappreciable. Variation of biochemical parameters in non-malignant
and malignant discharge
Parameters Non-malignant malignant CEA (µg mL-1) 5.0 10.0 LDH (µ L-1) 50.0
120.0 Protein (mg dL-1) 20.0 10.0 Cholesterol (mg dL-1) 80.0 40.0 Triglyceride (mg dL-1) 45.0 20.0 Occult blood (%) 25.0 Nil
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Cytopathology of the nipple secretion ( and touch imprint preparations of the biopsy samples) can predict the
patient’s survival who has breast cancer. The presence of the sex chromatin ( arrows ) in 20% or more of the malignant cells which are seen in the cythopathologic or touch imprint samples means a favorable behavior of tumor regardless of tumor grade or stage at the time of biopsy.
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References:
1• Koss. Leopold G. Diagnostic
Cytology. 4th edition. Philadelphia. J.B. Lippincott Company. 1992. Volume 2. 1221-1232
2•www.allamericanpatriots.com/news_topics/tuberculosis•http://health.allrefer.com/health/tinea-cruris-fungus.html
• http://t1.gstatic.com/images?q=tbn:ANd9GcQupYvuGiY56UkPWALWDrOe2cCeXRtC6uBPx_lt3qs2V54Bv6Aj
3 •INTERNATIONAL JOURNAL OF AGRICULTURE & BIOLOGY•1560-8530/2001/03-2-195-196•http://www.ijab.org
4 • http://www.medscape.org/viewarticle/713539_7