Discharge from nipple occurs in at least 40% of postmenopausal women, 55% of pregnant women, and 74% of women who had lactation during the last two years. Discharge is s generally formed from more than one duct, and color may vary from milky white, to dark green or brown. Green discoloration of discharge refers to the cholesterol content and is not associated with malignancy or infection. Multiduktalni discharge after pressure is considered to be physiological and does not require additional evaluation. However, the spontaneous discharge should be seen as pathological and requires additional diagnostic methods. Spontaneous discharge of milk, galactorrhoea, can also be caused by various disorders. Pregnancy may lead to the spontaneous discharge.
Milky discharge (galactorrhea) we see in women few months or years after birth. If there is milk or serous discharge from nipples in women who have not recently given birth or had not given birth at all , the possible cause for this could be hormonal disorder (hyperprolactinemia).
Bloody discharge is usually caused by a small benign growth in the milk ducts (intraductal papilloma). Some of these lumps can are palpable in the breast, while others can be detected with radiological examination (galactography) with the help of a contrast and mammography we can detect eventual localization of papillomas (tumors) in the milk ducts of the breast.
Malignity is associated with clear serous or bloody discharge from the nipple. Bloody discharge even minimal, should be considered suspect for cancer, until the diagnosis is excluded.
Spontaneous and persistent discharge in woman who were not breastfeeding, comes from only one duct and is serous or bloody. The incidence of cancer varies from 2% in young healthy women, and to 20% in older women with positive medical history.
Evaluation of the nipple discharge begins with physical examination of the breast. Through careful examination it can be determined which part of the areola leads to appearance of the discharge when pressured. The discharge is then sent for further analysis. Acellular discharge occurs in 25% of cases, but this does not exclude malignancy. Otherwise, if cancer cells are found in the discharge in a large number of of cases it suggest malignancy. Further steps include screening diagnostic procedures, ductography(Galactography ), ductogram (galactogram) Examination of subareolar ducts serve us for localization of intraductal lesions and as preparation for excision.
Before excision biopsy, patients with persistent discharge of any type should do a mammography.
Before excision biopsy, patients with persistent discharge of any type should do a mammography.
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