Nipple discharge may be serous (yellow), mucinous (clear and watery), milky, bloody, purulent, multicolored and sticky or bloody-serous (pink). It can be spontaneous or occur only in response to breast manipulation.
Nipple discharge is common in women who are not pregnant or breastfeeding, especially in the reproductive age. Also in postmenopausal women nipple discharge is not necessarily abnormal; However, it is always abnormal in men. Nipple discharge may be serous (yellow), mucinous (clear and watery), milky, bloody, purulent, multicolored and sticky or bloody-serous (pink). It can be spontaneous or occur only in response to breast manipulation. Pathophysiology nipple discharge may be breast milk or an exudate, which can be produced due to various causes. The production of breast milk in pregnant and non-lactating women (galactorrhea) is mostly attributed to increased levels of prolactin, which stimulates the glandular tissue of the breast. However, some patients develop a galactorrhoea with increased prolactin levels. Most etiology is the cause of nipple discharge benign (see table: causes of nipple discharge). In only <10% of cases of malignancy (usually intraductal or invasive ductal carcinoma) is the cause. The rest is on benign ductal changes (eg. B. intraductal papilloma, ductal ectasia of the breast, fibrocystic breast disease), endocrine diseases or abscesses or infections of the chest. Of these disorders intraductal papilloma is probably the most common cause; but it is also the most common cause of a bloody secretion without mass in the breast. Endocrine causes usually require increased prolactin levels, which have numerous causes. Causes of nipple discharge cause suspicious findings Diagnostic approach Benign breast diseases intraductal papilloma (most common cause) Unilateral bloody (or occult blood positive) or bloody serous secretion investigation as mass breast Ductal ectasia chest Unilateral or frequently sided bloody (or Hämokkult- positive), bloody-serous or multicolor (purulent gray od He milky) secretion investigation as mass breast fibrocystic changes a mass, often rubbery and sensitive to pain, usually in premenopausal women may serous, green or white discharge if necessary other masses in the history of investigation like lesion of the breast abscess or infection acute onset of pain, tenderness or redness If abscess painful lesion and possibly purulent discharge Clinical examination secretion itself does not improve with treatment, examination as mass chest breast cancer Most intraductal carcinoma or invasive ductal carcinoma, if necessary palpable lesions, skin lesions or lymphadenopathy sometimes bloody or occult blood positive secretion If Suspicion as with mass chest hyperprolactinemia many causes (see Table: Causes of hyperprolactinemia) Frequently bilateral, milky not bloody secretion of multiple ducts and without lesions may menstrual disorders or amenorrhea In pituitary lesion may mark a CNS lesion (visual field changes, headache) or other endocrinopathy prolactin, TSH, medication review MRI of the head in an elevated prolactin or TSH TSH = thyroid-stimulating hormone clarification history The history of the current disease should include: Whether the current discharge is unilateral or bilateral what its color is How long did it whether it is spontaneous or only with nipple stimulation occurs whether a lesion or chest pain present are. In reviewing the organ systems should be sought, which indicate possible causes, including the following for symptoms: fever mastitis or breast abscess cold intolerance, constipation or weight gain: hypothyroidism amenorrhea, infertility, headaches or blurred vision: pituitary tumor ascites or jaundice: liver disease, the history should possible causes of hyperprolactinemia include, including chronic renal failure, pregnancy, liver disease and thyroid disorders; also previous infertility, hypertension, depression, Still phases and malignant tumors as well as the menstrual patterns are queried. Physicians should ask for specific drugs which can release prolactin, such as oral contraceptives, anti-hypertensives (z. B. methyldopa, reserpine, verapamil), H2 antagonists (eg., Cimetidine, ranitidine), opioids, and dopamine D2 antagonists ( z. B. many psychiatric drugs, including phenothiazines, tricyclic antidepressants) .Körperliche investigation in the clinical studies are the breasts at the center. In the examination of the breasts is paid to symmetry, indentations of the skin, redness, swelling, color changes of the nipples and the skin as well as crusting, ulceration or retraction of the nipple. The breasts are sampled on masses and the underarm area or on Supraklavikulargegend lymphadenopathy. If there is no spontaneous secretion, is attempted by systematic scanning of the area around the nipple to stimulate secretion and indentifizieren any particular location that is associated with the secretion. Under bright light and using magnifying glass can be judged whether the secretion of one or several milk ducts austritt.Warnzeichen Certain findings are particularly important: Spontaneous secretion age ? 40 years Unilateral secretion Bloody or occult blood positive secretion Palpable mass Male gender interpretation of the findings important distinguishing features are whether a lesion is present, whether the discharge relates to one or both breasts Whether the outflow bloody (including guaiac-positive) is a mass exists, a malignant tumor disease should be considered. Since the beginning rarely both breasts or more milk ducts are affected by a malignant tumor disease, is at bilateral occult blood negative secretion suspected endocrine disorder. However, if the secretion is occult blood positive, even if it is on both sides, a malignant tumor disease should be considered. In mass in the chest, a bloody (or occult blood positive) secretion. spontaneous, unilateral secretion or anomaly in hydrolysis with mammogram or ultrasound, a follow-up examination by an experienced surgeon in breast disease is required. Other suspicious findings see Table: Causes of Mamillensekretion.Untersuchungen case of suspected endocrine cause the following parameters are determined: prolactin thyroid-stimulating hormone (TSH) In occult blood positive secretion following test is performed: cytology With palpable mass clarification takes place as with a mass of the chest, which usually begins with sonography Sometimes be aspirated cystic appearing lesions and clarified solid masses or all after aspiration remaining residues by mammography and radiologically controlled biopsy. If no mass is present, but a malignant tumor disease is suspected for other reasons or other tests unclear results have shown is carried out as follows: mammography Pathological findings are clarified by radiologically controlled biopsy. If mammography and sonography not identify the source and the secretion is spontaneous and comes from a single milk duct of a breast or a Duktographie (contrast medium-induced imaging of the milk duct) can be carried out. Treatment Treatment depends on the cause. If the cause benign and secretion is persistent and annoying, the terminal milk duct can be removed on an outpatient basis. Summary secretion from the nipple is usually benign. A both negative occult blood secretion of a plurality of ducts is usually benign and has an endocrine cause. Spontaneous, unilateral secretion requires diagnostic tests; this type of secretion may be cancer, especially if these bloody (or guaiac-positive). In mass in the breast, a bloody (or occult blood positive) secretion or anomaly in hydrolysis with mammogram or ultrasound, a follow-up examination by an experienced in breast disease surgeon is required.