Nipple discharge
- Physiologic
o Discharge only with compression o Multiple duct involvement o Bilateral o Fluid may be clear, yellow, white or dark green
- Pathologic
o Spontaneous discharge o Bloody o Unilateral o Associated with a mass
- Physiologic/Endocrinologic Discharge
o Lactation
+ Milk produced in presence of postpartum exocrin, parathyrin, thyroxine, cortisol, growth hormone and placental lactogen + Milk secreted via stimulation of lobular and ductal epithelium by PRL + Milk ejected via stimulation of muscular walls of lactiferous ducts by oxytocin + Oxytocin and PRL secreted by pituitary in response to nipple stimulation
o Galactorrhea:
+ Milk secretion unrelated to pregnancy/lactation + Usually due to hyperprolactin state, though can be idiopathic with normal prolactin (PRL) + Can occur via:
- Chronic breast stimulation (nipple manipulation, rubbing on bra)
- Oral Contraceptive Pills (OCPs) – E can stimulate PRL secretion
- Drugs that inhibit dopamine (loss of tonic inhibition of PRL)
- Hypothalamic/pituitary disease interfering with DA release
- Prolactinoma
- Hypothyroidism
- Chronic renal failure
- Chest wall injury – healing wound stimulates PRL release
- Pathologic Discharge
o Intraductal papilloma: monotonous proliferation of papillary cells growing into the lumen
+ Fluid typically straw-colored, transparent, sticky
o Duct ectasia: distention of subareolar ducts o Fibrocystic disease: associated irritation within the duct o Papillomatosis: formation of multiple papillomas
+ Associated with small increase in breast cancer risk
o Intraductal hyperplasia: increased number of epithelial cells lining the ducts
+ Cells appear benign but associated with small increase in breast cancer risk
o Breast cancer: risk much increased if mass associated with abnormal discharge