eMedicine Specialties > Radiology > Breast

Breast, Nipple Discharge Evaluation: Multimedia

Author: Edward Azavedo, MD, PhD, Director of Clinical Breast Imaging Services, Associate Professor, Department of Radiology, Karolinska University Hospital, Sweden
Contributor Information and Disclosures

Updated: Oct 26, 2009

Multimedia

A 42-year-old woman with serous discharge from he...Media file 1: A 42-year-old woman with serous discharge from her left nipple. Ductography reveals contrast-agent filling defects approximately 1.5 cm from her nipple. Cytology of smears of secreted fluid revealed malignant epithelial cells. Histopathology after surgery revealed intraductal carcinoma.
A 42-year-old woman with serous discharge from he...

A 42-year-old woman with serous discharge from her left nipple. Ductography reveals contrast-agent filling defects approximately 1.5 cm from her nipple. Cytology of smears of secreted fluid revealed malignant epithelial cells. Histopathology after surgery revealed intraductal carcinoma.

Close-up view of ductogram in Image above.Media file 2: Close-up view of ductogram in Image above.
Close-up view of ductogram in Image above.

Close-up view of ductogram in Image above.

A 47-year-old woman with serous discharge from he...Media file 3: A 47-year-old woman with serous discharge from her right nipple. Ductography reveals a contrast-agent filling defect approximately 3 cm from the nipple. Cytology revealed normal epithelial cells and cell debris. Histopathology after surgery revealed a solitary, lobulated intraductal papilloma.
A 47-year-old woman with serous discharge from he...

A 47-year-old woman with serous discharge from her right nipple. Ductography reveals a contrast-agent filling defect approximately 3 cm from the nipple. Cytology revealed normal epithelial cells and cell debris. Histopathology after surgery revealed a solitary, lobulated intraductal papilloma.

Close-up view of the ductogram in Image above.Media file 4: Close-up view of the ductogram in Image above.
Close-up view of the ductogram in Image above.

Close-up view of the ductogram in Image above.

A 50-year-old woman with serous discharge from he...Media file 5: A 50-year-old woman with serous discharge from her right nipple. Ductography reveals contrast-agent filling defect approximately 4 cm from her nipple. Cytology of the smears from her nipple discharge revealed normal epithelial cells. Histopathology after surgery revealed a solitary intraductal papilloma in a cystic lesion.
A 50-year-old woman with serous discharge from he...

A 50-year-old woman with serous discharge from her right nipple. Ductography reveals contrast-agent filling defect approximately 4 cm from her nipple. Cytology of the smears from her nipple discharge revealed normal epithelial cells. Histopathology after surgery revealed a solitary intraductal papilloma in a cystic lesion.

Close-up view of the ductogram in Image above.Media file 6: Close-up view of the ductogram in Image above.
Close-up view of the ductogram in Image above.

Close-up view of the ductogram in Image above.

A 48-year-old woman with serous discharge from he...Media file 7: A 48-year-old woman with serous discharge from her right nipple. Ductography reveals contrast-agent filling defects approximately 1.5 cm from the nipple, extending to a depth of approximately 2.5 cm. Cytology demonstrated epithelial cells arranged in papillary fragments. Histopathology after surgery revealed extensive involvement of intraductal papillomas.
A 48-year-old woman with serous discharge from he...

A 48-year-old woman with serous discharge from her right nipple. Ductography reveals contrast-agent filling defects approximately 1.5 cm from the nipple, extending to a depth of approximately 2.5 cm. Cytology demonstrated epithelial cells arranged in papillary fragments. Histopathology after surgery revealed extensive involvement of intraductal papillomas.

Close-up view of the ductogram in Image above.Media file 8: Close-up view of the ductogram in Image above.
Close-up view of the ductogram in Image above.

Close-up view of the ductogram in Image above.

A 45-year-old woman with serosanguineous discharg...Media file 9: A 45-year-old woman with serosanguineous discharge from her right nipple presented with no other clinical symptoms. Mammography was unrevealing. Ultrasonography revealed a 3-mm dilated duct with an intraluminal lesion (arrow) located close to the nipple. Cytology revealed epithelial cell fragments in a papillary formation. Histopathology confirmed the presence of a papilloma.
A 45-year-old woman with serosanguineous discharg...

A 45-year-old woman with serosanguineous discharge from her right nipple presented with no other clinical symptoms. Mammography was unrevealing. Ultrasonography revealed a 3-mm dilated duct with an intraluminal lesion (arrow) located close to the nipple. Cytology revealed epithelial cell fragments in a papillary formation. Histopathology confirmed the presence of a papilloma.

Additional sonogram obtained in the same patient ...Media file 10: Additional sonogram obtained in the same patient as in Image above.
Additional sonogram obtained in the same patient ...

Additional sonogram obtained in the same patient as in Image above.

More on Breast, Nipple Discharge Evaluation

Overview: Breast, Nipple Discharge Evaluation
Imaging: Breast, Nipple Discharge Evaluation
Follow-up: Breast, Nipple Discharge Evaluation
Multimedia: Breast, Nipple Discharge Evaluation
References
Further Reading

References

  1. Kapenhas-Valdes E, Feldman SM, Boolbol SK. The Role of Mammary Ductoscopy in Breast Cancer: a Review of the Literature. Ann Surg Oncol. Oct 8 2008;[Medline].

  2. Kapenhas-Valdes E, Feldman SM, Cohen JM, Boolbol SK. Mammary ductoscopy for evaluation of nipple discharge. Ann Surg Oncol. Oct 2008;15(10):2720-7. [Medline].

  3. Vaughan A, Crowe JP, Brainard J, Dawson A, Kim J, Dietz JR. Mammary ductoscopy and ductal washings for the evaluation of patients with pathologic nipple discharge. Breast J. May-Jun 2009;15(3):254-60. [Medline].

  4. Tokuda Y, Kuriyama K, Nakamoto A, Choi S, Yutani K, Kunitomi Y, et al. Evaluation of suspicious nipple discharge by magnetic resonance mammography based on breast imaging reporting and data system magnetic resonance imaging descriptors. J Comput Assist Tomogr. Jan-Feb 2009;33(1):58-62. [Medline].

  5. Carty NJ, Mudan SS, Ravichandran D, et al. Prospective study of outcome in women presenting with nipple discharge. Ann R Coll Surg Engl. Nov 1994;76(6):387-9. [Medline].

  6. Leis HP Jr. Management of nipple discharge. World J Surg. Nov-Dec 1989;13(6):736-42. [Medline].

  7. Sauter ER, Klein-Szanto A, Macgibbon B, Ehya H. Nipple aspirate fluid and ductoscopy to detect breast cancer. Diagn Cytopathol. Sep 30 2009;[Medline].

  8. Dooley WC. Breast ductoscopy and the evolution of the intra-ductal approach to breast cancer. Breast J. Sep-Oct 2009;15 Suppl 1:S90-4. [Medline].

  9. Hünerbein M, Raubach M, Gebauer B, et al. Ductoscopy and intraductal vacuum assisted biopsy in women with pathologic nipple discharge. Breast Cancer Res Treat. Oct 2006;99(3):301-7. [Medline].

  10. Makita M, Akiyama F, Gomi N, et al. Endoscopic and histologic findings of intraductal lesions presenting with nipple discharge. Breast J. Sep-Oct 2006;12(5 Suppl 2):S210-7. [Medline].

  11. Sardanelli F, Giuseppetti GM, Canavese G, Cataliotti L, Corcione S, Cossu E, et al. Indications for breast magnetic resonance imaging. Consensus Document "Attualità in Senologia", Florence 2007. Radiol Med. Oct 16 2008;[Medline].

  12. Mortellaro VE, Marshall J, Harms SE, Hochwald SN, Copeland EM 3rd, Grobmyer SR. Breast MR for the evaluation of occult nipple discharge. Am Surg. Aug 2008;74(8):739-42. [Medline].

  13. Van Goethem M, Verslegers I, Biltjes I, Hufkens G, Parizel PM. Role of MRI of the breast in the evaluation of the symptomatic patient. Curr Opin Obstet Gynecol. Feb 2009;21(1):74-9. [Medline].

  14. Reiner CS, Helbich TH, Rudas M, Ponhold L, Riedl CC, Kropf N, et al. Can galactography-guided stereotactic, 11-gauge, vacuum-assisted breast biopsy of intraductal lesions serve as an alternative to surgical biopsy?. Eur Radiol. Jun 30 2009;[Medline].

  15. Arnold GJ, Neiheisel MB. A comprehensive approach to evaluating nipple discharge. Nurse Pract. Jul 1997;22(7):96-102, 105-11. [Medline].

  16. Baker KS, Davey DD, Stelling CB. Ductal abnormalities detected with galactography: frequency of adequate excisional biopsy. AJR Am J Roentgenol. Apr 1994;162(4):821-4. [Medline].

  17. Ballesio L, Maggi C, Savelli S, Angeletti M, De Felice C, Meggiorini ML, et al. Role of breast magnetic resonance imaging (MRI) in patients with unilateral nipple discharge: preliminary study. Radiol Med. Mar 2008;113(2):249-64. [Medline].

  18. Böber E, Ozer E, Akgür F, et al. Bilateral breast masses and bloody nipple discharge in a two year-old boy. J Pediatr Endocrinol Metab. May-Jun 1996;9(3):419-21. [Medline].

  19. Nicholson BT, Harvey JA, Cohen MA. Nipple-areolar complex: normal anatomy and benign and malignant processes. Radiographics. Mar-Apr 2009;29(2):509-23. [Medline].

  20. Okazaki A, Hirata K, Okazaki M, et al. Nipple discharge disorders: current diagnostic management and the role of fiber-ductoscopy. Eur Radiol. 1999;9(4):583-90. [Medline].

  21. Okazaki A, Okazaki M, Hirata K, et al. Relationship between cytologic results and the extent of intraductal spread in nonpalpable breast cancers with nipple discharge. Tumor Res. 1996;31:89-97.

  22. Okazaki A, Okazaki M, Hirata K, et al. [Progress of ductoscopy of the breast]. Nippon Geka Gakkai Zasshi. May 1996;97(5):357-62. [Medline].

  23. Orel SG, Dougherty CS, Reynolds C, et al. MR imaging in patients with nipple discharge: initial experience. Radiology. Jul 2000;216(1):248-54. [Medline][Full Text].

  24. Paterok EM, Rosenthal H, Säbel M. Nipple discharge and abnormal galactogram. Results of a long-term study (1964-1990). Eur J Obstet Gynecol Reprod Biol. Aug 1993;50(3):227-34. [Medline].

  25. Räber G, Schneider HP. [Nipple discharge: differential diagnostic considerations]. Ther Umsch. May 1993;50(5):286-90. [Medline].

  26. Valdes EK, Boolbol SK, Cohen JM, et al. Clinical experience with mammary ductoscopy. Ann Surg Oncol. Jul 29 2006;[Epub ahead of print]. [Medline].

  27. Woods ER, Helvie MA, Ikeda DM, et al. Solitary breast papilloma: comparison of mammographic, galactographic, and pathologic findings. AJR Am J Roentgenol. Sep 1992;159(3):487-91. [Medline].

  28. Wunderlich M. [Mild, moderate and severe dysplasia in exfoliative cytological studies of breast secretions in connection with use of oral contraceptives]. Zentralbl Gynakol. 1994;116(11):622-7. [Medline].

Further Reading

Related eMedicine topics

Breast Cancer (Oncology)

Breast Cancer (Plastic Surgery)

Breast Cancer Evaluation

Breast Cancer, Mammography

Breast Cancer, Ultrasonography

Clinical guidelines

Diagnosis of breast disease.
Institute for Clinical Systems Improvement - Private Nonprofit Organization. 1994 Jan (revised 2008 Jan). 47 pages. NGC:006317

Common breast problems.
University of Michigan Health System - Academic Institution. 2007 Oct. 10 pages. NGC:006199

Keywords

breast nipple discharge, , breast discharge, nipple discharge, ductography, galactography, nipple discharge, galactorrhea, fiber-ductoscopy, intraductal carcinoma, intraductal papilloma, carcinoma, papilloma, cystic lesion, intraductal growth of the ductal epithelium, hyperplasia, micropapillary proliferation, solitary papillomas, ductal carcinoma, in situ ductal carcinoma, invasive ductal carcinoma, duct ectasia, periductal galactophoritis, galactography, ductography

Contributor Information and Disclosures

Author

Edward Azavedo, MD, PhD, Director of Clinical Breast Imaging Services, Associate Professor, Department of Radiology, Karolinska University Hospital, Sweden
Edward Azavedo, MD, PhD is a member of the following medical societies: Swedish Medical Association and Swedish Society of Medicine
Disclosure: Nothing to disclose.

Medical Editor

John M Lewin, MD, Section Chief, Breast Imaging, Diversified Radiology of Colorado, PC; Associate Clinical Professor, Department of Preventative Medicine and Biometrics, University of Colorado Denver
John M Lewin, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, Radiological Society of North America, and Society of Breast Imaging
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Edward Azavedo, MD, PhD, Director of Clinical Breast Imaging Services, Associate Professor, Department of Radiology, Karolinska University Hospital, Sweden
Edward Azavedo, MD, PhD is a member of the following medical societies: Swedish Medical Association and Swedish Society of Medicine
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Consulting Radiologist, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.