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Nipple Discharge

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  • kalicat
    kalicat Member Posts: 2
    edited December 2019

    Currently have clear (sometimes looks goldish) nipple discharge out of my LEFT nipple, from one duct only. Blood test for thyroids and prolactin levels were both normal

    The weird thing is, in my RIGHT breast there is a lump (4 o'clock) and I am having a mammo and ultrasound done on wednesday this week to look at that.

    Could they be related, considering they're in two different breast?

  • moderators
    moderators Posts: 7,654
    edited December 2019

    kalicat, we're sorry you are here and worried, but wanted to say welcome to Breastcancer.org!

    It sounds like two different conditions but we can't really answer your question so we would definitely recommend that you see your doctor, which you did, and we're happy they sent you to mammo and ultrasound. Please, come back to let us know how it goes tomorrow!

    Best wishes,

    The Mods

  • kalicat
    kalicat Member Posts: 2
    edited December 2019

    Than you so much for the response. Here’s to hoping neither is serious. I will definitely update once I know what’s going on :)

  • hazelb712
    hazelb712 Member Posts: 9
    edited January 2020

    Hi Everyone,

    I am 30 years old, unmarried, never pregnant and never breastfeeding.

    I first saw a bloody discharge on my right breast last year on 9/22/2019, 10 days after a car accident, I went to urgent care and had a ultrasound, the result was unrevealing. The discharge stopped after that once.

    I then had another bloody discharge with manual expression on 10/13/19 and then scheduled for diagnostic mammogram on 10/16, which were still unrevealing, with a BI/RADS 3. But they did say I had a dense breast.

    A ductogram was taken on 11/7/19, they still said they were able to have a small spot discharge at 10:00 direction but no lesion/ objecting defect.

    Then I was referred to see a breast suregon on 11/14, he referred for me for MRI, which I just took 01/08/2020, I have anxiety and I am stupid enough to believe that I can dodge a bullet with my head hiding.

    The breast surgeon told me he would contact me a soon as possible once the result is available.

    After the first time, all other bloody discharges were from manual expressions. Doctor told me to stop doing that, I would try my best to restrain myself.

    I am from Asia so please pardon my English and my breast knowledge was so limited until I google/research recently. The more I visit different websites, the more scared I get.

    Feeling is mixed, I want to get to the bottom of my answer but I guess all I can do is to pray.


  • moderators
    moderators Posts: 7,654
    edited January 2020

    Welcome, hazelb! We know that waiting is horrible and it's hard not to worry about it, but just know that you are not alone here in this wonderful Community. The next few days try to keep calm and busy, to keep yourself distracted and keep your mind off the worse.

    Wishing you good luck with MRI results! Please keep us posted!

    The Mods

  • hazelb712
    hazelb712 Member Posts: 9
    edited January 2020

    Thanks for the kind response.

    I am actually in emotional turmoil right now, couldn’t go to work, cried whole night before and even during the MRI, the fear, and the uncertainty it will bring... I am really not a fighter type, but it is the first time I feel my health is out of my own hands.

    Breast surgeon kept telling me to stop squeezing the nipple, but I couldn’t control myself from doing it after the first incident, so October and December incidents were all happened after nearly torture squeezes. embarrassingly, the doctor couldn’t get anything out during the two visits, and I was so awkward and thought if I need to see a shrink instead.

  • hazelb712
    hazelb712 Member Posts: 9
    edited January 2020

    Hi DJMammo,

    I keep looking at the results from my ultrasound, mammogram, and ductogram... couldn't figure out why the contrast couldn't be injected entirely for ductogram... is it the reason why I was pushed by my breast surgeon for a MRI because all other procedures were inconclusive? I have this really wonderful breast surgeon, he actually pushed me for doing MRI twice, first time I didn't listen and second time I followed his advices.

    US BREAST RIGHT COMPLETE 10/9/2019 4:05 PM CLINICAL INDICATION: Bloody discharge for 10 days COMPARISON: None. TECHNICAL FACTORS: Real time scan of the right breast wasperformed. Four-quadrant evaluation was performed and evaluationof the retroareolar region. SONOGRAPHIC FINDINGS: RIGHT BREAST: There is no evidence of a cyst or mass. This is anegative examination. IMPRESSION:Negative examination. BI-RADS: 0 - Incomplete.

    MAMMOGRAM DIAGNOSTIC RIGHT DIGITAL 10/16/2019 12:22 PM CLINICAL INDICATION: Parenchymal asymmetry. Previous nippledischarge which has resolved COMPARISON: None. TECHNIQUE: right digital diagnostic mammogram images wereobtained. FINDINGS: The breast tissue displays scattered areas offibroglandular density. There is no new dominant mass, architectural distortion, clusteredmicrocalcifications or other mammographic evidence of malignancy. There is mild right upper outer quadrant parenchymal asymmetry IMPRESSION:Mild right upper outer quadrant parenchymal asymmetry. Likelybenign. BI-RADS: 3



    Right breast ductogram. INDICATIONS: Right breast discharge. Radiologist wore sterile attire. This included a cap and face/eyeshielding.Radiologist's hands were scrubbed with Triseptin solution. Handsallowed to completely dry. Sterile gloves were worn. The patient's skin was scrubbed with Chlorhexidene gluconate. Theskin prep agent was allowed to completely dry.Insertion site: Right nipple. TECHNIQUE: After informed consent was obtained, the skin aroundthe right breast was cleaned and draped and prepped in usualsterile fashion. Using manual technique, a small partiallydischarging duct was noted at the 10:00 position. A small amountof brownish discharge was seen. Using a sialography catheter,attempts were made to cannulate the discharging duct. Thedischarging duct was partially cannulated and the patient hadinjection of 1 cc of Omnipaque 350 and mammogram was performed. FINDINGS: There is partial extravasation of contrast outside ofthe duct and the discharging duct is only opacified forapproximately 8 to 9 mm. No obstructing lesion is seen. No fillingdefect is identified. At conclusion, results were reviewed with the patient. There areno immediate complications. IMPRESSION:1. Small discharging duct at 10:00 is identified. Using asialography catheter, the discharging duct was partiallycannulated with retrograde injection identifying 8 to 9 mm ofperiareolar duct with no suspicious filling defect identified.

  • djmammo
    djmammo Member Posts: 1,003
    edited January 2020

    hazelb712

    Papillomas are most often the cause of bloody discharge and are not visible on mammo unless calcified also they are inconsistently seen on US. From the description it sounds like the ductogram was unsuccessful. The cannula did not go all the way in and the contrast leaked out of the duct which at least in part would keep the duct from being filled with contrast. Since the discharge was brown and not red/bloody we cant be sure it was in the correct duct. The only exam left would be the MRI but often the papilloma is so small it is difficult to identify on those images. Let us know what they find.

  • hazelb712
    hazelb712 Member Posts: 9
    edited January 2020

    Hi DJMAMMO,

    thanks for your response. But when I went to the urgent care, the doctor tested that the discharge contains blood, that’s why she referred me to see a breast surgeon and ordered a ductogram. if the ductogram is unsuccessful, why the radiologist still said that “ No obstructing lesion is seen. No filling defect is identified” ? I think I am having panic attack now, couldn’t really functioning at all, crying all the time and after googling so many websites for different types of breast cancer, I also feel pain from the left breast. I heard there are a lot of cases that the bleeding breast is ok but the non-bleeding one has problem.

    One thing I should mention was I keep pressing the nipple really harsh and it’s almost a daily torture for me to see if there are more blood coming out, but when I was at the breast surgeon’s office, he couldn’t get the bloody discharge out anymore. Should I stop pressuring my nipple?

    thanks again


  • djmammo
    djmammo Member Posts: 1,003
    edited January 2020

    hazelb712

    STOP SQUEEZING. Squeezing can cause bloody discharge so it answers no questions. If you are determined to keep testing, press around the areola away from the nipple as if it were a clock face from 12, to 1, to 2 etc and note where you are pressing when the discharge occurs. Give this info to the next ultrasound tech.

    "...if the ductogram is unsuccessful, why the radiologist still said that " No obstructing lesion is seen. No filling defect is identified"

    Radiology reports are very specifically worded. It does not say there is no abnormality, it says no abnormalities were seen. There is a difference.

    There is no reason to panic at this point since, although they need to be removed, the vast majority of papillomas are benign.

    If it is upsetting you, stop Googling.

  • hazelb712
    hazelb712 Member Posts: 9
    edited January 2020

    Hi DJMammo,

    Does abnormality means cancer?

    Thanks


  • djmammo
    djmammo Member Posts: 1,003
    edited January 2020

    hazelb712

    When I use the word "abnormality" in an x-ray report I am referring to something I saw that should not be there. It is a neutral term not meaning benign or malignant but it is something that will need a work up to see which of those things it might be.

    Going back to the wording of your ductogram report: If I open the pantry and look for a box of crackers but I am unable to move things and look behind them, the best I can say is "no crackers are seen" or "there is no evidence of crackers" but at that point I cannot definitively say "there are no crackers in the pantry".

  • hazelb712
    hazelb712 Member Posts: 9
    edited January 2020

    Hi Djmammo,

    The result for MRI just came back...

    MRI BREAST BILAT WO/W CONTRAST W/CAD

    CLINICAL INDICATION: 30-year-old woman presenting for evaluation of intermittent right-sided bloody nipple discharge. No family

    history of breast cancer.

    COMPARISON: Reports from ductogram dated 10/30/2019, mammogram dated 10/16/2019, and ultrasound dated 10/9/2019. Images is not available for comparison at this time.

    TECHNICAL FACTORS: Utilizing Siemens SKYRA 3T magnet, axial T1, axial T2 STIR, axial gradient echo T1 with fat saturation pre and

    post contrast, axial VIEWS, sagittal T2 with fat saturation, axial

    diffusion were obtained. Subtraction images, 3D reconstruction

    and analysis was performed on independent CAD workstation by DynaCAD.

    IMAGING MEDICATIONS: gadobutrol (GADAVIST) 7.5 mmol/7.5 mL (1 mmol/mL) injection 6 mL

    FINDINGS:

    Overall breast composition: There is heterogenously dense fibroglandular tissue. The background parenchymal enhancement is mild and symmetric.

    Right Breast: No abnormal areas of enhancement or other MR features of malignancy are identified. No definite MRI correlate to the reported symptom of intermittent bloody right nipple discharge is identified.

    Left Breast: No abnormal areas of enhancement or other MRI features of malignancy are identified.

    Other: The axillae and visualized chest are unremarkable.

    IMPRESSION:

    Right Breast: No MRI features of malignancy. No definite MRI correlate to the reported symptoms of intermittent bloody right nipple discharge is identified, therefore management should be based on findings at clinical breast exam.

    Left Breast: No MRI features of malignancy.

    BI-RADS: Category 1 normal examination. Recommend clinical management of intermittent bloody right nipple discharge.

    COMMENT: Please note that breast MRI may not be sensitive to low grade and some intermediate grade DCIS as well as low grade tumors such as mucinous and tubular carcinomas. This examination does not evaluate the high axillary nor supraclavicular lymph nodes.

    ASSESSMENT: BIRADS 1: Negative

    RECOMMENDATION: Bilateral/Clinical Management Recommendation WITHOUT Due Date

    However, it says that “ Please note that breast MRI may not be sensitive to low grade and some intermediate grade DCIS as well as low grade tumors such as mucinous and tubular carcinomas. This examination does not evaluate the high axillary nor supraclavicular lymph nodes"

    So no one really knew what happened last September for the first time / spontaneous bleeding, if we said the other three times were because I squeezed so hard and ruptured the blood vessel... the breast surgeon told me to have a more healthier life style, lose some weights, and go back to see him immediately if I find bloody stain on my bra next time... also he said during his 20 + years of experiences, he saw a lot of situations like this, he said it was not uncommon. he also said it might be physiological(?)...So should I be assured and came back to follow up every 3 months as he said? I am surprised that my Mammo is BIRADS 3 but MRI is BIRADS 1.

    Thanks a lot for the help and for this forum. I already started making monthly recurring donations to Breast Cancer Research Foundation. Dollar amount is really small as I don't earn a lot... but I hope I can help with the research and with more people.


  • djmammo
    djmammo Member Posts: 1,003
    edited January 2020

    hazelb712

    I am surprised that my Mammo is BIRADS 3 but MRI is BIRADS 1

    The Birads number is assigned to the individual study not all your studies together as a whole.

    For diagnostic purposes, it is important that any bloody discharge you have is spontaneous and not provoked. Waiting until you see it as a spot in your clothing is good advice.

    As far as the MRI results are concerned many papillomas measure well under 1cm and may not easily seen on MRI.

  • AnnaBNana712
    AnnaBNana712 Member Posts: 2
    edited January 2020

    Hi, DJmammo et al... I had some bloody nipple discharge after I squeezed my nipple a few months ago, and the mammogram, ultrasound and MRI all came back negative (benign). I also had an MRI because my prolactin was raised and I have a prolactinoma, but that, too, came back fine. I was told to come back in 6 months (March) for follow up and another routine mammo. Around New Year's, my breasts were, again, sore, and 'full.' I am 67, not nursing. I am an endometrial cancer survivor of over 5 years, and I am thinking that perhaps this newest incident is just 'more of the same.' and not cancer..

    So this time, I squeezed it - very gently, and only '2 squeezes.' Again, blood came out. I called the breast surgeon I'd seen before, and asked if I really needed to come in, as my tests were all benign, or if it could wait until my March mammo. The nurse called me back and said I needed to come in, so I made an appointment for 1.27. This week, I went to my primary care doc for general follow-up, and she saw that I had an appointment with the breast surgeon.

    She felt my breast, and found no lump (unlike last time), and she was going to try to express the fluid. I was afraid it would hurt, so I did it for her - very gently, only once. A fat drop of dark red blood came out. It looked sort of 'brownish-red' on the paper towel she gave me, and it wasn't thick or sticky. She was clearly uncomfortable seeing the blood. I asked if it could be a papilloma. She told me she didn't know, but she was glad they moved my appointment up from March, because 'that's not normal.' She had turned to her computer when she said that. She said the surgeon would see her notes.

    This prompted more reading online (yeah, I know...but I do try to stick with good sites), and most of the articles about 'nipple discharge' and 'papilloma' said that, 'if you have to express the fluid for it to come out, don't worry about it.' Then I saw a few articles that left the door open for expressed discharge to also be cancer. I had made up my mind to ignore it, as it was 'benign' on prior tests, but now I'm not so sure. I also just read the topic above, and your reply, and you told the writer that it was important for diagnosis that the discharge was spontaneous. My question simply is, "Can expressed blood from one breast, in the center, be a sign of breast cancer, or is it most likely benign? Just trying to get as much info as i can before going for my appointment. Thanks.

  • Asuncions
    Asuncions Member Posts: 2
    edited January 2020

    Hello

    I'm 39. About two weeks noticed a clear water discharge from one of my breasts. It only happens if I squeeze the breast. But I can see that it only comes out of one duct. Went to my general dr. She did a self check and didnt notice any lumps. She ordered blood work and everything came back normal. She ordered a mammogram and an ultrasound. Getting them them next week. But I'm worried sick. Thinking the worst

  • djmammo
    djmammo Member Posts: 1,003
    edited January 2020

    AnnaBNana712

    A papilloma may not be visible on mammo or US or MRI as they may only measure a few millimeters. The gold standard for seeing them is a ductogram. Most are benign. Some are found to have some atypical or other suspicious cells in them under the microscope, but all of them are removed regardless. I have yet to see an outright intraductal cancer but thats just my experience.

  • djmammo
    djmammo Member Posts: 1,003
    edited January 2020

    Asuncions

    See my reply to AnnaBNana712 above.

  • AnnaBNana712
    AnnaBNana712 Member Posts: 2
    edited January 2020

    Thanks. I am thinking it would be benign, but as I was seen initially by a breast surgeon, at a hospital cancer center, on referral from my PCP,, was fearing they might want to do more stuff, like a ductogram. Just hoping I don't need for them to do a biopsy or surgery. Thanks for your reply.

  • Twinkle01
    Twinkle01 Member Posts: 1
    edited January 2020

    I have had some tenderness and areola spots for over a year to my right breast, it also appears more fuller recently. A few nights ago I noticed a dark brown discharge coming from one specific spot on my right nipple. It has continued since.

    I went to my GP today and have been referred to Breast Clinic. I’m 36 and my grandmother had a pre cancerous breast mass removed 10 years ago.

    I’m so scared, I haven’t noticed any masses though. So glad I found this forum

  • MelC66
    MelC66 Member Posts: 1
    edited January 2020

    Thank you so muchfor the information. I just hate the wait 😟.

  • CalicoKitty2000
    CalicoKitty2000 Member Posts: 5
    edited May 2020

    djmammo, I finally was able to get an ultrasound of my nipple area for clear/yellowish nipple discharge. They didn’t want to do it because nothing was showing on my mammogram, but with a few appointments, I was able to get them to do it. This is the report, but now my surgeon called and said it needed to be removed. Also, the office lady is calling me saying it is very important that I come in right away. I am out of town and told her I would call next week when I know when I will be back and she acted like I needed to come in right away.I don’t understand the rush. Also, is there any research around just monitoring? I’d rather not have unnecessary surgery because of risks that come with surgery and it would cost me quite a lot of money with my high deductible. But I do have quite a bit of burning and sharp what seems to be cyclical pain, and at 42, I believe I am experiencing peri menopause. I just want to the right thing by weighing the risks. (The fibroidenomas have been there for about 10 years now)


    Exam: E100764797 US BREAST LIMITED RT CLINICAL INDICATION: Nipple discharge, fibrocystic disease

    Comments: Examination of the right breast at 6:00 and 10-11 o'clock positions shows hypoechoic sharply defined lesions presumably fibroadenomas that measures 2.1 x 1.9 x 1.3 cm 1.5 x 0.7 cm. There are horizontally placed and has sharply defined margins.

    Examination of the breast at the 12:00 position, in the subareolar region shows a dilated duct that measures up to 3 mm. There is presence of a focal area of increased echogenicity in the duct suspicious for a possible intraductal papilloma.

    IMPRESSION: 1. Dilated duct in the subareolar nn region at 12:00 position containing an echogenic area in the eight suspicious for presence of an intraductal papilloma. If needed, the duct and the lesion can be needle localized under ultrasound guidance.

    BI-RADS CATEGORY 3

  • djmammo
    djmammo Member Posts: 1,003
    edited May 2020

    CalicoKitty2000

    All pappillomas are routinely removed due to a risk of malignancy. The gold standard for diagnosis is a ductogram. If there was blood flow within the intraductal finding on your study that is also a + sign for a pap. I dont see that mentioned in the report though. Debris can look like a nodule. Ask the radiologist to review the images and ask if there was blood flow in this finding on Doppler.

  • CalicoKitty2000
    CalicoKitty2000 Member Posts: 5
    edited May 2020

    Djmammo, thank you for the reply. I don’t really know how to talk to the radiologist since he never came to speak with me? Is it common to just call and ask? I logged into my electronic medical record to see the report. I do know that the tech took what seemed to be 1000 images of it. She said she was sorry she was taking so long and pushing so hard but she wanted to get really good images. I couldn’t watch the screen because it was giving me anxiety, but I did see her do the blood flow imaging, but I didn’t watch long enough to see it. Is surgery reall something that needs to be rushed? Or do I have time to let the hospitals get back to normal? I just didn’t understand her urgency when she called me. The surgeon left me a voice mail and just simply stated that it needed to be removed and he could remove the fibroidenomas at the same time.

  • djmammo
    djmammo Member Posts: 1,003
    edited May 2020

    CalicoKitty2000

    If it were me or my family I would want to know if there was blood flow in that finding as that is a hallmark of a papilloma. It sounds like they did the Doppler but it was not referenced in the report you posted. Call your doc and tell them you'd like the case reviewed and amended to include the Doppler findings. If there is no blood flow it might just be debris in the duct. They are more likely to comply if you don't schedule any procedures until that is done.

    ==========================

    This next part is my personal opinion for what its worth.

    If a good cosmetic appearance/result is important to you, consider having the procedure done by a fellowship trained breast surgeon as they usually have some cosmetic/plastic surgery training and make an effort to leave as little scarring as possible. Also ask if they feel its medically necessary to have the FA's removed as this may cause further disruption of the breast's appearance. If the FA's are causing symptoms and you want them out, that's a different story, and is your choice.

  • CalicoKitty2000
    CalicoKitty2000 Member Posts: 5
    edited May 2020

    Thank you for all the information. Would debris cause consistent nipple discharge? The first instance was late February on the first day of my period, it was spontaneous and clearish/yellowish. Then I messed around with it so much, it bled. The it cleared back up to clear/yellow. I can push down on one spot in particular on the nipple and make it consistently come out.

    I will call and ask for the Doppler imaging. Are there other less invasive tests could I ask for?

    This surgeon removed my first fibroidenoma and did a good job. I'm not as worried about appearance as I am about just being healthy.

  • djmammo
    djmammo Member Posts: 1,003
    edited May 2020

    CalicoKitty2000

    The place you pressed is where the papilloma is. Does that spot correspond to the location of the US finding? Show that spot to the surgeon. The Doppler is the blood flow eval done at the time of your ultrasound already, you just want to know what it showed.

  • CalicoKitty2000
    CalicoKitty2000 Member Posts: 5
    edited May 2020

    Yes the spot corresponds, I showed the US tech where to start based on that.

    I knew what you meant on the Doppler, I meant is there any other non-invasive tests I should ask for before considering surgery

  • stangin
    stangin Member Posts: 1
    edited June 2020

    Hi, new here. Seeking reassurance as I am not feeling it from the health people. I am almost 52. Since last quarter 2017 have had clear, one duct, nipple discharge in left breast. Have dense breasts. No blood or any other color. When rubbed between fingertips, fluid very very slightly sticky. Expels on its own as if something is full. Would not amount to a teaspoon, probably. First mammo said to watch, follow up in 6 mos. Next one I asked technician what this is... saw a doctor. No answers but she ran me thru a digital mammo?, ductogram, MRI, ultrasound, and ultrasound biopsy / titanium marker. Was told by technician it was benign but not what it was, what was going on. Doc said could do surgery, but may lose feeling in nipple. Like if I wanted surgery??? Didn't explain what was happening or going on - I asked. Not one to jump on having surgery. Heard or read lesion in medical reports. Heard hormonal related?? The rest of the report is not in "English" to me. Skipped 6 mos followup in late 2018 - changing insurance and money issues after having all of those other tests. Thought for a minute the biopsy created scar tissue to close up duct and leak. Covid happened on year since last mammo. Haven't scheduled any yet. Discharge did slow down or pause entirely during Covid timeframe. Recently noticeable again but not as much as before the tests. After reading thru here, still confused. Want to gain knowledge before I go back in for mammo...... as it is close to 3 years since it started. Thanks in advance.

  • Tuc
    Tuc Member Posts: 1
    edited November 2020

    Hello,

    I have been experiencing unilateral spontaneous serous/bloody discharge for a few years. I joined this breast cancer.org site in March/2017. I have (breaking rules)posted a picture of the problem breast. I will not try to post picture again. I do hope that my breast health concerns will be found to be benign. The latest primary( non-profit) asked me a few months ago if my discharge had been seen under a microscope. I told them no. In April or May of this year I developed a hard swollen parotid gland in my neck--- one side only. I had a diagnostic mammogram and ultrasound in Nov. I got a letter in mail stating there was an abnormality seen and that I needed a biopsy.( My past imaging pointed out dense breast tissue, fibroadenoma microcalci., Hypoechoic--" what is that") can't recall anything about bi rad. I have been feeling very unwell for a few years. I had a hysterectomy in 2012-- fibroids(bled Alot)I am experiencing shortness of breath, cough /rash that won't resolve after medication. I have experienced other symptoms. I will recall to new primary Dec 3. Wish me luck--- that after about 13 yrs of symptoms ramping up that I will receive the correct diagnosis. My mother died of colon cancer 61 yrs old. I will be 59 in summer. Saying all this-- because---there is so much about what I am going through that so far-- no answerz.

    Thank you for listening,

    Tuc.