Topic: Nipple Discharge

Forum: Not Diagnosed But Worried — For those who are experiencing symptoms or received concerning test results, but haven't been diagnosed with breast cancer.

Posted on: Jul 29, 2017 04:43AM

Posted on: Jul 29, 2017 04:43AM

djmammo wrote:

from the American College of Radiology

"Nipple discharge is a common complaint that leads patients to breast imaging evaluation. At least 80% of women will experience at least 1 episode of nipple discharge during their reproductive years. Nipple discharge is the third most common breast complaint after breast pain and breast mass, with a prevalence of 4.8% to 7.4%, and accounts for 5% of all breast symptoms. It is categorized as physiologic or pathologic.

Pathologic nipple discharge tends to be unilateral, from a single duct orifice, spontaneous, and serous or bloodstained. Nipple discharge that exhibits any one of these features may be considered pathologic.

Physiologic nipple discharge tends to be bilateral, from multiple duct orifices, and white, green, or yellow in color. In a study by Goskel et al, nonspontaneous nipple discharge, which was frequently colored or milky, was differentiated from spontaneous nipple discharge, which was considered pathologic. In this study, none of the patients with nonspontaneous nipple discharge developed cancer on follow-up examination. In another study by Bahl et al, no in situ or invasive cancers were found in patients whose nipple discharge did not exhibit any of the pathologic features. If patient history and physical examinations demonstrate physiologic nipple discharge and routine screening mammography is up to date, no radiologic investigation is needed.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Feb 15, 2019 01:28PM djmammo wrote:

Hopingitsbenign

In addition to the list you made, small bubbles introduced into the duct during the ductogram present as filling defects but they are usually recognizable as bubbles.

Your history is not classic for an intraductal papilloma. The most convincing history is spontaneous unilateral blood from only one duct on several occasions. One finds blood in the bra at the end of the day for example. If the blood comes from squeezing, it doesn't count since that is trauma. Likewise the mammogram compression is technically trauma and there is a small chance that caused the bleeding. Was blood identified coming from one duct when they did the ductogram? Thats how we know which duct to image otherwise its just a guess.

Also, in my experience having done many many ductograms over the years, there have been two times when the ductogram appeared to be grossly abnormal with multiple fixed filling defects present, all of which had completely disappeared when the ductogram was repeated on the day of surgery. No explanation for either case.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Feb 15, 2019 03:20PM Hopingitsbenign wrote:

Thank you for your reply. They had to really try, but after a lot of squeezing they were able to get blood from the duct to identify it for the ductogram. They also put some of it on slides which came back benign. You said that a papilloma usually causes spontaneous bleeding, is it the same for DCIS? And just to confirm, you believe it is possible for the things I listed to cause filling defects: Ectasia, fibrocystic changes, debris, or even little blood clots from the bleed? That would put my mind at ease a bit.

One last question... I have a lot of bruising and a hematoma from the biopsy... I’m an easy bleeder. Will the hematoma interfere with the MRI? It’s getting much better using warm compresses.

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Feb 15, 2019 08:03PM - edited Feb 15, 2019 08:04PM by Motheroftwo36

I have biopsy on Monday but the lump beside my nipple (that didn't show up on mammogram or ultrasound except for calcifications) when I press down on the lump a yellow discharge comes out. What does this sound like? If it didn't show up on scans? The discharge always comes out at the same spot on nipple and it doesn't take much pressure

Dx 2/5/2019, DCIS, Right, 3cm, Stage 0, Grade 3, 1/2 nodes, ER+/PR+ Surgery 4/17/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Feb 16, 2019 07:17AM djmammo wrote:

Hopingitsbenign

Bloody nipple discharge is not a key feature of DCIS. It is usually found initially as calcifications on mammo.

For me personally, squeezing the nipple to produce bloody discharge just confuses things as the blood can be from the trauma of squeezing and not from a papilloma.

Yes debris can cause filling defects.

Before your MRI make sure they know you have one before they scan you so the person reading the scan knows ahead of time as it will be visible.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Feb 16, 2019 07:25AM djmammo wrote:

Motheroftwo36

This is more of a clinical than imaging topic since it does not show up on imaging. I would ask the doc when you go for your biopsy.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Feb 21, 2019 04:36PM - edited Feb 21, 2019 04:38PM by Hopingitsbenign

I had my MRI today, the doctor called tonight and said everything looks great! No sign of whatever caused the ductogram filling defects 2 weeks ago. She said the same thing you said, DJ, that the trauma of the mammogram compression combined with my inflamed ducts probably caused the bleeding. I haven't bled since that day, but I am to call her if I do. She also wants me to come in 4 months for a follow up mammogram and ultrasound, and then in 6 months for another mri... just to check for any post biopsy changes. I'm not sure what that means but she said it's routine? Needless to say, I'm very relieved tonight. It's been a scary 2 weeks. I'm grateful for this site and especially DJ for your help.

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Feb 22, 2019 07:30AM djmammo wrote:

Hopingitsbenign

Yes its quite routine, and you're welcome. :-)

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Jun 3, 2019 02:34PM Mari1217 wrote:

Hi everyone , I am new to this forum and this is my first post. I am a 35 years old female.I have a 12 year old son and my husband passed away from colon cancer 7 years ago. 5 years ago I started having right breast nipple discharge that looks clear transparent yellow. I got an ultrasound and they also checked the nipple discharge which all came back normal. I continue to have the nipple discharge and still have it only when I squeeze a certain part of the areola part of my nipple but every time I do the discharge is there. Now aside from the discharge I have a tingling , electric shock like pain on the side of the breast that is leaking. It kind of feels like when milk is coming down or like when mastitis is develop.. I feel feverish and check my temp this morning and it was 99.6 by breast continues leaking when I squeeze the areolar part and the yellow clear discharge is coming only from one duct. I have lost my insurance and I am really scared , mainly scare because my son already lost his dad and I am all he has left. I am in the process of getting new insurance and will see a doctor soon but does anyone know if this can be a strong signed of breast cancer. I havent told anyone about this and I cry all the time because of it and starting to get depress.Thank you.

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Jun 3, 2019 04:42PM CGLion wrote:

Mari, I am so sorry you are under this stress also.  I am 36 and in the process of waiting to see a breast specialist/surgeon.  I too have that pain on the side of my breast that is affected.  My discharge I first noticed in my bra.  I then gently squeezed and saw clear fluid coming from 2 ducts.  The fluid was clear with just a bit of cloudiness.  After a few weeks I was again noticed discharge in my bra.  This time when I checked the discharge it came from only one duct and was completely clear, no sign of color at all.  It was also sticky, which I found odd.  After a few more weeks I noticed a dark brown discharge in my bra twice.  I again checked my nipple and that same duct now had dark brown sticky discharge.  When I went in to see the doctor they told me they were concerned about the discharge due to it coming spontaneously in my bra.  They tested the discharge and it tested positive for blood.  My diagnostic mammogram and ultrasound were negative for any abnormalities.  After the negative diagnostic imaging my doctor consulted a breast specialist and she requested to see me.  They told me most of the time my symptoms are caused by a benign papilloma in the duct, though it can also be a sign of cancer.  My doctor said on the phone if the discharge had not been spontaneous in my bra or contained blood they would be satisfied after the negative imaging.  I am also considered high risk due to my family history, so any breast changes I have are thoroughly looked into.

I am glad you plan to get it checked out!  Based on my conversations with my doctor, concerning discharge is spontaneous (not squeezed) and clear or bloody.  I would still 100% get it evaluated by a doctor, but I hope you can take a deep breath and know your symptoms are not the typical ones associated with cancer, at least according to my conversations with my doctor.  

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Jun 5, 2019 03:07PM - edited Jun 5, 2019 03:14PM by Kelseytonsfeldt0311

I have a concern to add. This happened out of nowhere this morning. I got out of the shower and noticed blood on my hand, couldn't figure out where it was coming from and then I realized it was my nipple. It is one tiny spot on left side of my nipple on left breast. It was leaking red red blood pretty good. I was squeezing it a bit to see what was going on with me I saw a tiny bit of almost reminded me ornament breast milk (I nursed two babies for a year each, but the last was 3 years ago or more now). There was barely any of what seemed like milk and it came from the center (different area than blood). I now notice a pain feeling to the left of the spot the blood came from on the breast part. It feels a Lot like when I was nursing and would have a clogged milk duct. Freaking out!

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