Bloody or brown serous fluid from the nipple
Introduction
Introduction The nipple overflowing bloody or brown serous liquid is the nipple discharge characteristic of intraductal papilloma in the breast duct: about 80% of the patients present are the main symptoms of intraductal papilloma, and the patient often inadvertently finds blood on the shirt, nipple The discharge comes from the milk duct, which is often bloody or serous. It is statistically that bloody discharge accounts for 78% and serous discharge is 22%. The secretion of young women is often serous, while older women have more It is a turbid or milky liquid, which can cause bleeding or secretions to be rust-colored due to the slight compression of the fragile blood vessels of the tumor tissue. It is the most common cause of bloody milky discharge in intraductal papilloma.
Cause
Cause
The cause of the disease is still not very clear. Most scholars believe that the level of progesterone is low and the level of estrogen is high. It is the result of abnormal stimulation of estrogen. The same as the cause of cystic hyperplasia of the breast. Almost 70% of intraductal papilloma is a concomitant lesion of mammary gland hyperplasia.
Examine
an examination
Related inspection
Thoracic B-ultrasound palpation mammography X-ray examination breast ultrasound examination ovarian tumor markers
At the time of the patient's visit, the nipple is overflowing with bloody or brown serous fluid, sometimes absent and intermittent. Small bumps can be touched in the breast, which can be excreted by the squeezed liquid, and the mass shrinks or disappears. During the physical examination, a nodular mass with a diameter of about 1 cm can be found in the areola, accompanied by tenderness. When using the index finger edge, follow the direction of the milk duct, gently press from the base of the breast to the nipple, press one by one clockwise to avoid the omission of symptoms and signs. Bloody or serous fluids can be seen at the corresponding nipple delivery. According to these characteristics, clinical diagnosis is not difficult, and the above methods can be used to check the diagnosis for suspicious cases.
Diagnosis
Differential diagnosis
Differential diagnosis of nipple overflow bloody or brown serous fluid:
Cystic hyperplasia of the breast
The discharge of this disease is mostly serous or yellow-green. Clinically, the disease is periodic pain, and the pain before menstruation is obvious. The breast can be sputum and nodular, tough and tender. Breast ductography showed no filling defect. The sclerosing adenosis is characterized by the thinning of the milk duct and its branches, which are thin-lined; the cystic type is characterized by a large cystic dilatation connected with the catheter; the small duct and acinar hyperplasia are characterized by uniform ductal acinar Small cystic or beaded expansion.
2. Large catheter or ampullary inflammation
Occasionally, nipple discharge can be seen, mostly purulent, and there is a history of obvious inflammatory disease. The smear of effusion smear shows inflammatory cells, and it is not difficult to diagnose.
3. Catheter dilatation
The breast lumps of the disease are located in the areola area, with local redness, burning pain, itching and swelling. In the acute phase of the disease, there is an acute breast infection, all breast edema and nipple retraction, like inflammatory breast cancer. Some patients have nipple discharge, but the discharge is a sticky clot, non-self-contained, mostly due to extrusion. The angiography of the breast tube showed that the large catheter under the areola was significantly dilated and tortuous, and the cystic sac was severe, with no filling defect.
4. papillary carcinoma
Papillary cancer masses are mostly located in the center of the breast or deep in the areola, or in the breast tissue outside the areola area, often accompanied by nipple bloody discharge, which is clinically easily confused with intraductal papilloma. To distinguish the two, pathological examination is necessary. Microscopically, papilloma can be seen in the nipples of the glandular epithelium and myoepithelial cells and the regular arrangement of ductal cells. There is no abnormality, and nuclear fission is rare or absent, often accompanied by apocrine glandular metaplasia. The nipple branches are few, the interstitial is large and the nipple is coarse, which can be fused into a complex adenoid structure. Papillary carcinoma, on the other hand, has obvious cell abnormalities, and nuclear fission is common. There is no sclerosing adenosis in adjacent breast tissue, and a sieve-like structure can be seen in cancer cells.
5.Paget disease
Although Paget's disease originates from a large catheter at the nipple, there is an eczema-like change on the surface of the nipple, and the skin is thickened, often accompanied by symptoms such as tingling, itching, and burning sensation of the nipple. Thickened skin often has a clear boundary with normal tissues, and there are not many blood secretions, so it is easy to identify, but it must be confirmed by pathology.
