A 25 year old lady presents with spontaneous nipple discharge of 3 months duration. On examination the discharge is bloody and from a single duct. The following statements about management of this paicular patient are true, EXCEPT:
Unilateral, spontaneous, serous or serosanguinous discharge from the single duct is usually caused by an intraductal papilloma or rarely, by an intraductal cancer. Mostly the underlying cause is a ductal papilloma or ductal ectasia, but since the chances of malignancies are high, it must be investigated fuher. The risk of malignancy is increased if an underlying mass is present. Also know: Investigation used are: 1. Mammography: can show any underlying suspicious lesion 2. Cytological examination: this may identify malignant cells, but a negative finding does not rule out cancer. 3. Galactography/ductography: The primary indication of the ductography is nipple discharge, paicularly when bloody. Ductography though helpful in reaching a diagnosis is not essential, since excision of the bloody ductal system is needed regardless of the diagnosis. In ductography, a contrast medium is injected into the duct and a mammogram taken. This may show an intraductal papilloma as a filling defect surrounded by contrast. Cancers may appear as irregular or as multiple intraluminal filling defects, or abrupt obstruction. Ductal ectasia or fibrocystic disease may appear as dilated cystic structures. USG may show underlying mass or ductal ectasia. The final diagnosis is made by excising the involved duct (microdochectomy) and any underlying mass if present and subjecting them to a histopathological diagnosis. Radical duct excision (meaning removal of all lactiferous duct) is not done. Ref: CSDT 12/e, page 299.
USG can be an useful investigation
Radical duct excision is the operation of choice
Galactogram, though useful, is not essential
Majority of blood stained nipple discharge are due to papillomas or other benign conditions