Eureka! Institutional Repository

Nipple discharge is the third most common clinical complaint after breast pain and breast mass. More than 80% of women experience nipple discharge during their lifetime. In the majority of cases, however, nipple discharge is benign and can be treated successfully. It can be classified as normal or abnormal depending on features such as laterality (contralateral-bilateral), color, consistency as well as presentation (i.e., induced vs spontaneous). It can be related to benign conditions, such as intraductal papilloma , duct ectasia or galactorrhea, as well as malignant causes as lobular or papillary carcinoma. The algorithm for evaluating unexpecting nipple discharge, initially includes evaluation of both breasts (visual inspection-palpation) and the clinical test of the secretion. Next comes further imaging evaluation. Normal discharge does not require more extensive imaging apart from mammography, on the contrary pathological discharge is evaluated based on mammography and breast ultrasound. If additional imaging is needed, MRI is preferred because of its increased sensitivity, specificity, and patient comfort. Although central duct excision is the current standard for evaluation of malignancy in patients with pathologic nipple discharge, studies suggest that, given the high negative predictive value of MRI, surveillance may be a reasonable alternative to surgery. Finally, this thesis deals with anatomy, embryology of the normal human mammary gland, as well as the benign and malign conditions, that are responsible for nipple discharge. In addition, it refers to the macroscopic and microscopic evaluation ,the available imaging methods and the dealing-algorithm for nipple discharge.