Master the board step 3

Section 7
Gynecology
contributing author Elizabeth August, MD
The Breast
Benign Breast Disease
1. Fibroadenoma
2. Fibrocystic disease
3. Intraductal papilloma
4. Fat necrosis (think of this with trauma to the breast)
5. Mastitis (inflamed, painful breast in women who are
breastfeeding)
Malignant Breast Disease (i.e., Breast Cancer)
1. Ductal carcinoma in situ (DCIS)
2. Lobular carcinoma in situ (LCIS)
3. Invasive ductal carcinoma
4. Invasive lobular carcinoma
5. Inflammatory breast cancer
6. Paget’s disease of the breast/nipple
Nipple Discharge
If the history describes bilateral nipple discharge, think of prolactinoma.
Order prolactin levels and TSH levels.
Most Common Cause
The most common cause of unilateral nonbloody nipple discharge is intraductal
papilloma. It commonly presents with watery, serous or serosanguinous
fluid discharge. The likelihood of cancer is greater if there is an associated
palpable mass, involvement of more than one duct or bloody discharge.
Diagnostic Testing
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Mammogram: Look for underlying masses or calcifications.
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Surgical duct excision: Perform this for definitive diagnosis.
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Cytology is not helpful in the diagnosis and is never the answer for nipple
discharge.
• Nonbloody nipple
discharge = most likely
intraductal papilloma.
May also be malignancy.
• Bloody nipple
discharge = most likely
malignancy.
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