Bloody nipple discharge: systematic literature review and case report

Authors:

Bada Bosch I^a, Cerdá Berrocal J^b, López Varela MC^c, Peláez Mata D^d, del Cañizo López A^e, Fanjul Gómez M^f, Pérez Egido L^g, de la Torre Macías M^h, Ordóñez Pereira Jⁱ, Blanco Verdú MD^j, de Agustín Asensio JC^k

^aServicio de Cirugía Pediátrica. Hospital General Universitario Gregorio Marañón. Madrid, España.
^bServicio de Cirugía Pediátrica. Hospital General Universitario Gregorio Marañón. Madrid, España.
^cServicio de Anatomía Patológica. Hospital General Universitario Gregorio Marañón. Madrid, España.
^dServicio de Cirugía Pediátrica. Hospital General Universitario Gregorio Marañón. Madrid, España.
^eServicio de Cirugía Pediátrica. Hospital General Universitario Gregorio Marañón. Madrid, España.
^fServicio de Cirugía Pediátrica. Hospital General Universitario Gregorio Marañón. Madrid, España.
^gServicio de Cirugía Pediátrica. Hospital General Universitario Gregorio Marañón. Madrid, España.
^hServicio de Cirugía Pediátrica. Hospital General Universitario Gregorio Marañón. Madrid, España.
ⁱServicio de Cirugía Pediátrica. Hospital General Universitario Gregorio Marañón. Madrid, España.
^jServicio de Cirugía Pediátrica. Hospital General Universitario Gregorio Marañón. Madrid, España.
^kServicio de Cirugía Pediátrica. Hospital General Universitario Gregorio Marañón. Madrid, España.

Correspondence: I Bada. Email: isabel.bada.bosch@gmail.com

Reference of this article.:

Bada Bosch I, Cerdá Berrocal J, López Varela MC, Peláez Mata D, del Cañizo López A, Fanjul Gómez M y cols. Telorragia: revisión de la literatura a propósito de dos casos. Rev Pediatr Aten Primaria. 2022;24:e147-e155..

Published in Internet: 12/04/2022

Abstract:

Nipple discharge in children is uncommon, whereas it is considered a warning sign in adulthood. Hence these patients are referred to the Paediatric Surgeon to assess whether it is necessary to perform aggressive procedures to avoid the risk of malignancy. However, the most common ethology is ductal ectasia, a benign and self-limited process.

We present two cases of a 4 and 5-month-old male patients with bloody nipple discharge. Once malignancy was ruled out by physical examination, ultrasound and cytology, a conservative approach was adopted and the symptoms disappeared over a period of 12 months. Then we conducted a systematic review including pediatric patients (0-16 years) with monosymptomatic bloody nipple discharge.

We found a total of 59 cases published. It is more prevalent in male patients (1,5:1) and 74% present before the age of 12 months. In the articles reviewed several tests are mentioned (secretion culture, cytology, hormonal blood test) but only ultrasound provided useful information, showing altered results in 69.2% of the patients. The classical therapeutic approach was breast surgical resection but in more recent reports ductal ectasia has been shown to be a self-limited pathology. Therefore, conservative treatment is now advocated while surgery is reserved for persistent symptoms or cases where there is a diagnostic doubt. Relapse is infrequent (9.8%).

Conclusions: despite of being a disturbing sign, bloody nipple discharge in infants should be managed conservatively, avoiding aggressive surgical procedures that might cause permanent consequences.

Keywords: Bloody nipple discharge. Nipple secretion. Children. Mammary duct ectasia.