Bloody Nipple Discharge in a 4-Year Old Child

Abstract

Breast enlargement is considered a physiologic event in male and female neonates. However, it is rarely encountered in infancy and is deemed unusual in young children beyond the first year of life.1,2 Breast enlargement along with bloody nipple discharge, first reported in 1983 3 appears to be even more uncommon in children. We report a case of a 4-year-old boy with a 2-week history of left breast enlargement with serosanguinous nipple discharge and ipsilateral palpable axillary lymph nodes. Case ReportA 4-year-old boy was referred to the pediatric surgical service after the mother presented her child with a history of bloody nipple discharge of one week duration to the emergency room physician. The mother noted blood stains initially on the boy's underwear and later saw blood coming out of the left nipple. There was no history of breast enlargement, pain or fever. Trauma and drug ingestion were denied. Physical examination revealed a healthy child with normal findings except for an ovoid mass measuring 2.5 x 1.5 centimeters above the left nipple. It was mobile, not attached to underlying structures or skin, firm, and not tender or hot. There was no erythema. Slight pressure on the mass instigated bloody discharge from the nipple (Figure 1). The left axilla revealed two enlarged lymph nodes, one measuring 0.5 centimeter, the other 2.0 centimeters in diameter. The right breast and axilla were normal. The testes were of normal size, configuration and consistency. The complete blood count, prothrombin time and partial thromboplastin time were normal. The breast mass, including the small nipple, were excised. Both axillary lymph nodes were removed as well.The frozen section proved to be a benign lesion. The paraffin section demonstrated many dilated ducts containing granular eosinophilic material and red blood cells. In some, there were many macrophages containing foamy granular material within the lumen and pronounced periductal fibrosis with a moderate chronic inflammatory reaction in the adjacent wall (Figure 2). An occasional dilated duct proved that focal ulceration was present. A section from the left nipple showed a few dilated ducts with similar microscopic changes. A section from the axillary lymph nodes illustrated sinus histiocytosis.

Mammary duct ectasia in infant breast with bloody nipple discharge: Sonographic findings

“…There are several cases reported in the literature in which biopsy and mastectomy specimens in children and neonates showed the same type of duct ectasia seen in adults. 3,[5][6][7][8] Mammary duct ectasia is a benign process characterized by dilated ducts surrounded by fibrosis and inflammation. 8 Duct ectasia with BND seen in neonates and infants is a self-limiting condition that resolves spontaneously.…”

Report of an 18-Month-Old Male Infant with Unilateral Bloody Nipple Discharge

“…BND in infancy was first reported by Berkowitz et al in 1983 and a few case have been reported so far. In the early cases, subcutaneous mastectomy was generally performed in patients with BND and histological diagnosis was mammary duct ectasia (1)(2)(3)(4)(5)(6). Although these patients were over-treated with surgery, histological examinations highlighted their benign nature.…”

Bloody Nipple Discharge (BND) in an 8 Months Old Girl and a 9 Months Old Male – Rational Diagnostic Approach

“…These hormones lead to persistence of mammary ducts, which resolve spontaneously after a few weeks or months. This assumption is based on histological results because in most cases mammary duct ectasis was identifi ed as the underlying alteration [1,4,15,17,25,33] . The authors suggest that widened mammary ducts lead to a bleeding from ulcers within the ducts.…”