Bloody nipple discharge in infants

Siglas, John; Roilides, Emmanuel; Tsanakas, John; Karpouzas, J.

doi:10.1016/s0022-3476(85)80540-0

Cited by 19 publications

(25 citation statements)

References 2 publications

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“…Subtle bleeding events, such as bleeding from nipple, umbilical stump, nose, gum and hematospermia, and also fatal intracranial bleedings have been reported [8][9][10]. Another unique feature of factor V is that, in contrast to other coagulation factor inhibitors, the risk of bleeding does not correlate with factor V inhibitor levels, prolongation of PT or aPTT, factor V activity, or the duration of presence of factor V inhibitor, thereby obviating the possibility to predict bleedings [11].…”

Section: Discussionmentioning

confidence: 99%

A Confounding Case of Inherited Factor V Deficiency Complicated by Inhibitors at First Presentation

Subramanian

Kar

Charles

et al. 2016

Transfus Med Hemother

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Introduction: Inherited factor V deficiency / Owren's disease has varied clinical manifestations ranging from asymptomatic laboratory abnormalities to massive hemorrhage. The acquired form due to inhibitors following antibiotic therapy, infection, or surgery is less common, and spontaneous development of inhibitors is not known. Case Report: An 18-year-old boy presented with bleeding axillary and groin ulcers. At the age of 15, due to recurrent epistaxis and gum bleed, he was diagnosed with acquired factor V deficiency with positive inhibitor screen and treated with fresh frozen plasma (FFP) transfusion and temporary azathioprine. Coagulation workup at his current presentation also revealed acquired factor V deficiency with presence of inhibitors. The tests were repeated after 6 weeks of intermittent FFP transfusion, and the differences observed included negative inhibitor screen and complete correction on mixing studies, but factor V level was 2%. Discussion: Evidence of inhibitors at presentation favored acquired disease. However, younger age of onset, detection of inhibitors 1 year after first episode of self-regressing bleed, lack of identifiable triggers, and persistent bleeding with reduced factor levels after disappearance of inhibitors favored inherited factor V deficiency. Conclusion: In this case report, we have described an interesting case of severe inherited factor V deficiency with spontaneous appearance and disappearance of inhibitors exhibiting nonspecific factor inhibitory activity.

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Section: Discussionmentioning

confidence: 99%

A Confounding Case of Inherited Factor V Deficiency Complicated by Inhibitors at First Presentation

Subramanian

Kar

Charles

et al. 2016

Transfus Med Hemother

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“…We also reviewed the literature, and we found that up to date, 25 breasts with BND in 19 patients were reported in the pediatric literature [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. The findings of total 39 breasts are summarized according to etiologies and sex in Table 3.…”

Section: Discussionmentioning

confidence: 99%

“…The spectrum of breast disease in the pediatric age group is different from that in adults, and since most lesions are benign, surgical biopsy to rule out the malignancy should be avoided because of the risks of deformity to the developing breast [2]. This has lead to a policy of noninvasive treatment approach of breast masses in this age group by many physicians, especially in female patients [3][4][5][6][7][8][9][10]. However, additional invasive interventions are needed in certain situations such as in cases of infections, duct ectasia, persistent cyst and solid masses for definitive treatment [9][10][11][12][13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Bloody nipple discharge in children: possible etiologies and selection of appropriate therapy

İmamoğlu¹,

Çay²,

Reis³

et al. 2005

Ped Surgery Int

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An understanding of underlying causes of bloody nipple discharge (BND) is necessary to be able to advise treatment guidelines of this rare symptom in the pediatric age group. Of 11 patients with 14 breasts that had BND, data regarding age, sex, side and duration of BND, physical examination findings, laboratory values, culture reports, ultrasonography (US) findings, treatment approach, histopathologic details, and outcomes were obtained, and also, literature was reviewed. The patients were between 3 months and 12 years of age. There were six males and five females. The BND was located in the right breast in six patients, in the left in two, and it was bilateral in three. On physical examinations, seven patients had palpable cystic nodules located at the areolar area and three had a diffuse breast enlargement without skin findings. Laboratory investigations showed normal hormone levels in all patients. At US examinations, seven breasts had cystic lesions, three had hypoechoic tissue in the subareolar region, and others had normal US findings. In a girl with positive culture for Staphylococcus aureus, BND resolved after oral antibiotics. Two cases resolved spontaneously, with 6 months and 4 months follow-up periods, respectively. Surgical intervention was performed for the remaining eight patients, and mean time to operation after onset of symptoms was 10 months (range = 1-34 months). Histopathologic findings showed that the underlying cause of BND was duct ectasia in five breasts, gynecomastia in three, and fibrocystic change in two. Their follow-up periods ranged between 3 months and 6 years, and no recurrences were observed. Classification of breasts with BND for selecting appropriate therapy on the basis of results of careful physical examination, with an US evaluation in selected cases, is effective, and prevents unnecessary investigations.

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“…4 It was observed in association with diffuse breast enlargement, with distinctmass or masses 1,3 or without any appreciable growth. 5,6 It has been reported in early and late infancy, preschool and pubertal children.…”

Section: Discussionmentioning

confidence: 99%

“…Despite limited clinical experience, the extreme rarity of malignant tumors in this age group and its self-limiting nature should reassure parents during the few months needed for cure. 3,5,6,9 The fact that 17 cases of juvenile secretory carcinoma of the breast have presented as asymptomatic swellings and none have given rise to nipple discharge, may support this recommendation. 15 Excisional biopsy should, as a general rule, be avoided, particularly in girls.…”

Section: 35-9mentioning

confidence: 99%

Bloody Nipple Discharge in a 4-Year Old Child

et al. 2003

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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.

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Bloody nipple discharge in infants

Cited by 19 publications

References 2 publications

A Confounding Case of Inherited Factor V Deficiency Complicated by Inhibitors at First Presentation

A Confounding Case of Inherited Factor V Deficiency Complicated by Inhibitors at First Presentation

Bloody nipple discharge in children: possible etiologies and selection of appropriate therapy

Bloody Nipple Discharge in a 4-Year Old Child

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