Nipple Secretion in Pregnancy:ACytologic and Histologic Study

Bloody nipple discharge during pregnancy: A rationale for conservative treatment

“…Among 160,000 deliveries, Betson and Golden [6] reported that 16 (0.01%) had an associated cancer of the breast, If one reviews the overall number of cancers of the breasts associated with pregnancy compared to those not associated with pregnancy, the percentages are quite low and range from 1.3% to 2.1 % of all breast cancers [7,8]. Cytologic and histologic studies of breasts with nipple discharges have been done during pregnancy and lactation by Kline and Lash [3,9]. Although they reported only four cases with frankly bloody discharges [3], they documented cytologically that 10 of 50 pregnant patients with discharges had red blood cells (RBCs) in the discharge and that 17 of 72 lactating women had RBCs in their nipple secretion [9].…”

“…Unfortunately, very little information can be gathered from these cases, but some facts can be stated. In the cases described by Kline and Lash [3] and Haagensen [4], the bloody discharge occurred during the second or third trimester of the pregnancy. Age, parity, status and location of the discharge were not available.…”

Treatment of the Pregnant Patient with Breast Cancer

“…The authors demonstrated desquamated epithelial cells, similar to those seen with intraductal papillomas, and believed that pregnancy-induced changes in the ducts that led to the formation of delicate intraductal epithelial spurs, easily traumatized and shed, resulting in bleeding. 50,51 These persisted for up to 2 months (and rarely, longer) after delivery. 51 Nipple discharge cytology is unlikely to be helpful in this situation because the proliferative changes associated with pregnancy may be mistaken for those of a neoplastic process.…”

“…51 Nipple discharge cytology is unlikely to be helpful in this situation because the proliferative changes associated with pregnancy may be mistaken for those of a neoplastic process. 34,43,[50][51][52][53][54] There are no data available on use of ductal endoscopy, lavage, or ductography in this setting. If the bloody discharge persists more than 2 months after delivery, localizes to one duct, or is associated with a palpable mass, mammography and biopsy may be indicated to exclude breast cancer.…”

Medical Complications of Mothers

“…223 Lymphocytes, plasma cells, and eosinophils infiltrate during the proliferation process. 119 Biopsies during the third trimester of pregnancy, as described by Kline and Lash,156 had "tufts of cells forming spurs or invaginations into duct and alveolar lumens and similar structures that were desquamated into lumens and groups of cells found in the breast secretions." Cytologic appearance of the breast during pregnancy is cellular; the cell types are the same as in the resting breast, although the proportions differ.…”