Bloody nipple discharge in infancy

Juvenile Papillomatosis in a Young Child: A Case of Infantile Bloody Nipple Discharge

BACKGROUND

Bloody nipple discharge (BND) is a rare and distressing finding in infants, although its etiology is usually benign. Diagnostic management of BND and breast lesions in children calls for an adapted approach.

CASE

We present the case of an 11-month-old girl with unilateral BND and a painless breast mass. Sonographic and histologic examination identified juvenile papillomatosis of the breast.

SUMMARY AND CONCLUSION

Juvenile papillomatosis of the breast is a rare cause of breast lesions in young patients with specific sonographic and histologic characteristics. Because of the associated risk of malignancy, surgical excision is the preferred therapy.

Bloody nipple discharge as a benign, self-limiting disorder in young children: A systematic review including two related case reports

BACKGROUND/PURPOSE

Bloody nipple discharge (BND) is rare, distressing for parents, and presents a challenge for physicians.

METHODS

We used PubMed to search for cases of BND that were diagnosed before adolescence and added data from two of our cases.

RESULTS

The analyzed cohort comprised 46 patients (28 boys and 18 girls; mean [SD] age, 12.5±13.3months; range, 20days to 4years). The mean time for spontaneous resolution was 2.8±2.4months (range, 1week to 8months) after onset of BND without any intervention. The diagnosis was mammary ductal ectasia (MDE) in 15 patients, gynecomastia with MDE in two patients, hemorrhagic cysts in two patients, and gynecomastia alone in one patient. The majority (89.3%) of patients <1year old were managed conservatively, but half of them aged >1year (50.0%) underwent surgery. Surgery was performed more often in patients in whom a mass had been identified.

CONCLUSIONS

Age and findings at physical examination affect selection of treatment, but not sex. We found no reported cases of malignancy. Symptoms in children who are managed conservatively resolve within 10months. Children with BND should be conservatively managed to avoid the risk of developing breast deformities before adolescence.

Uncommon benign breast abnormalities in adolescents

The authors discuss benign breast abnormalities in the adolescent breast other than fibroadenoma. Although fibroadenoma is the most common benign abnormality in the adolescent breast, other diagnoses are possible. The majority of adolescents who present with a palpable concern or lump have no discrete abnormality on ultrasound and are diagnosed with clinical fibrocystic change and followed up to ensure clinical stability. Intraductal papilloma and duct ectasia are two benign abnormalities associated with bloody nipple discharge, occurring more rarely in adolescents compared with adult women. Breast infections can occur in adolescents, including both mastitis and/or abscess, and are treated similarly to adults, with drainage and antibiotic coverage for Staphylococcus. When infections are due to nipple piercing, other organisms should be suspected. All surgical procedures in the developing breast should be performed cautiously, as trauma to the undeveloped breast can result in failure of breast development or asymmetry, and surgical disruption of subareolar ducts can impair or preclude future lactation.

Factor v deficiency: a subtle presentation

Congenital factor V deficiency (also known as labile factor or proaccelerin) is a rather uncommon [1:1000,000] inherited coagulopathy (autosomal recessive inheritance). Affected patients become symptomatic in early childhood with spontaneous or post-traumatic bleeding complications. The authors report an infant who presented with a much feared complication of the same probably as a neonatal presentation.

Bloody nipple discharge in infancy: a case report and recommendations for management

We report a 5-month-old male infant with benign unilateral bloody nipple discharge, and we present a brief review of 20 previously described cases of bloody nipple discharge in infancy. On the basis of our case and previous reports, we offer recommendations for the management of the bloody nipple discharge in the first year of life: (1) diagnosis should be based on noninvasive diagnostic procedures, in the absence of dubious ultrasound or cytological diagnostic findings; (2) the condition resolves spontaneously, and surgical intervention should be avoided; (3) manipulation of the nipple can prolong the bleeding; (4) antibiotics should be given only in the presence of clear clinical and cytological signs of infection; and (5) parent reassurance is an important part of infantile bloody nipple discharge management.

Bloody nipple discharge in 2 infants with interesting cytologic findings of extramedullary hematopoiesis and hemophagocytosis

Bloody nipple discharge in the infantile period is an uncommon finding. Despite its stressful course to the parents, it is generally a benign condition with a spontaneous resolution. The approach to bloody nipple discharge in the infantile period is well documented in the literature even though the number of these cases is limited. We report 2 infants with unilateral bloody nipple discharge. Their physical examination, laboratory, and ultrasound findings were normal but the cytologic examinations of the discharge revealed signs of extramedullary hematopoiesis and hemophagocytosis. These extraordinary findings made us brainstorm on the probable ongoing processes in the infantile breast tissue.

Bloody nipple discharge in a 7-month-old boy

Isolated bloody nipple discharge is rare in infancy and is usually idiopathic. Discharge commonly resolves spontaneously, and ultrasonography is a useful diagnostic technique to detect the cause of discharge. The authors report a 7-month-old boy who presented with unilateral spontaneous bloody nipple discharge for 1 month without signs of infection or mass.

Bloody nipple discharge in an infant

Although milky nipple discharge appears frequently in infants, bloody nipple discharge is a very rare finding. We experienced a 4-month-old, breast-fed infant who showed bilateral bloody nipple discharge with no signs of infection, engorgement, or hypertrophy. The infant's hormonal examination and coagulation tests were normal, and an ultrasound examination revealed mammary duct ectasia. The symptoms resolved spontaneously within 6 weeks without any specific treatment, except that we advised the mother to refrain from taking herbal medicine. Since no such case has been previously reported in Korea, we present this case with a brief review of the literature.

Unilateral bloody nipple discharge in a two-month-old male

Bloody nipple discharge is a rare but distressing finding in neonates and infants. We report on a 2-month-old boy with unilateral bloody nipple discharge. Ultrasound examination revealed dilated mammary ducts. This benign phenomenon is most likely to be caused by mammary ductal ectasia. Invasive investigations or surgery should be avoided in neonates or infants with bloody nipple discharge unless the discharge is unilateral, spontaneous, persistent and accompanied with a palpable mass. Otherwise only serial clinical follow-up is recommended until spontaneous resolution.

A neonatal presentation of factor V deficiency: a case report

BACKGROUND

Factor V deficiency is a rare autosomal recessive coagulation disorder. Awareness of presenting features and management is important to avoid bleeding complications associated with mortality and neurodisability.

CASE PRESENTATION

A 6-day-old Pakistani boy was admitted with bleeding from the left nipple. His parents were first cousins. A coagulation screen showed a prothrombin time of 41 s (control 14 s), a partial thromboplastin time of 132 s (control 33 s) and a normal thrombin time of 15 s (control 14 s). Factor V activity was <0.01 IU/ml. Oral tranexamic acid was started. At 5 weeks of age the child presented with irritability, lethargy and reduced feeding and a drop of hemoglobin to 5.6 g/dl. A cranial computed tomography scan showed a right intra-cerebral bleed extending from the frontal lobe to the parieto-occipital region with shift of the midline to the left. A regime of 20 ml/kg of fresh frozen plasma four times a week was instituted and has prevented further bleeds up to the present age of 21 months. Neurodevelopment remained normal.

CONCLUSION

This case illustrates that in an unusually bleeding newborn of consanguineous parents rare severe homozygous bleeding disorders need to be considered. Nipple bleeding may be the first presentation of a congenital bleeding disorder. In cases of factor V deficiency where factor concentrates are not available long term use of fresh frozen plasma can prevent potentially life threatening bleeding.

Bloody nipple discharge in infants

Though milky nipple discharge is frequently seen in neonates, blood stained discharge from the nipple is an exceptionally rare phenomenon. We noted a case of a three-month-old baby girl who presented with bilateral blood stained nipple discharge without signs of inflammation; engorgement or hypertrophy and which subsided without any intervention. This case is reported along with literature review about managing this rare condition.

Bloody nipple discharge in an infant and a proposed diagnostic approach

Bloody nipple discharge is a rare finding in infants and is associated most often with benign mammary duct ectasia. The rarity of this symptom in infants and its association with breast carcinoma in adults can lead to unnecessary investigation and treatment. Here we describe a 4-month-old boy with bilateral bloody nipple discharge that resolved spontaneously without treatment by 6 months of age. Furthermore, we propose a strategic method for the evaluation of such infants.

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

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.

Clinical management of nipple discharge in neonates and children

Bloody nipple discharge is a rare but distressing finding in neonates and infants. We report an 8-month-old boy who showed bilateral bloody nipple discharge for 5 months without signs of infection. Ultrasound examination revealed dilated mammary ducts. This benign phenomenon is most likely caused by mammary duct ectasia. On the background of the reviewed literature, intensive investigations should only be performed in neonates and infants if bloody nipple discharge is unilateral, continues, expands in size or shows signs of inflammation. We discuss the clinical management of nipple discharge during infancy and childhood.

Cytologic findings from a nipple discharge in an infant with premature telarche

Premature telarche is a condition of isolated unilateral or bilateral breast development without additional signs of sexual maturation in girls primarily under 2 yr of age presumably occurring as a response to hormonal stimulation by estrogens. Prior reports concerning pathologic findings in premature telarche have been scarce. We report the cytologic findings from a nipple discharge in a 10-mo-old girl with unilateral breast enlargement due to premature telarche. The discharge showed an increased number of clusters of breast ductal epithelium, with a few in a papillary configuration. There was a moderate degree of nuclear irregularity in the epithelial cells, but no significant nuclear overlapping. No atypical single cells were present, and a rare myoepithelial cell was noted. These cytologic findings are in accord with a prior study describing the histology in three cases of premature telarche.

Bilateral breast masses and bloody nipple discharge in a two year-old boy

Breast enlargement with bloody discharge is very rare in childhood. We report a two year-old boy with breast enlargement and bloody discharge. Because of persistent bloody discharge, subcutaneous mastectomy was performed. The specimen showed histologic changes identical to those seen in adult mammary duct ectasia. We suggested that the infant's own endocrine system is responsible for breast enlargement and mammary duct ectasia, possibly occurring as a result of a mechanism similar to that in adults.

Infantile gynecomastia with bloody nipple discharge

Gynecomastia and bloody nipple discharge are very rare in childhood. In this report, a case of infantile gynecomastia together with bloody nipple discharge is presented. A hemorrhagic discharge was expressible from the mammary gland. Endocrinologic findings were within the normal limits. Because of persisting bleeding, a subcutaneous mastectomy was performed. The specimen was reported as gynecomastia. This boy is the first reported prepubertal gynecomastia with bloody nipple discharge in the medical literature.

Infantile mammary duct ectasia: a cause of bloody nipple discharge

Bloody nipple discharge in infancy has been rarely reported in the medical literature. Its cause is unknown. We report a three-year-old male infant and a five-month-old female infant with bloody nipple discharge. Because of persistent bloody discharge, a subcutaneous mastectomy was performed in the boy; the problem resolved in the girl after a period of observation. The specimen showed histologic changes identical to those seen in adult mammary duct ectasia. All the endocrinologic work-up was normal. We suspect that bloody nipple discharge in infancy is underreported. This is a benign condition with histologic changes similar to adult mammary duct ectasia and if persistent, should be properly investigated; biopsy or excision are not indicated.