Can anyone help with some answers? Bloody nipple discharge

Ncf

Hello,

I have posted before with no responses so I thought I would try again..

I’m 29 I have been through every test imaginable, all have which came back negative. MRI came back birads 4a the first time and now birads 3 the second time (which I know isn’t a negative buy “probably benign”. What made me come in for a breast exam to begin with was bloody nipple discharge tha went away and now has come back with mild breast pain. Doctors have no answer for me and I’m so worried. Help!!

MelissaDallas

Can they not do a ductagram on the duct that is bleeding? The most common reason for this is benign papilloma. They can be too small to show up on other imaging.

Falconer

I'd keep after it. My doctor was convinced I had a papilloma when I was bleeding. Sorry it's so frustrating, but Melissa is right, a ductogram could rule it out. Do you feel a lump anyehere?

Ncf

I’m going in for another MRI in January. I could ask them about a ductogram then. They never brought this up to me before. Thanks for that suggestion Melissa. I’m just worried cause this bleeding has been on and off for a year.

Falconer- Yes it is really frustrating to not have an answer no lumps can be felt, but the mri picked up an area of enhancement that they have been watching, and it went down a birads rating so I’m not sure what to think of it!

Rizz

Did they biopsy the area of enhancement?

Ncf

@rizz

Yes they did biopsy the area of enhancement.

Rizz

so what was the result

Ncf

The first MRI said “an irregular area of enhancement which occupies a large portion of the right breast is lobulated and difficult to measure accurately. It is suspicious and asymmetric. No abnormal adenopathy or skin thickening or nipple retraction” birads 4a

The MRI biopsy came back as “ the abnormality persists, it has been biopsied and came back as benign. Birads 3 6 month follow ups recommended.

djmammo

Ncf

Do you have a specific diagnosis from that path report? Papillomas are benign but so is normal breast tissue. The former would be the reason for the bleeding and the latter would mean they may have missed the target during the biopsy. Do you have a copy of the path report?

Ncf

I have the reports yes. No where on the paper does it say diagnosis. Just says findings and impression. Last one says under findings” the lobulated area of irregular hetergenous enhancement occupying a major portion of the lateral right breast is noted and stable.” No new mass detected” birads 3. I don’t know how they could miss the spot during biopsy since they make it sound so large

djmammo

Ncf

The pathology report not the MRI report.

Ncf

no I don’t have that just the mri report.

Ncf

@djmammo

I dont know if this the pathology report but I did some searching through my papers and found this...

"Pathology reviewed. Diagnosis benign breast tissue with sclerosing adenosis, columnar change, fibrocystic change, scattered itraluminal microcalcifications. Negative for aytpia and neoplasm"

Im not sure if thats the pathology you were asking for, but I thought I would send this out there to you, and see if that has anything to do with the ongoing bloody nipple discharge?

Thank you for all your help!

djmammo

Ncf

That's exactly what I wanted to see. THIS article will explain a bit more. It explains that you can have suspicious enhancement while still being benign.

Not sure those findings explain the bloody nipple discharge though

Ncf

@djmammo

Thank you so much for that article that explains a lot more. No doctor has explained that to me before!

Although I just want to confirm with you. It is benign, but mimicks malignancy. Is this something I should be worried about? Could it be mistaken as benign? Should I do more tests? even though I’ve done them all besides ductogram. Any suggestions would be greatly appreciated because doctors don’t tell me much and I’m not sure exactly what to ask for.

Thank you so much

djmammo

Ncf

My understanding is it mimics malignancy on imaging. Nothing much gets past the microscope though, especially with today's staining techniques. SclerAd is extremely common in the breast and all pathologists who routinely deal with breast tissue would be familiar with it.

Here is an article on columnar cell change from a site I highly recommend for this kind of information specifically written for patients: https://breast-cancer.ca/clmncellesions/

I am a big fan of ductograms myself (https://www.radiologyinfo.org/en/info.cfm?pg=galactogram) and I have performed many. If the duct that is producing the bloody discharge can be isolated and injected, very clear sharp images of the inside of the duct can be produced and if there is a mass growing in there it should be visible in the contrast filled duct.

Ncf

@djmammo

Thank you for all this information! I did make another appointment with my doctor to see if I could get a ductogram. I think this explains a lot to me now seeing as in the first article you sent me, “sclerad” could have something to do with papillomas? That’s what I took from it anyways! I will investigate further

djmammo

Ncf

Sclerosing adenosis and papillomas are unrelated.

Ncf

Oh ok. Did anything in that pathology report stand out to you that may be the cause for the blood you discharge? Sorry to ask you so many questions and thank you for your quick reply! You’ve been been the only person to give me real answers so far thanks again

djmammo

Ncf

As I mentioned in a reply above, I don't see anything that explains the nipple bleeding to me.

Ncf

Oh ok thank you, I’ll push for the ductogram then!