Can anyone help with some answers? Bloody nipple discharge

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Ncf
Ncf Member Posts: 18
edited October 2018 in Not Diagnosed But Worried

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!!

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  • MelissaDallas
    MelissaDallas Member Posts: 7,268
    edited September 2018

    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.

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  • Falconer
    Falconer Member Posts: 1,192
    edited September 2018

    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?

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  • Ncf
    Ncf Member Posts: 18
    edited October 2018

    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!

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  • Rizz
    Rizz Member Posts: 72
    edited October 2018

    Did they biopsy the area of enhancement?

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  • Ncf
    Ncf Member Posts: 18
    edited October 2018

    @rizz

    Yes they did biopsy the area of enhancement.

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  • Rizz
    Rizz Member Posts: 72
    edited October 2018

    so what was the result

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  • Ncf
    Ncf Member Posts: 18
    edited October 2018

    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.

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  • djmammo
    djmammo Member Posts: 2,939
    edited October 2018

    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?

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  • Ncf
    Ncf Member Posts: 18
    edited October 2018

    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

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  • djmammo
    djmammo Member Posts: 2,939
    edited October 2018

    Ncf

    The pathology report not the MRI report.

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  • Ncf
    Ncf Member Posts: 18
    edited October 2018

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

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  • Ncf
    Ncf Member Posts: 18
    edited October 2018

    @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!

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  • djmammo
    djmammo Member Posts: 2,939
    edited October 2018

    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

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  • Ncf
    Ncf Member Posts: 18
    edited October 2018

    @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

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  • djmammo
    djmammo Member Posts: 2,939
    edited October 2018

    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.


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  • Ncf
    Ncf Member Posts: 18
    edited October 2018

    @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

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  • djmammo
    djmammo Member Posts: 2,939
    edited October 2018

    Ncf

    Sclerosing adenosis and papillomas are unrelated.

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  • Ncf
    Ncf Member Posts: 18
    edited October 2018

    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

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  • djmammo
    djmammo Member Posts: 2,939
    edited October 2018

    Ncf

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

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  • Ncf
    Ncf Member Posts: 18
    edited October 2018

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

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