Patient's question:
Patient: Female, 35 years old. Some patients have nipple discharge that is yellow-green, brown, bloody, or colorless serous in nature.Doctor's answer:
1. Galactophoritis: In some patients with this disease, the initial symptoms are nipple discharge. The discharge is often brown, with a few cases of bloody nipple discharge. Laboratory tests show a large number of plasma cells and lymphocytes, but no tumor cells. This disease is more common in women over 40 who are not breastfeeding or in menopause. The areola area with discharge may have a mass adhering to the skin, usually less than 3 cm in diameter, and the ipsilateral axillary lymph nodes may be swollen, soft, and tender. If infection occurs, the mass may show redness, swelling, heat, and pain.Xiamen Traditional Chinese Medicine Hospital, Department of Breast Surgery, Yang Lihua
2. Intraductal papilloma: This disease is more common in people aged 40 to 50. 75% of the tumors occur near the nipple. The tumor is small, pedunculated, and has villi with many thin-walled blood vessels, making it prone to bleeding. Tumor cells can be found in the discharge during laboratory tests. Sometimes, when patients carefully palpate their breasts, they may find a cherry-sized mass under the areola, which is soft, smooth, and movable.
3. Breast cystic hyperplasia: This disease is more common in women of childbearing age. In some patients, nipple discharge may be yellow-green, brown, bloody, or colorless serous. Laboratory tests show no tumor cells in the discharge. This disease has two characteristics: First, it is characterized by cyclical breast pain, which is more common or worsens before menstruation. Mild cases are often not bothersome to patients, while severe cases can affect work and daily life. Second, breast masses are often multiple and can be found on one or both sides, or localized to a part of the breast or scattered throughout. The masses are nodular and of varying sizes, firm but not hard, not adhering to the skin, with unclear boundaries to surrounding tissues. The masses may shrink after menstruation.
4. Breast cancer: Some breast cancer patients have bright red or dark red nipple discharge. Sometimes, clear watery discharge may occur, colorless and transparent, occasionally sticky, without residue after discharge. Tumor cells can be found in the discharge during laboratory tests. The two peak ages for this disease are 45–49 and 60–64. The onset is slow, and patients may accidentally discover a breast mass, usually located in the inner or outer upper quadrant, painless, and gradually increasing. In advanced stages, skin changes resembling orange peel and satellite nodules may appear. Axillary lymph nodes may be swollen, hard, and merge into clusters as the disease progresses.