Nipple Discharge Men
How nipple discharge men is related to breast cancer
Male breast carcinoma is a rare malignancy. Indeed, 900 cases were diagnosed in the US during 1991. Male breast cancer results in around 300 deaths a year. However, there are approximately 181,000 new breast cancer cases diagnosed in women annually with 46,000 deaths.
However, in men and women, breast intraductal carcinoma, often coexists with an infiltrative component. This is an extremely rare form of breast cancer that constitutes only 5% of all male breast cancers.
A diagnosis of breast intraductal carcinoma is often made through fine needle biopsy. The diagnosis through cytology of the nipple discharge in men has not been previously reported. Hirschman reports a case of a 50 year old man with a bloody nipple discharge in his right breast. This patient had a family history in that his mother had breast cancer at the age of 48.
The discharge was positive for neoplastic cells
Furthermore, this patient did have a subareolar mass of 1.8 cm. A mastectomy and an axillary dissection with 20 negative lymph nodes was performed. The results of this gave a diagnosis of comedo-type intraductal carcinoma of a high nuclear grade. The actual nipple was tumor free.
Be that as it may, this case proved the usefulness of cytology for diagnosing carcinoma in situ, (potentially aggressive) from nipple discharge in the male breast.
Breast disease is relatively rare in men
Interestingly, the broad spectrum of malignant and benign lesions that occur in the female breasts can also be observed in the male breast.
Perhaps, the only specific tumor of the male breast is a gynecomastia. The only specific tumor for the female breast is the infant adenoma. Although the most common symptom of male breast carcinoma is a subareolar mass, approximately 20% of patients have nipple discharges.
A nipple discharge in men obviously lacks a physiological lactational category. However, a bloody nipple discharge in a male should be considered as strongly suspicious for carcinoma. But according to Hirschman y col. the cytology of nipple discharge in men has not been formally studied.
Only about 5% of male breast carcinomas are entirely intraductal injuries
Male breast cancers that present with atypical epithelial cells found in the discharge cytology include:-
- intraductal papilloma
- papillary carcinoma
- metastatic tumors.
Usually the discharge cytology of the intraductal papilloma will reveal cells in closed sheets or clusters mixed with stromal cells. The discharge cytology of papillary carcinoma is generally similar. Except for a greater monotonous appearance of the cells and an absence of stromal elements.
Surgical excision is recommended in these cases
Metastatic tumors are clinically indistinguishable from primary breast carcinomas in all cases. However, it is unusual for a metastatic tumor to have a positive discharge cytology. One exception to this, is if the tumor breaks the breast duct structures.
Nipple discharge in men is always worth having checked out with a physician and can be of significant importance. Nipple discharge in men is more often associated with carcinoma than with women.
With that said, only one male patient in the series of Van Zee the only clinical sign was the sanguineous discharge. The duct excision was performed without preoperative galactography, and revealed a carcinoma.
Anyway, a man with any type of nipple discharge should be fully evaluated. It must be assumed that there is a high probability of carcinoma. Therefore, long-term studies of the cytology of male nipple discharge may help to establish the importance of this diagnostic technique.