الفهرس 
EmbryogenesisOnly 14 pages are availabe for public view
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Abstract
Nipple discharge is the release of fluid from the nipples of the breasts. Although it is considered normal in a wide variety of circumstances it is the third major reason involving the breasts for which women seek medical attention, after breast lumps and breast pain. It is also known to occur in adolescent boys and girls going through puberty. (1)
Nipple discharge in a woman who’s not pregnant or breast-feeding isn’t necessarily abnormal, but should be evaluated by a doctor. Nipple discharge in a man under any circumstances is a problem that should be investigated.One or both breasts may produce a nipple discharge, either spontaneously or when you squeeze the nipples or breasts. A nipple discharge may look milky, or it may be yellow, green, brown or bloody.. The consistency of nipple discharge varies from thick and sticky to thin and watery.(2)
The most commen causes of pathologic nipple discharge are: Cancer (usually intraductal carcinoma or invasive ductal carcinoma) causes < 10% of cases. The rest result from benign ductal disorders (eg, intraductal papilloma, mammary duct ectasia, fibrocystic changes), endocrine disorders, or breast abscesses or infections. Of these causes, intraductal papilloma is probably the most common; it is also the most common cause of a bloody nipple discharge without a breast mass.(3)
Evaluation of patients with nipple discharge includes history,physical examination,mammography ,sonography cytology, ductography and recently ductoscopy.(4)
The ability of soft tissue mammography to identify and localize intraductal papillomas is limited. Galactography is better than soft tissue mammography in its ability to visualize and localize small intraductal papillomas however, its ability to differentiate benign from malignant lesions is limited. (5)
Ultrasonography is not typically used unless the nipple discharge is accompanied by a palpable mass or a positive mammographic finding. Ultrasonography may be useful in presurgical localization if galactography reveals a dilated duct larger than a few millimeters in width. Modern, high-resolution ultrasonographic techniques are becoming more sensitive for the visualization of intraductal changes. Tiny, solitary papillomas can sometimes be visualized by using this sophisticated technology(6)
Magnetic resonance imaging (MRI) may play an adjunctive role, aiding in the differentiation of benign ductal abnormalities from malignant ones. However, a prospective study comparing MRI with galactography and sonography will be necessary before MRI’s role can be determined.(7)
Mammary ductoscopy is a medical diagnostic procedure for viewing and collecting epithelial cells and other internal features of the milk ducts. It is capable of detecting smaller abnormalities than mammograms, or ultrasound tests. The advantage of mammary ductoscopy is that it is possible to gain direct access to the ductal system via the nipple. Direct visualization of the duct epithelium allows the operator to precisely locate intraductal lesions, enabling accurate tissue sampling and providing guidance to the surgeon during excision. (8)
Biopsy and histologic examination must be done in patients with surgically significant discharges to rule out cancer or precancerous mastopathy. The exception to this is the near term patient who does not have a mass or adverse cytologic findings. In these patients, the discharge, which is most often bloody, is usually due to vascular engorgement and, in most cases, it will clear up within a few weeks after delivery when the engorgement subsides. Of course, if it persists, a biopsy is recommended.(9)
Treatment of nipple include:Treatment for breast infections, hypothyroidism, and pituitary tumors.Changing any medications that caused the discharge.Abnormal findings on a mammogram or breast ultrasound will be biopsied and often removed.Most women with breast discharge who have a normal mammogram, breast ultrasound, and physical examination can be followed safely over 1 - 2 years with a mammogram and physical examination repeated during that time..(10)