The Open Access Journal of Science and Technology AgiAl Publishing House Vol. 2 (2014), Article ID 101037, 5 pages http://www.agialpress.com/ doi:10.11131/2014/101037 Case Report Pathological Nipple Discharge Sala Abdalla 1 , Louis Savage 1 , Yazan Masannat 1 , Sarah E. Pinder 2 , Ian S Fentiman 1 , and Hisham Hamed 1 1 Department of Breast Surgery, Guy’s Hospital, Great Maze Pond, London, SE1 9RT, United Kingdom 2 Department of Breast Pathology Research, Academic Oncology, King’s College London, Guy’s Hospital, Great Maze Pond, London, SE1 9RT, United Kingdom ∗ Corresponding Author: Yazan Masannat; email: yazanmas@hotmail.com Received 13 October 2013; Accepted 4 May 2014 Academic Editor: Marco Picichè and Jaques Waisberg Copyright © 2014 Sala Abdalla et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract. Introduction: Pathological nipple discharge is usually of benign aetiology but cancer may be the underlying cause in up to 20% of the presentations. The diagnostic value of discharge cytology and signicance of presence of blood remains a topic of interest. Our study sets out to review the distribution of histopathology and diagnostic application of blood-staining and cytology in pathological nipple discharge. Methods: We performed a retrospective analysis of those patients that had surgery for pathological nipple discharge. The hospital’s electronic medical records and breast cancer information systems were used to identify our study cohort. Parameters evaluated included patient demographics, radiological assessment, if discharge was blood-stained and histological/cytological analysis. Results: Of 123 patients, intraductal papilloma was the leading diagnosis ( = 62) followed by duct ectasia ( = 34). Carcinoma in-situ and invasive carcinoma occurred in nine cases. Seventy-one patients presented with blood-stained nipple discharge of which 41 had a diagnosis of intraductal papilloma, 17 had duct ectasia, and seven cases were due to carcinoma. Two cases of cancer were negative for blood. Cytology was done only in 23 patients and was not diagnostic of carcinoma and identied intraductal papilloma in only 3 cases. Conclusion: This study supports the generally accepted view that cytology has very poor sensitivity for detecting breast cancer and has therefore very limited diagnostic value. Nipple discharge that is negative for blood is still associated with cancer. It also conrms that intraductal papilloma is the leading cause of pathological nipple discharge. Keywords: Breast cancer, nipple discharge, cytology, papilloma 1. Introduction Spontaneous nipple discharge (SND) is a relatively common manifestation of breast disease, accounting for up to 5% of overall breast symptoms [1, 2]. Bilateral nipple dis- charge involving multiple lactiferous ducts is usually non- pathological and reported by up to 90% of these patients [3–5]. Conversely, pathological nipple discharge (PND) is typically spontaneous, unilateral, uniductal and may be serous or bloody, the latter either overt or occult [1, 3–5]. While the commonest cause of PND is intraductal papilloma (IDP), responsible for nearly 40% of cases [3], an underlying malignancy, usually ductal carcinoma in-situ (DCIS), has a reported incidence of 4-20% [6–9]. The likelihood of malignancy is greater in women over the age of 50 or those presenting concurrently with a palpable mass [4, 5, 8, 10]. Until 2010 the consensus was that all women with PND should have mammography if they were over the age of 35 years in order to identify ipsilateral lesions [11]. However, in the Association of Breast Surgery’s diagnostic guidelines document published in November 2010 the recommended age for mammography was revised to patients over 40 years of age [12]. Ultrasound scan may be helpful in visualising retro-areolar lesions that can potentially be biopsied. Other