Does bloody nipple discharge occur during normal breast development in infancy?

Abstract

Bloody nipple discharge (BND) is a rare finding in neonates and infants. In contrast to BND in adults, BND in infants has been reported as a benign disorder. [1][2][3][4][5][6][7][8][9] Breast carcinoma under the age of three years has not been reported. 3 We report a case of unilateral BND in a 6-month-old boy and describe the cytological findings. An overview of the existing literature on normal breast development and BND and a hypothesis on the pathogenesis of BND is put forward. Case ReportA 6-month-old boy presented with painless unilateral BND (dark brown/red color) for one week. There was no breast hypertrophy. The boy was in good health and had no other complaints. There was no history of local trauma. He was exclusively breast-fed until the age of 4 months. Familial history was negative for bleeding diathesis, breast carcinoma or endocrine disorders. Mild pressure on the areola revealed a few drops of bloody discharge. Cytology of the nipple discharge was performed and showed fat cells, erythrocytes, eosinophils, neutrophils, and macrophages ( Fig. 1). There were no malignant cells. Culture of the fluid was sterile. Ultrasound of the breast revealed dilatation of the glandular ductile system. Mammary duct ectasia was diagnosed. The nipple discharge diminished gradually and resolved spontaneously within two months. Follow up until the age of 12 months was uneventful. Discussion Normal infant breast developmentFew data exist on the development and the growth of the human breast during the first months of life. 10-12 Breast hypertrophy in newborns with or without milky discharge is often seen. This phenomenon is sex independent. It is hypothesized that breast hypertrophy is caused by hormone excess either from maternal origin or from the gonads of the newborn itself. 4,10 McKiernan et al. studied the histology of breast development in infants who died between the age of 3 weeks and 2 years and found well-formed lobules, which contained dilated ducts filled with secretions. Foci of hematopoiesis were present. 10 Two other studies reported that development of the mammary ducts seemed to follow a certain chronology: cystic dilatation followed by regression with accumulation of eosinophilic and inflammatory cells around the basement membrane.

Bloody nipple discharge in infancy—report of two cases: Figure 1

“…Moreover, all reported cases of children submitted to total subcutaneous mastectomy showed histological findings compatible with mammary duct ectasia 2 3. This suggests that an expectant line of management would be appropriate in this age group.…”

“…Although many factors including maternal hormonal stimulation, congenital abnormalities of the nipple and duct system, infection, trauma or autoimmune reaction have been implicated, neither was confirmed 1 3 5. There is a wide range of age at presentation, with infants as young as 6 weeks presenting with the disease 2. This condition is more prevalent in the male gender with a male-to-female ratio of 11:4 which contrasts to the reported female sex predilection in the adult population 1–6.…”

“…This benign phenomenon is linked with placenta-transmitted maternal and fetal hormones and relates to the hormonal adaptation process that occurs in the first months of life 1 2. In contrast, bloody nipple discharge (BND) is an extremely uncommon entity in childhood and relates mostly to benign processes such as mammary duct ectasia.…”

“…In contrast, bloody nipple discharge (BND) is an extremely uncommon entity in childhood and relates mostly to benign processes such as mammary duct ectasia. However, this is a distressing condition to both parents and physicians because of its association with breast carcinoma in adulthood 2. This may lead to unnecessary diagnostic approach and treatment.…”

Spontaneous Brownish Nipple Discharge in a 9‐Year‐Old Boy

“…Bloodstained nipple discharge is an extremely uncommon but distressing finding in children. Although milky nipple discharge is frequently seen in neonates and infants, usually associated with a palpable breast enlargement (linked to maternal hormones in the first months of life), brownish nipple discharge is rarely seen in children . Berkowitz and Inkless first reported bloody nipple discharge in two neonates in 1983.…”