Bloody Nipple Discharge in Children: Single-Center Experience

INTRODUCTION: Bloody nipple discharge (BND) in children is an exceptionally rare entity. The aim of the study was to evaluate the underlying etiologies, treatment strategies, and clinical outcomes in children with BND.
METHODS: The retrospective study included pediatric patients (aged below 18 years) who presented with BND in our clinic between May 2015 and May 2020. Demographic and clinical characteristics including age, gender, laboratory, ultrasound (US), and histopathological findings, treatment modalities, and follow-up records were evaluated for each patient.
RESULTS: Patients comprised six (75%) girls and two (25%) boys. Median age at diagnosis was 15 years (minimum-maximum: 3–192 months) and all the girls were adolescents. BND was located in the left breast in five and in the right in three patients, and bilateral BND was not detected in any patient. All patients had normal serum hormone levels and a negative discharge culture. In US examination, mammary ductal ectasia (MDE) was diagnosed in two patients, one patient had hypoechoic tissue in the subareolar region, whereas the others had normal US findings. Cytology showed ductal epithelial cells without malignancy, which confirmed MDE in all patients. BND resolved with antibiotic treatment in one patient and resolved with no treatment in other patients.
DISCUSSION AND CONCLUSION: BND can occur in adolescent girls as well. MDE is a leading cause of BND. Given that MDE is usually a self-limiting condition, unnecessary invasive interventions should be avoided. Cytological and US examinations seem to be highly useful in the diagnosis and follow-up of patients with BND.