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Sunday, April 20, 2014
Undiagnosed case of bleeding from both breast
I’m a doctor by profession. My niece is a 17 yr old female(body wt-55 kgs, ht-5 feet and 2 inches) is admitted in hospital for Bilateral spontaneous multiduct nipple discharge for last 1 month. Episode-3-4 times a day.Earlier it was sometimes milky and sometimes bloody in nature,but now it is always bloody in nature. The amount of bleeding and intensity of pain is gradually increasing.Pain increases during bleeding..Her menstrual cycle is absolutely normal and regular still now.No swelling or lump or local inflammation or signs of infection noted during examination along with no lymphadenopathy, but only a granular(?) feeling noted as a palpatory findings. She also c/o constipation for 2-3 days at 2-3 months interval(in the remaining time period bowel habit is absolutely normal) followed by watery stool and painless bleeding per rectum for last 1 yr. She is also suffering from an occipital bilateral headache radiating to the forehead associated with severe nausea without vomiting and cramping pain all over abdomen since 6 yrs of age,frequency-once in a month or 2 months, having family history of migraine. She is taking a medicine containing Sodium valproate and valproic acid 200 mg BD for this vascular headache (as diagnosed) and the symptoms reduced. Investigations done-Blood for Hb%,TC,DC,ESR,FBS,PPBS,Urea,Creatinine and complete coagulation profile (Platelets,BT,CT,PT with INR,aPTT) are normal. Blood Prolactin level was 63 ng/ml 20 days ago and she was advised cabergoline(Dopamine agonist) 0.5 mg once in a week, but stopped because the abnormal level now thought due to prolonged intake of Domperidone(combined with PPI). A second blood prolactin level result was subnormal, may be due to prolonged acting cabregoline. So the test will be repeated after 2 wks again. Her thyroid function test is within the lab normal reference range. Urine R/E, M/E,C/S and Stool for R/E and occult blood is also normal. Colonoscopy done shows a minor rectal tear only. USG of both breast is normal, shows ductal prominence only. Chest X-Ray PA and Lateral view normal. CT Scan of Brain- with and without contrast is also normal. Cytology and a PAP Smear test done taking nipple discharge which shows epithelial cells, lymphocytes etc(normal cytology) present in aHaemorrhagic background. No malignancy detected. Now we really don’t know what to do. No one can come to a diagnosis or can’t tell what to be the next step? PLEASE HELP.
Thank you for visiting NetWellness. On this site, we try to answer general questions about breast cancer but cannot diagnose, give second opinion or recommend treatment. If your physicians are unable to provide you with the information you need, you should get a second opinion. Take care.
Jean T Stevenson, MD, FACS
Associate Professor of Surgery
School of Medicine
Case Western Reserve University