Nipple Abnormalities

CLINICAL DIAGNOSIS MANUAL

Nipple abnormalities can be indicative of a variety of pathological conditions, ranging from benign infections to malignant cancers.

These abnormalities may present in various forms, including changes in appearance, abnormal discharges, pain, or structural alterations of the nipple and areola. A thorough evaluation is crucial to determine the underlying cause of these alterations and to plan appropriate treatment.

Pathology	Symptoms and Clinical Signs	Diagnosis of Suspicion	Diagnosis of Confirmation
Paget’s Disease of the Nipple caused by Carcinoma	Itching, burning, pain in the nipple. Erythema, exudation, ulceration of the nipple and areola, possible nipple retraction.	Clinical history and physical examination. Suspicion due to characteristic appearance of the nipple.	Nipple skin biopsy. Mammography and MRI to assess extent.
Duct Ectasia and Chronic Infection	Pain, tenderness in the nipple, breast discharge. Dilated mammary ducts, periareolar inflammation, purulent discharge.	Clinical history and physical examination. Suspicion due to discharge and pain.	Discharge culture. Breast ultrasound.
Ductal Papilloma	Bloody nipple discharge, sometimes pain. Palpable mass in the mammary ducts.	Clinical history and physical examination. Suspicion due to bloody discharge.	Ductography. Fine needle aspiration biopsy (FNA).
Mammary Fistula	Pain, inflammation, persistent discharge. Presence of a fistula in the nipple with chronic discharge, inflammation.	Clinical history and physical examination. Suspicion due to chronic discharge.	Discharge culture. Breast ultrasound to assess extent.