Differential Diagnosis for Blood Nipple Discharge

• Single most likely diagnosis
  • Intraductal papilloma: This is the most common cause of bloody nipple discharge, accounting for approximately 50% of cases. It is a benign tumor that grows in the milk ducts of the breast and can cause bleeding, leading to bloody discharge.
• Other Likely diagnoses
  • Ductal carcinoma in situ (DCIS): This is a type of non-invasive breast cancer that can cause bloody nipple discharge. It is less common than intraductal papilloma but still a significant consideration.
  • Breast cancer (invasive): Invasive breast cancer can also cause bloody nipple discharge, although it is less common than DCIS or intraductal papilloma.
  • Fibrocystic changes: Hormonal fluctuations can cause fibrocystic changes in the breast, leading to ductal ectasia, which may result in bloody nipple discharge.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Inflammatory breast cancer: This is a rare and aggressive form of breast cancer that can cause bloody nipple discharge, among other symptoms. It is crucial to consider this diagnosis due to its poor prognosis if left untreated.
  • Paget's disease of the breast: This is a rare form of breast cancer that affects the skin of the nipple and areola, potentially causing bloody discharge.
• Rare diagnoses
  • Breast hemangioma: A benign vascular tumor that can cause bloody nipple discharge, although this is extremely rare.
  • Endometriosis of the breast: Endometrial tissue can rarely implant in the breast, leading to cyclical bloody nipple discharge.
  • Tuberculosis of the breast: Although rare in many parts of the world, breast tuberculosis can cause a variety of symptoms, including bloody nipple discharge, especially in endemic areas.