title: Bloody nipple discharge as a benign, self-limiting disorder in young children: A systematic review including two related case reports.
abstract: OBJECTIVE
  Bloody nipple discharge (BND) is rare, distressing for parents, and presents a challenge for physicians.
  
  
  METHODS
  We used PubMed to search for cases of BND that were diagnosed before adolescence and added data from two of our cases.
  
  
  RESULTS
  The analyzed cohort comprised 46 patients (28 boys and 18 girls; mean [SD] age, 12.5±13.3months; range, 20days to 4years). The mean time for spontaneous resolution was 2.8±2.4months (range, 1week to 8months) after onset of BND without any intervention. The diagnosis was mammary ductal ectasia (MDE) in 15 patients, gynecomastia with MDE in two patients, hemorrhagic cysts in two patients, and gynecomastia alone in one patient. The majority (89.3%) of patients <1year old were managed conservatively, but half of them aged >1year (50.0%) underwent surgery. Surgery was performed more often in patients in whom a mass had been identified.
  
  
  CONCLUSIONS
  Age and findings at physical examination affect selection of treatment, but not sex. We found no reported cases of malignancy. Symptoms in children who are managed conservatively resolve within 10months. Children with BND should be conservatively managed to avoid the risk of developing breast deformities before adolescence.
authors.affiliation: Department of Pediatric Surgery, Faculty of Medicine, Başkent University, 6th Road, 70/1, 06490, Bahçelievler, Ankara, Turkey. Electronic address: tugba_acer@yahoo.com.
authors.forename: Tuğba
authors.initials: T
authors.lastname: Acer
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Başkent University, 24 Temel Kuğuluoğlu Street, 06490, Bahçelievler, Ankara, Turkey. Electronic address: murat_derbent@yahoo.com.
authors.forename: Murat
authors.initials: M
authors.lastname: Derbent
authors.affiliation: Department of Pediatric Surgery, Faculty of Medicine, Başkent University, 6th Road, 70/1, 06490, Bahçelievler, Ankara, Turkey. Electronic address: akgunh@baskent-ank.edu.tr.
authors.forename: Akgün
authors.initials: A
authors.lastname: Hiçsönmez
mesh_terms: D001941:Breast Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D002675:Child, Preschool; D015331:Cohort Studies; D003560:Cysts / Q000150:complications; D004108:Dilatation, Pathologic / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D005122:Exudates and Transudates / Q000378:metabolism*; D005260:Female; D006177:Gynecomastia / Q000150:complications / Q000175:diagnosis; D006801:Humans; D007223:Infant; D008297:Male; D009558:Nipples / Q000378:metabolism* / Q000473:pathology; D010290:Parents; D010808:Physical Examination
keywords: Bloody nipple discharge; Children; Infants; Mammary ductal ectasia