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Re: chcolate cyst/armpit pain

From: Hannah (anonymous@obgyn.net)
Mon, 19 Nov 2001 14:15:09 -0500 (EST)

Dear Madge-

Like you, I have not heard the term "chocolate cyst" used in the context of breast--only re: the ovaries. I have not seen the term used in the medical literature. This does not mean it isn't true, just that I have never seen it. In any case, I would certainly be concerned, like you, if the discharge persisted. While there are cysts that drain themselves out through the nipple, the fluid is usually dark green or yellow-brown. Bloody fluid may indicate a growth, such as a papilloma (benign); less often, it may indicate a small, early cancer. If the discharge persists, if it is coming from a single duct, if a slide done of the discharge comes back with anything other than cyst fluid, the best approach would be a diagnostic workup. Some surgeons may order a "ductogram"--a picture of the breast after a contrast material has been injected into the offending duct. Others may go straight to duct excision, using a small probe to localize the offending duct and then removing the area of breast tissue along this duct. Again, these are done for persistent, unilateral, uniductal breast discharges. Hannah Brooks, MD, FACS

------------------ Reply Separator -------------------- Originally From: madge@ap.net (Madge) ------------------ Reply Separator -------------------- Subject: chcolate cyst/armpit pain ------------------ Reply Separator -------------------- Date: 11/19/2001 00:32am

I had what looked like a bloody discharge from my right nipple in June. A mammogram came out normal, and no lump was felt upon examination. The surgeon said there was a fullness behind the nipple, and said this was part of fibrocystic breast disease, and that the discharge was from a 'chocolate cyst', and that the discharge was not in fact blood. It was a bit darker than blood, actually. Upon searching for info about chcolate cysts, I have only found reference to them in relation to ovaries, not to breasts.

The surgeon said no biopsy was required, and told me to avoid coffee & vit. E. I've since read that vit. E is in fact recommended in the management of fibrocystic disease. ??? Also, I've determined that, at age 49, I am estrogen dominant, and since beginning to use transdermal natural progesterone cream, the pain in my armpit has subsided considerably. However, it still comes & goes.

I'm at a loss whether or not to pursue further diagnostic measures, such as ultrasound. The surgeon was able to squeeze a drop of the discharge out of my nipple, but did not send it to a lab for scrutiny. This worries me. Should I pursue this?

I'm assuming that my hormones are on the move right now, being perimenopausal. I just don't know whether it's safe to assume that the breast situation is benign.

thanks, Madge

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