Clinicopathological Characteristics and Surgical Outcomes of Women with Nipple Discharge and Palpable Breast Masses: A 20-Year Retrospective Study in Yemen

Abstract

Background: Although nipple discharge is frequently associated with benign breast conditions in high-income countries, its clinical implications may differ in resource-limited settings where delayed presentation and limited access to organized breast cancer screening are common. In Yemen, many patients seek care at private surgical centers only after symptoms have progressed. This study aimed to evaluate the clinicopathological characteristics and surgical outcomes of women presenting with concurrent nipple discharge and palpable breast masses at a private surgical center over a 20-year period.

Materials and Methods: This retrospective cohort study included 37 female patients who presented with both a palpable breast mass and pathological nipple discharge at Al-Nasar Hospital, Ibb, Yemen, between January 2004 and August 2024. All patients underwent clinical assessment and breast imaging followed by definitive surgical management. Final diagnoses were established by postoperative histopathological examination. Clinicopathological characteristics and surgical outcomes were analyzed descriptively.

Results: The mean patient age was 48.2 years, and most patients were 40–60 years old (59.5%, n = 22). Sanguinous nipple discharge was the most common presentation (51.4%, n = 19), followed by serosanguinous (29.7%, n = 11) and serous discharge (18.9%, n = 7). Fourteen patients (37.8%) presented with malignant fungating breast wounds, indicating locally advanced disease. Histopathological examination identified invasive ductal carcinoma in 29 patients (78.4%). Grade III tumors were observed in 11 patients (29.7%), while axillary lymph node involvement was documented in 19 (51.4%). Modified radical mastectomy was the most frequently performed procedure (56.8%, n = 21), reflecting the advanced stage of disease at presentation.

Conclusion: Among women presenting to this private surgical center in Yemen, the combination of a palpable breast mass and pathological nipple discharge was frequently associated with advanced breast malignancy requiring extensive surgical treatment. The high proportion of patients presenting with malignant fungating wounds suggests substantial delays in diagnosis and referral. These findings highlight the importance of timely surgical evaluation and improved integration of private surgical services with multidisciplinary oncologic and palliative care to facilitate earlier diagnosis and improve patient outcomes.