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PubMed2003

[Primary malignant lymphoma arising from the nipple and areolar area of the breast].

A 56-year-old woman noticed soreness and swelling in the right nipple. Two weeks later, she noticed a mass in the outer lower region of the right areolar area, which was excised and the pathology of which was consistent with diffuse large B cell lymphoma (DLBCL). She was admitted when the right nipple mass was noted to be increasing, and was diagnosed as having stage I lymphoma. Her nipple mass was excised, and the pathology was consistent with DLBCL. CHOP therapy was administered three times and she was judged as having complete remission. Malignant lymphoma accounts for 0.15-0.17% of primary breast malignancies. Though the nipple and areolar area seem to be a rare primary site, this should be recognized as a sentinel zone for malignant lymphoma.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2004

Patients with Paget disease of nipple and with palpable mass in breast have unfavorable prognosis.

Recent data indicate that in breast cancer patients the presence of Paget disease of the nipple may be related to poor prognosis. Therefore, we decided to assess long-term results of the treatment of such patients, and to assess the relationship between the physical and pathological findings and prognosis. The files of 60 patients with Paget disease of the nipple who were treated between 1977 and 2000 were analyzed retrospectively with respect to the results of physical and pathologic examinations, disease recurrence and survival. In 38/60 patients, the cancer was invasive. In 26/60 patients, palpable masses in the breast were diagnosed. The 5-year overall survival probability was 0.68; the probability was 0.82 for patients without palpable masses, 0.51 for those with palpable masses, 0.91 for patients without invasive cancer and 0.58 for patients with associated invasive cancer. In conclusions, patients with Paget disease of the nipple and with palpable mass in the breast had unfavorable diagnosis. The nature of all nipple changes should be explained as early as possible in order to diagnose the disease when no mass is palpable in the breast.

Adult↗

PubMed1992

[Clinical usefulness of carcinoembryonic antigen measurement in nipple discharge as an adjunctive tool for diagnosis of breast cancer].

We measured carcinoembryonic antigen (CEA) in 43 cases with abnormal nipple discharge by means of enzyme immunoassay utilizing monoclonal anti-CEA antibodies. When the cut-off value was set at 400 ng/ml so that the cases where measured values are not less than this value may be interpreted to be positive, the sensitivity and specificity were 60% and 75% respectively. The clear relationship was virtually observed between the concentration of CEA in nipple discharge and the cytological diagnosis. 9 of 10 malignant cases showed positive in both or either of the CEA assay and the cytological examination. And we could find 1 case of the zero stage of breast cancer and 4 cases in non-invasive carcinoma (Tis) through the combined diagnosis. On the other hand, only 2 of 8 benign cases showed false positive results. The correlation between the CEA concentration in nipple discharge and intratumoral expression of CEA was also observed. In this study, we concluded that the combined use of the enzyme immunoassay and the cytological examination would be more effective in the detection of early breast cancer accompanied with abnormal nipple discharge.

Adult↗

PubMed2005

[Pseudolymphoma of the breast nipple. The problem overview].

Clinical, pathological, and molecular-genetic features as well as etiology of cutaneous pseudolymphoma (CPL, cutaneous lymphoid hyperplasia, lymphocytoma cutis) of the breast nipple are summarized. CPL presents as a nipple induration and it is often suspected to be Paget carcinoma pre-operatively. Histologically, atypical microscopic features of a dense lymhoid infiltrate with follicles often mislead to the diagnosis of a malignant lymphoma. However, CPL runs a benign course. Rare cases of CPL contain a clonal lymphoid population. A substantial number of CPL in the breast nipple is caused by antigenic stimulation by Borrelia burgdorferi. In some patients a tick bite is documented. CPL of the breast is commonly treated by excision, but some patients may be cured by antibiotic therapy. The presence of Borrelia burgdorferi should be detected using methods of serology, culture, and molecular biology. Beside CPL, the differential diagnosis of the breast nipple lesions further includes Paget carcinoma, eczema, and florid papillomatosis.

Adult↗

PubMedDate not supplied

[The influence of breastfeeding technique on the frequencies of exclusive breastfeeding and nipple trauma in the first month of lactation].

OBJECTIVE: To investigate the influence of breastfeeding technique on the frequencies of exclusive breastfeeding and nipple trauma in the first month of lactation. METHODS: We searched for unfavorable parameters of breastfeeding (five related to mother/baby positioning and three related to baby's latch on) in 211 mother-baby pairs in the maternity ward and at day 30, at home. We compared the frequencies of these parameters between mothers practicing or not exclusive breastfeeding at days 7 and 30, and between mothers with or without nipple trauma at the hospital. RESULTS: The number of unfavorable parameters in the maternity ward was similar for mother-baby pairs practicing or not exclusive breastfeeding at day 7 and 30. However, at day 30, it was, on average, lower among those under exclusive breastfeeding, regarding positioning (1.7+/-1.2 vs 2.2+/-1.1; p = 0.009) as well as latch on (1.0+/-0.6 vs 1.4+/-0.6; p < 0.001). The number of unfavorable parameters related to latch on in the maternity ward was similar for women with or without nipple trauma, but women without trauma presented a higher number of unfavorable parameters related to positioning. (2.0+/-1.4 vs 1.4+/-1.2; p = 0.04). CONCLUSIONS: The frequencies of exclusive breastfeeding in the first month and of nipple trauma were not influenced by the breastfeeding technique in the maternity ward, but there was an association between a better technique at day 30 and the practice of exclusive breastfeeding. New studies may help to elucidate whether an improvement in breastfeeding practices over time helps the maintenance of exclusive breastfeeding or whether the introduction of bottle-feeding determines a negative effect on breastfeeding.

Adult↗

PubMed2004

Paget's disease of the nipple diagnosed on cytology: a case report.

Paget's disease of the breast nipple is an eczematous skin change of the nipple-areola complex often associated with an underlying in-situ or invasive carcinoma. The usefulness of cytology in the diagnosis of Paget's disease has been suggested only in few studies despite the fact that it offers definitive advantages over surgical excision biopsy. Easy practicability, quick, cost-effective and non-invasive stands opposite a limited sensitivity as disadvantage. We report a case of Paget's disease of nipple diagnosed by nipple touch smears.

Biopsy, Fine-Needle↗

PubMed2006

[Nipple confusion and breastfeeding: a literature review].

Among the ten steps to successful breastfeeding advocated by the WHO and UNICEF, steps six and nine clearly state that formula supplementation and pacifier use, except when medically necessary, should be avoided. Early formula supplementation may not only interfere with the mother's lactation but also result in nipple confusion on the part of the baby. To avoid nipple confusion, the encouragement of cup feeding and the non-provision of pacifiers or bottles are required nursing practice in baby-friendly hospitals. However, the relationship between nipple confusion and the duration of breastfeeding has not been well examined. The purpose of this paper is to explore the relationships between three methods of feeding (i.e. pacifier, bottle feeding, and cup feeding), nipple confusion, and duration of breastfeeding. A hypothetical framework is proposed to explain these relationships on the basis of a review of the literature.

Bottle Feeding↗

PubMed1976

Involvement of the nipple and areola in carcinoma of the breast.

The records of all patients in whom a mastectomy was performed for carcinoma of the breast at this clinic during a recent two year period were reviewed, and the gross specimens were re-examined to study the incidence of cancerous involvement of the nipple and areola and related local clinical findings. Cancer was present in the nipple or areola, or both, in 12.2 per cent of the specimens. When the nipple and areola were clinically normal, involvement of the nipple and areola by carcinoma was rare if the primary tumor was less than 2 centimeters in diameter and was not situated behind the areola.

Adenocarcinoma, Mucinous↗

PubMed1990

Paget's disease of the nipple. A continuing enigma.

Paget's disease of the nipple, although recognized since 1874, remains in several respects enigmatic. The two main theories of its origin are 1) epidermotropic, i.e. ductal cancer cells migrating to the epidermis of the nipple, and 2) in situ appearance of malignant keratinocytes expressing the multicentricity of breast cancer. The literature is reviewed. Clinical, histologic (including classification), histochemical and electron microscopy observations and diagnostic considerations are discussed. Diagnosis is often delayed, with adverse consequences for treatment. The nipple lesions may be accompanied by ductal carcinoma of local or more extensive in situ type, or invasive tumour. Lymph-node metastasis seems to be the most important prognostic factor. The merits of radical vs. modified radical mastectomy and local excision, with or without adjuvant radiotherapy, are considered. Major studies of breast-conserving management of Paget's disease of the nipple are in progress.

Breast Neoplasms↗

PubMed1990

[Erosive adenomatosis of the nipple. Report of 10 cases with immunohistochemistry].

Erosive adenomatosis of the nipple (also called florid papillomatosis of the nipple ducts) is an uncommon disease since only 358 cases have been published. We observed 10 cases in 10 years, corresponding to 1 case in 8,500 skin biopsies. One of these cases concerned a male patient and is the 13th of this kind in the literature. In our series the mean duration of symptoms was 15 months, as against 25 months in the 121 published cases where duration was clearly specified. In 8 of our 10 cases the patients consulted for oozing erosion or discharge of the nipple. Physical examination showed a palpable nodule in 2 cases, a small pediculate tumour in 1 case and nipple enlargement in 50 p. 100 of the cases. The patients were followed up for as much as 7 years. The outcome was always favourable. Recurrence was observed in only one patient, 7 months after limited excision; 6 years after a second excision no relapse was noted. Histological examination showed a papillomatous lesion in 5 cases, an adenomatous lesion in 2 cases and a mixed lesion in 3 cases. Myoepithelial cells were found in all cases, but they were doubtful or discreet in 4 cases. The apical pole of columnar cells was labelled by the ACE antibody, but labelling was very weak and partial in 4 cases. The columnar cell cytoplasm was constantly and strongly labelled by the KL1 anti-keratin antibody. The apical pole of parietal cells was strongly labelled by the antiepithelial membrane antigen antibody (EMA) in all cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma↗

PubMedDate not supplied

Nipple discharge cytology in mass screening for breast cancer.

Since 1977 mass screening for breast cancer has been conducted in Miyagi Prefecture, Japan; inspection, palpation and cytologic examination of any nipple discharge are part of the initial screening procedures. Among 149,681 subjects examined, 404 cancer cases and 63 papilloma cases were detected. The nipple discharges from 20,537 women were examined cytologically; of the 61 cancer cases, the smears were positive in 18 cases, suspicious in 7, negative with atypical findings in 12 and negative in 24. Ten of the cancer cases were detected exclusively by the cytologic examination of a nipple discharge. In eight of these ten cancer cases, there was no other initial evidence of the primary tumor. The cytologic diagnosis of discharges without blood from 28 cancer cases was positive or suspicious in 10 cases and negative in 18. Thirty-seven of the papilloma cases were initially detected only by the cytologic examination of a nipple discharge; neither physical examination nor mammography showed any abnormal findings.

Adult↗

PubMedDate not supplied

Nipple development in female puberty.

Nipple diameters of 230 girls aged between 11-17 were calculated with the aim of finding measurable criteria for breast development during female puberty. There was a significant increment in nipple diameters in each breast and pubic hair stage with respect to the previous stages. The maximum increment was found to be from B 1 to B 2 (2.44 mm), and from PH 1 to PH 2 (2.69 mm). With respect to menstrual status, the greatest growth in nipple diameter occurred from the premenstrual period (M(-)) to one year postmenarche (M +1) (2.35 mm). These results are compared with other studies in the literature, and it was concluded that increments in nipple size in each pubertal stage is related to the hormonal status as well as to race, nutrition and genetics. More longitudinal and cross-sectional data are needed in order to find a measurable criteria for the Tanner breast stages.

Adolescent↗

PubMed1989

Involvement of the nipple in early carcinoma of the breast.

Cancerous involvement of the nipple and subareolar tissue (nipple and areolar complex, NAC) was confirmed histopathologically in 24 of 65 patients with gross tumors measuring 2.5 centimeters or less. Erosion of the nipple as a clinical manifestation of involvement of NAC was seen in only two patients. The other 22 were all subclinical. The histologic form of involvement of NAC included intraductal-1 in 19 patients, stromal in one patient, lymphatic in two patients and intraductal-1 as well as stromal in two. Stepcut and serial observation of the whole breast suggested that both intraductal spread and stromal invasion of carcinoma were continuous processes from the underlying tumor. Involvement of NAC was more frequent if the patient was aged 50 years or less and if the proximity of the tumor to the nipple was less than 4 centimeters, regardless of the size of the tumor.

Adult↗

PubMed1987

[Paget's disease of the nipple without any associated mammary tumor clinically or radiologically detectable. Apropos of 51 cases treated at the Curie Institute].

Between 1960 and 1984, 51 patients with Paget's disease of the nipple, with no concomitant palpable or radiological breast tumour, were treated at the Institut Curie. The diagnosis was made in all cases through a simple biopsy of the nipple and/or the areola. All slides were reviewed for the present study. 20/51 patients were treated conservatively, with external radiotherapy alone (17/20 pts), or limited surgery and radiotherapy (3/20 pts). The mean age was 54 years (range 40 to 80). The median follow-up was 7.5 years. No patients died of breast disease. Three local recurrences occurred and were treated by mastectomy. All were located in the nipple or areola and were Paget's disease without intraduct or invasive carcinoma. The actuarial probability of living 4.5 years free of disease when the breast is preserved with a good cosmetic result is 81%. 31/51 patients underwent mastectomy; 30 a modified mastectomy, 1 a simple mastectomy. The mean age was 66 years (range 55 to 90). Associated intraduct carcinoma was found in 30/31 microscopic examinations. No axillary node invasion was found after dissection of the axilla. In the group treated by surgery, the median follow-up was 5 years. No patient died of breast disease. No chest wall recurrence occurred. The 5 years disease-free survival rate was 87%. This retrospective non randomized study of 51 patients treated for Paget's disease of the nipple suggests that radiotherapy is a valuable alternative to mastectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

Adenoma of the nipple. Cytopathologic features.

The cytologic appearances of two examples of adenoma of the nipple are described. The cellular samples from both lesions contained large numbers of epithelial cells, which were present both singly and in numerous clusters. The uniform nuclei contained finely distributed chromatin and inconspicuous nucleoli. Some of the cells varied in size and shape; a few had hyperchromatic nuclei. Small amounts of cellular debris, inflammatory cells and hemosiderophages were also present. Adenoma of the nipple can usually be distinguished cytologically from other lesions that may involve the nipple, such as Paget's disease, adenocarcinoma, fibrocystic disease, mammary duct ectasia, intraductal papilloma and chronic subareolar abscess; the cellular features of fibroadenoma, however, overlap those of adenoma and may cause diagnostic confusion. The increasing use of cellular samples obtained from breast lesions underscores the importance of recognizing this uncommon neoplasm and its cytologic manifestations. Adenoma of the nipple can be treated successfully by limited resection, and preoperative recognition will obviate unnecessary extensive surgery.

Adenoma↗

PubMed1988

[Autotransplantation of nipple-areolar complex in a modified radical mastectomy--indications and three-stage breast reconstruction].

Necessity of breast reconstruction after mastectomy has been increasing in recent years. For better reconstruction, we preserve a nipple-areolar complex (NAC) by transplanting it temporarily onto the lower abdominal wall and retransplant it to the restored breast mound in a subsequent operation. Indications for NAC preservation are as follows: (1) by palpation the tumor is found to be smaller than 3.0cm in diameter without apparent regional and distant metastasis, (2) neither abnormal nipple discharge nor nipple retraction is observed, (3) tumor is remote more than 3.0cm from the areolar margin, (4) no abnormal shadows are seen below the nipple and areola in the mammogram, (5) no microscopic extension of the cancerous cells is detected beneath the resected NAC. We have performed 18 transplantations using this procedure with good cosmetic results. There were no recurrent cases due to NAC preservation. It is concluded that this technique for preserving the NAC by autotransplantation is easy to perform and useful for breast reconstruction because of low risk of recurrence and better cosmetic results.

Adult↗

PubMed1988

Nipple-areola reconstruction using intradermal tattoo.

A technique of nipple-areola reconstruction with intradermal tattoo is presented. By using various colors, it is possible to tattoo a nipple-areola complex onto the breast that will have an illusion of projection. This technique alone is acceptable to older patients. In younger patients, or in those in whom nipple projection is desired, a simple technique of using a subcutaneously based nipple pedicle is found to be highly effective.

Breast↗

PubMed1987

[Contrast enhancement of the nipple in nuclear magnetic resonance tomography of the breast with Gd-DTPA].

Contrast enhancement around the nipple has been evaluated retrospectively in 51 of 70 patients in respect of the underlying breast disease. 2 of the patients had to be considered separately because of malignant disease of the nipple or areola itself. The remaining 49 patients showed no close relation between the underlying breast disease and the amount of contrast enhancement in the nipple. This phenomenon of a non-pathological significant contrast enhancement of the nipple appears important to avoid false positive diagnoses in MRI of the breast with Gd-DTPA.

Breast↗