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Chemical lavage of the nipples of anesthetized maternal rats virtually eliminated suckling by their 4- to 5-day-old pups. Normal suckling was immediately reinstated, however, by painting a vacuum distillate of the wash or of pup saliva onto the nipples. Thus, a substance necessary to direct and release suckling, possibly rat pup saliva, appears to coat the nipple surface.
PURPOSE: To investigate the potential of magnetic resonance (MR) imaging in patients with nipple discharge. MATERIALS AND METHODS: Between February 1992 and December 1998, 23 patients with nipple discharge underwent contrast material-enhanced MR imaging at 1.5 T. Mammographic findings were negative in 22 of 23 patients and revealed asymmetry in one patient. Galactography was attempted in two patients, with negative findings in one patient and no success in the other. Fifteen of 23 patients underwent excisional biopsy-seven of 15 with MR imaging-guided localization, and one of 15 with mammographic localization. Eight of 23 patients were followed up clinically (range, 7-24 months; mean, 20 months). RESULTS: In 11 of the 15 (73%) patients who underwent excisional biopsy, MR imaging findings correlated with histopathologic findings. MR imaging demonstrated four of six benign papillomas and one of two fibroadenomas as circumscribed, enhancing subareolar masses. Findings of one MR imaging examination were negative, and benign tissue was found at excisional biopsy. MR imaging findings were suspicious in six of the seven patients with excisional biopsy findings of malignancy (regional enhancement [n = 2], ductal enhancement [n = 2], peripherally enhancing mass [n = 1], and spiculated mass [n = 1]). In one of the seven patients, a benign-appearing intraductal mass was identified at MR imaging; excisional biopsy revealed a benign papilloma with an adjacent focus of DCIS. CONCLUSION: MR imaging can help identify both benign and malignant causes of nipple discharge. It potentially offers a noninvasive alternative to galactography.
PURPOSE: New approaches to the early detection of breast cancer are urgently needed as there is more benefit to be realized from screening. Nipple aspiration is a noninvasive technique that yields fluid known to contain breast epithelial cells. Silencing of tumor suppressor genes such as p16(INk4a), BRCA1, and hMLH1 have established hypermethylation as a common mechanism for tumor suppressor inactivation in human cancer and as a promising target for molecular detection. EXPERIMENTAL DESIGN: Using sensitive methylation-specific PCR, we searched for aberrant promoter hypermethylation in a panel of six normally unmethylated genes: glutathione S-transferase pi 1 (GSTP1); retinoic acid receptor-beta2 (RARbeta2); p16(INk4a); p14(ARF); RAS association domain family protein 1A (RASSF1A); and death-associated protein kinase (DAP-kinase) in 22 matched specimens of tumor, normal tissue, and nipple aspirate fluid collected from breast cancer patients. RESULTS: Hypermethylation of one or more genes was found in all 22 tumor DNAs (100% diagnostic coverage) and identical gene hypermethylation detected in 18 of 22 (82%) matched aspirate fluid DNAs. In contrast, hypermethylation was absent in benign and normal breast tissue and nipple aspirate DNA from healthy women. CONCLUSIONS: Promoter hypermethylation of important cancer genes is common in breast cancer and could be detected in matched aspirate DNAs from patients with ductal carcinoma in situ or stage I cancer. Promoter hypermethylation represents a promising marker, and larger studies may lead to its useful application in breast cancer diagnosis and management.
OBJECTIVE: To determine the cytomorphologic spectrum of nipple discharge in florid gynecomastia. STUDY DESIGN: During a 22-year period (July 1979-June 2001), nipple discharge from nine males with breast lesions were examined. Smears from four of these cases with histologically documented gynecomastia were reviewed along with the tissue sections. RESULTS: In the three patients with florid gynecomastia the smears were cellular, with numerous benign ductal cells and papillary fragments along with foam cells and inflammatory cells. Epithelial atypia was mild in two cases and moderate in one. One of the three cases had an associated breast lump that showed features of florid gynecomastia on fine needle aspiration cytology. The biopsy from this case showed cystic hyperplasia of the breast similar to that in women with an intraductal papilloma. One case of simple gynecomastia on histology showed two fragments of benign ductal cells with occasional apocrine and foam cells. CONCLUSION: Nipple discharge in florid gynecomastia may pose problems in identification as the cellularity and atypia may lead to a misdiagnosis of carcinoma.
OBJECTIVE: To increase cytodiagnostic accuracy for women with spontaneous nipple discharge using a simple intraductal aspiration method. STUDY DESIGN: We compared the cytodiagnostic accuracy of the conventional squeezing collection method and intraductal aspiration by intravenous catheter in a total of 146 women with spontaneous nipple discharge in a single duct without a mass; they had been pathologically identified at Kaohsiung Medical University Hospital. RESULTS: Adequate specimens were collected in 96.6% (141/146 cases) of the sample by the intraductal aspiration method as compared to 76.0% collected by the conventional squeezing method (P < .05). An adequate specimen should consist, at a minimum, of six cohesive clusters of well-preserved epithelial cells, with each cluster composed of at least five cells other than foam cells. The cytologic diagnosis was divided into five categories: positive in 9 cases, suspicious in 10, negative with atypical findings in 59, negative in 33 and inadequate specimens in 35 cases that employed the squeezing method. These results were less satisfactory than with the intraductal aspiration method: the smears were positive in 17 cases, suspicious in 14, negative with atypical findings in 78, negative in 32 and inadequate specimens in 5. Our results showed a sensitivity of 92.3% and specificity of 93.9% for the intraductal aspiration method as compared to a sensitivity of 52.9% and specificity of 89.3% for the squeezing method. Among the 27 cancers in this series, correct cytodiagnosis, including suspicious cases, was made in 24 cases by intraductal aspiration, with an accuracy of 88.9%, as compared to the 33.3% (9/27) accuracy of the squeezing method (P < 0.5). CONCLUSION: For patients with spontaneous nipple discharge, the intraductal aspiration method provides much more accurate cytodiagnosis than does the conventional squeezing method.
A clinical and galactographic investigation was carried out on 103 patients with hematic, serous-hematic, and serous nipple discharge. The age of the patients ranged from 18 to 72 years. A single papilloma was found in 20 cases, diffuse papillomatosis in 2 cases, atypical ductal hyperplasia in 8 cases, and ductal carcinoma in 4 cases (3 of these were infiltrating and 1 was noninfiltrating associated with a diffuse papillomatosis). Mammography gave no indications of carcinoma in any of the 4 cases. In the remaining 49 patients, pictures of ductal hyperplasia, periductal mastitis or sclerosis, sclerosing adenosis, or ductal ectasia were observed. The various types of lesions were often associated. Lacunae, stenosis, or occlusion of the ducts, evidenced by galactography, correlated well with the histologic findings of proliferative lesions of the ductal epithelium. Nevertheless, in practice, it should be the type of discharge that indicates surgery rather than galactographic or cytologic data, which appeared to have little diagnostic value. The frequency with which preneoplastic (or limit) lesions, and also nonsuspect carcinomas were found in patients with a significant nipple discharge confirm the importance of this symptom for a secondary prevention of early diagnosis of mammary neoplastic lesions originating from galactophorous ducts. Finally, complete resection of the galactophorous ducts must be considered as the best treatment in all patients with a suspicious nipple discharge that requires surgery.
To obtain detailed information about the histological changes occurring in the mouse nipple during the reproductive cycle, we examined and quantified the S-phase of cell by immunohistochemical staining with bromodeoxyuridine (BrdU), and analysed histologically the subepithelial fibrous elements. The nipple markedly increased in size dramatically on days 15-18 of pregnancy. The densities of cells in the epidermis and dermis were very high during the early stages of pregnancy but low during lactation. In the epithelium of the lactiferous sinus, the densities of cells did not differ significantly among stages. The BrdU antibody labeling revealed a number of BrdU-positive cells in the basal layer of the epidermis and epithelium of the lactiferous sinus. The ratios of BrdU-positive cells to total cells in the epidermis and the epithelium of the lactiferous sinus were highest on day 15 and day 10 of pregnancy, respectively. After lactation, however, the ratios were similar to those in the virgin stage. No significant differences were detected in the dermis among all stages. The number of collagen and elastic fibers increased during lactation. These results indicate that cells in the epidermis and lactiferous sinus proliferated actively from day 10 to day 15 of pregnancy. The observation that cellular proliferation in the epithelial system of the nipple was stimulated at the early stage of pregnancy, while the dermis has two growth phases, with cellular proliferation during pregnancy and an increase in extracellular matrix during lactation, suggests that these two phenomena might be regulated by different factors.
Our objectives were to verify the occurrence of nipple damage, according to the newborn and mother characteristics; to characterize the suction pattern of newborn, whose mothers present nipple damage. The sample was of 1020 lactating women and their infants, and of them, 84 were followed up by the researcher. It was verified that the gestational age of the newborn, the skin color, parity and the type of anesthesia received by the mothers during the labor were statistically significant for the occurrence of nipple damage. Only 5.95% of the newborn revealed appropriate grasp and dynamic suction, increasing to 43.33% at the first appointment after hospital discharge. The most of women presented complete healing of lesion from 5 to 6 days postpartum, this indicate that this period of a week is critical, when the mother needs stimulation and follow-up to the maintainance of lactation.
Nursing behavior of 56 singleton infant pigtail monkeys (Macaca nemestrina) was monitored. Infants over 1 mo. of age showed strong preferences for one of their mothers' nipples, while few infants less than 1 mo. old did so. The infants which had the lowest birthweights for each sex showed no clear preference even though they were older than 1 mo. A trend toward lateral preference (for the right nipple) was identical for male and female infants. Analysis of the development of preference for nipple may provide useful information of assessing development progress.
Plasma prolactin and cortisol levels were measured in mothers breast feeding with or without the use of a thin latex nipple shield, and in mothers wearing a nipple shield but who were not nursing. Suckling duration and milk transfer were also recorded. Suckling duration ranged between 6 and 31 min, being significantly correlated with prolactin levels 40 to 120 min after the feed started. At the latter time, baseline prolactin level and time spent nursing accounted together for most of the variance in prolactin levels: R2 was 0.79 and 0.82 at 90 min and 120 min respectively. Prolactin was released as usual when the shield was in place: levels were not significantly different from levels without the shield. Suckling duration was also unaffected by the shield, but milk transfer was significantly reduced. Cortisol was not released by using the shield, and the shield alone (without suckling) did not release prolactin. The thin latex nipple shield has therefore no untoward effect on the release of these hormones during nursing.
In a series of 80 consecutive mastectomies it was investigated histologically, by a horizontal sectioning technique, how often the nipple and/or areola were involved in breast cancer. Such involvement was found in 35 cases (43.8%). In the same series the value of the clinical findings as to involvement of the nipple and/or areola was assessed. Only 6 of the 35 cases had shown clinical changes that could give rise to a suspicion of spread to the nipple and/or areola.
To evaluate the decrease in circulation in the nipple-areola complex after subcutaneous mastectomy and immediate implantation of a submuscular prosthesis, the blood flow was studied by both fluorescein flowmetry and laser Doppler flowmetry in 24 patients with invasive breast cancer. In 14 patients a lazy-S-shaped horizontal lateral incision was used, and 10 underwent a subcutaneous reduction mammaplasty. After subcutaneous mastectomy with a lazy-S incision there was no significant decrease in blood flow in the nipple-areola complex compared with that in the untreated contralateral breast. In the breasts in which reduction mammaplasty had been done, the blood flow was reduced by 74% as measured by fluorescein (p less than 0.01), and 70% by laser Doppler flowmetry (p less than 0.05), compared with the contralateral breast. Five patients had partial or complete epidermal, and one patient had total dermal, necrosis of the complex, but there was no deep necrosis. No fluorescence was seen within the areas in which necrosis later developed in any of these six cases. The laser Doppler signal in the corresponding areas, however, was not reduced. The results show that the circulation in the nipple-areola complex is reduced more after subcutaneous reduction mammaplasty than after subcutaneous mastectomy with a lazy-S incision.
Necrosis of the skin resulting from impaired perfusion is one possible complication of subcutaneous mastectomy. The aim of this study was to evaluate the influence of two differently sited skin incisions on the circulation in the nipple-areola complex and in the surrounding skin. Sixty-nine patients with invasive breast cancer underwent subcutaneous mastectomy and immediate reconstruction with a subcutaneously placed prosthesis. In 26 of them a "lazy-S"-shaped horizontal lateral incision was made, and in 43 patients a transverse incision 1.5 cm above and parallel to the submammary fold. The skin circulation was measured by two methods, laser Doppler flowmetry (LDF) and fluorescein flowmetry, two or three days postoperatively. The skin circulation in the nipple-areola complex and in the skin 2 cm above the complex was the same irrespective of which of the two incisions was used, both by LDF and fluorescein flowmetry, but 2 cm below the complex fluorescein flowmetry showed 36% lower circulation in the submammary incision group than in the group with a lazy-S incision (p < 0.01), in contrast to LDF, which did not show any differences between the incisions. The circulation measured by LDF was higher in all three areas both with the lazy-S incision and with the submammary incision than in the opposite untreated breast. With fluorescein flowmetry there was a corresponding increase by 36% (p < 0.01) below the complex in the lazy-S incision group. There was no skin necrosis. In conclusion, the site of the skin incision used in this study did not influence the circulation in the nipple-areola complex or in the skin 2 cm above the complex as measured by LDF and fluorescein flowmetry. However, there was a reduction of the superficial circulation as measured by fluorescein flowmetry 2 cm below the complex in the submammary incision group. The increased circulation in the breast operated on was probably the result of traumatic hyperaemia.
A 45-year-old, white woman, following mastectomy for a large inflammatory carcinoma of the left breast with multiple involved nodes, had her nipple body-banked in her left groin. She subsequently developed locally recurrent breast carcinoma in the areola of the transplanted nipple with metastases to the groin nodes, for which she received a radical groin dissection. Clinical and pathologic criteria for screening the nipples to be preserved are reviewed, and a plea is made for employing similarly stringent screens to eliminate future cases such as this.
Nevoid hyperkeratosis of the nipple and areola is a rare dermatosis with unknown etiology, (Perez-Izquierdo JM, Vilata JJ, Sanchez JL, et al. Retinoic acid treatment of nipple hyperkeratosis. Arch Dermatol 1990;126:687-688). Only 40 cases have been reported until 1997 (Alpsoy E, Yilmaz E, Aykol A. Hyperkeratosis of the nipple: report of two cases. J Dermatol 1997;24:43-45). The disease has a benign course and may only be a cosmetic problem. Different modalities have been used in the treatment of NHNA. In our case treatment with topical retinoic acid induced an acceptable response.
Among 253 cases of nipple discharge, 96 cases of them were diagnosed as intracanalicular papilloma(37.9%), 73 cases as cystic disease of breast(28.9%), 41 cases as mammary duct ectasia (16.2%), 35 cases as breast cancer(13.8%) and 8 cases as acute suppurative mastitis(3.2%). The masses beneath areolar region were smaller those outside areola. Finding of cancer cells or suspicious cancer cells through cytologic examination of nipple discharge smear and breast mass puncture usually had important significance. In addition, near infrared ray scanning shows high rate of correct diagnosis; estimation of carcinoembryonic autigen(CEA) in nipple discharge is beneficial to the early diagnosis of malignant diseases.
BACKGROUND: Genital leiomyoma is a rare benign solitary skin tumor, not painful, developed from smooth muscle. Genital leiomyoma arising from the nipple is extremely rare, especially in males. CASES REPORT: A 47 year-old male had a 2 cm cutaneous plaque with nodules located on the right nipple. This plaque was circumscribed, erythematous, pruriginous and was not painful. The lesion had been noticed by the patient two years ago. A 37 year-old male showed a 1.5 cm cutaneous plaque located on the left nipple. The plaque was slightly erythematous, pruriginous, not painful and had been noticed by the patient 5 years earlier. Histology provided the diagnosis of genital leiomyoma in both cases. No surgical therapy was performed. DISCUSSION: Cutaneous leiomyomas are classified in 3 types regarding their origin: multiple or solitary piloleiomyoma, arising from arectores pilorum muscles, solitary genital leiomyoma, arising from the dartoic, vulvar, or mammillary muscles, and solitary angioleiomyoma, arising from the vein muscles. Clinically, genital leiomyoma is a 1 cm diameter solitary erythematous, firm nodule. According to many authors, genital leiomyoma is asymptomatic, but in the 2 patients, the lesions were pruriginous. Surgical excision is usually performed.
The objective of this study was to assess the diagnostic value of preoperative cytology and galactography in women with nipple discharge using a simple intraductal aspiration method. From May 1997 to February 2002, 172 patients with unilateral, spontaneous nipple discharge without palpable masses underwent intraductal aspiration cytology followed by galactography. Major duct excision was performed in 133 of 155 successful cases. Pathological findings showed solitary papilloma in 65 cases, breast cancer in 16 cases, fibrocystic disease in 17 cases, papillomatosis in 12 cases, ductal hyperplasia in 11 cases, and finally, duct ectasia in 12 cases. Our results showed sensitivity of 75.0% and 68.8%, specificity of 86.3% and 62.4%, and overall accuracy of 85.1% and 63.2%, respectively, for cytological analysis and galactography. This suggests that the intraductal aspiration method for preoperative cytology and galactography is a minimally invasive and well-tolerated procedure that seems to be useful in differentiating between benign and malignant lesions in patients with unilateral, spontaneous nipple discharge.