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PubMed2003

[Diagnostic management of nipple discharge].

Nipple discharge may be a symptom of a variety of diseases. The importance of nipple discharge is its possible association with breast carcinoma. Not only the precise clinical evaluation but also particularly imaging evaluation by mammography, ultrasound, galactography or MR-galactography is necessary to establish the exact diagnosis and plan proper treatment. Depending on the underlying pathology--most commonly intraductal papilloma, fibrocystic changes or breast carcinoma--the optimal therapeutic regimen, such as single lactiferous duct excision on the one end and modified radical mastectomy on the other end of the spectra may be chosen.

Breast Cyst↗
PubMedDate not supplied

Tuberculosis of the breast. A cytomorphologic study of needle aspirates and nipple discharges.

A cytomorphologic diagnosis of tuberculosis of the breast by examination of needle aspirate and nipple discharge smears was made in 14 of 410 cases of mammary lumps and nipple discharges studied over a period of two years. The importance of aspiration cytology of breast lumps, which clinically may be diagnosed as benign or malignant lesions, is high-lighted. Although acid-fast bacilli were demonstrated in only one case, the clinical response to antituberculosis therapy was indirect but fairly convincing evidence supporting the cytologic diagnosis of tuberculosis of the breast in all 14 patients.

Adult↗
PubMed1983

Survey of baby bottle rubber nipples for volatile N-nitrosamines.

A local market survey of 27 baby bottle rubber nipples for volatile N-nitrosamines was conducted. N-Nitrosodimethylamine, N-nitrosodiethylamine, N-nitrosodibutylamine, and N-nitrosopiperidine were found at levels up to 387 ppb. All 4 nitrosamines migrated from the rubber nipples into water, milk, and infant formula when sterilized together in a manner typical of that used in the home. The source of the nitrosamines is the chemical accelerators and stabilizers added to raw rubber during the vulcanization process.

Animals↗
PubMed1979

Hereditary acrolabial telangiectasia. A report of familial blue lips, nails, and nipples.

We describe a mother and two daughters who had the following clinical manifestations: bluish discoloration of the vermillion ridge of the lips, nipple areolae, and nail beds; discrete telangiectasia of the chest, elbows, and dorsa of the hands; varicosities of the lower part of the legs; and (in the two daughters) migraine headaches. Routine histologic examination of tissue from the lips and elbows disclosed extensive, dilated, horizontal subpapillary telangiectases. Enzyme histochemical stains demonstrated activity of adenosine triphosphatase and leucine aminopeptidase around these dilated vessels. Alkaline phosphatase activity was strikingly absent from the dilated subpapillary vessels. By electron microscopy, these vessels were demonstrated to be postcapillary venules. We propose an autosomal dominant mode of inheritance.

Adult↗
PubMed1983

Occurrence of supernumerary nipples in newborns.

A prospective study on supernumerary nipples (SNNs) was performed on 1,691 consecutively born neonates. We used a new technique for easier routine detection of SNNs. The incidence of this anomaly was one per 40 or 25 per 1,000 live births. Association of other congenital abnormalities with SNNs was not found.

Breast↗
PubMed1987

Supernumerary nipples and renal anomalies in neonates.

A high rate of association between supernumerary nipples (SNNs) and hidden renal anomalies has previously been reported. We examined 2035 term infants and detected SNNs in 49. Only one patient, at age 4 months, was found to have a renal anomaly, as determined by ultrasound examination. The likelihood of finding a renal anomaly in a term infant with an SNN is likely to be lower than previously reported.

Breast↗
PubMed1999

Surgical approach to nipple discharge: a ten-year experience.

BACKGROUND AND OBJECTIVES: The actual relationship between malignancy and secreting breast has not yet been extensively verified, mainly in patients with nipple discharge but without evidence of a breast lump. This study was carried out in 1,251 consecutive patients to evaluate the reliability of cytology combined with galactography in order to assess the relationship of malignant and premalignant lesions with discharge without the presence of a breast lump. METHODS: Those patients with bilateral discharge were approached endocrinologically, whereas the patients (433) with unilateral secretion were evaluated by cytology, mammography, fine needle biopsy, and galactography. Of 194 patients without a breast lump, 94 with positive cytology were surgically treated after mammogalactography. Surgical treatment included ductgalactophorectomy in 53, segmentectomy in 23, microdochectomy in 13, and mastectomy in 5 patients. RESULTS: Pathologic findings showed a solitary papilloma in 49 cases, minimal breast cancer in 20, fibrocystic disease in 11, papillomatosis in 7, lobular cancer in 5, and, finally, a duct ectasia in 2. CONCLUSIONS: In the patients with secreting breast but without lump, cytological analysis in addition to galactography seems to be useful in identifying minimal breast cancer and in detecting premalignant lesions like papillomatosis.

Adolescent↗
PubMed1998

Cytologic findings from a nipple discharge in an infant with premature telarche.

Premature telarche is a condition of isolated unilateral or bilateral breast development without additional signs of sexual maturation in girls primarily under 2 yr of age presumably occurring as a response to hormonal stimulation by estrogens. Prior reports concerning pathologic findings in premature telarche have been scarce. We report the cytologic findings from a nipple discharge in a 10-mo-old girl with unilateral breast enlargement due to premature telarche. The discharge showed an increased number of clusters of breast ductal epithelium, with a few in a papillary configuration. There was a moderate degree of nuclear irregularity in the epithelial cells, but no significant nuclear overlapping. No atypical single cells were present, and a rare myoepithelial cell was noted. These cytologic findings are in accord with a prior study describing the histology in three cases of premature telarche.

Breast↗
PubMed1985

Nipple aspirates of breast fluid and the epidemiology of breast disease.

Epidemiologic data were obtained, and nipple aspiration attempted, from 289 healthy women, 548 women currently having or with a history of benign breast disease, 153 untreated women with breast cancer, and 106 women previously treated by mastectomy. Breast duct fluid was produced in detectable amounts by 59% of the controls and patients with benign or untreated malignant breast disease; in 35% the volume was in excess of 10 microliters. There were more secretors aged 30 to 50 years (72%), than either those who were younger (52%), or older (44%). Overall, 57% of premenopausal women were secretors, compared with 38% of postmenopausal women. Healthy women who had their menarche before age 13 years were more likely to be secretors. Neither parity, age at first completed pregnancy, nor body weight affected secretor status. There was a trend for the 141 benign breast disease patients aged 40 to 49 years to include more women yielding greater than 10 microliter of fluid (57%) compared with 46 controls (39%). Although breast cancer per se did not appear to influence secretor status, postmastectomy patients were more likely to secrete large fluid volumes, an effect that was particularly pronounced after menopause. Hormonal factors related to age and fibrocystic disease risk and endocrine activity after mastectomy may be the principal determinants influencing the secretion of breast duct fluid.

Adult↗
PubMed1983

Cerumen phenotype and epithelial dysplasia in nipple aspirates of breast fluid.

The relationship between presence of dysplastic epithelial cells in nipple aspirates of breast fluid and wet or dry cerumen phenotype was studied in 1,150 white and Asian American women. A statistically significant greater proportion of premenopausal white women of wet cerumen phenotype, compared to women of the dry cerumen type, was found to have cytologic dysplasia (relative risk 6.5 [1.8--22.3]). The effect was not observed in postmenopausal women. The finding offers new support for our hypothesis that an apocrine genetic factor affecting breast gland secretion may influence exposure of the breast epithelium to potential carcinogenic substances of exogenous or endogenous origin.

Adult↗
PubMed1988

Microdochectomy for single-duct discharge from the nipple.

Microdochectomy has been the accepted treatment for single-duct nipple discharge. Review of 97 consecutive patients undergoing microdochectomy between 1980 and 1987 revealed a total of eight patients with ductal carcinoma in situ. All of these had pre-operative mammography, results of which were highly suspicious of malignancy in six patients. Tiny foci of ductal carcinoma in situ were found in the two patients with normal mammograms. We suggest an expectant policy in cases where the mammogram is normal, omitting routine microdochectomy.

Adult↗
PubMed2004

Feasibility and utility of using chromosomal aneusomy to further define the cytologic categories in nipple aspirate fluid specimens: a preliminary study.

BACKGROUND: There is renewed interest in using the cytologic changes in the epithelial cells obtained from specimens such as nipple aspiration fluid (NAF) and ductal lavage for risk stratification of women at increased risk for developing breast carcinoma. METHODS: Molecular tests such as fluorescence in situ hybridization (FISH) have the potential to be used as adjuncts to conventional cytology for more accurately categorizing cells in these types of specimens. The current study investigated the feasibility and utility of FISH analysis of aneusomy in chromosomes 1, 8, 11 and 17 as an adjunct to conventional cytology in the classification of NAF specimens. RESULTS: The authors found chromosomal aneusomy for at least one chromosome in all three malignant and both markedly atypical cases. Of the five cases classified as being mildy atypical on cytology, four were disomic, and only one showed aneusomy in chromosomes 8 and 11. CONCLUSIONS: The current study established the possibilities, limitations, and feasibility of using FISH in conjunction with routine cytology for a more accurate classification of ductal epithelial cells in NAF specimens. FISH-based detection of chromosomal aneusomy helped to define mild atypia, thereby aiding in the selection of the truly atypical cases for appropriate therapeutic intervention. In addition, FISH-based detection of chromosomal aneusomy can also be a valuable adjunct to conventional cytology in selected cases for confirming a benign, suspicious, or malignant diagnosis.

Biopsy, Needle↗
PubMed2005

Fiberoptic ductoscopy findings in women with and without spontaneous nipple discharge.

BACKGROUND: Fiberoptic ductoscopy (FD), which allows direct visualization of the breast ductal lumen, is performed in women with and without spontaneous nipple discharge (SND). Previous reports suggested that cytologic evaluation of SND may be falsely interpreted as containing malignancy. The purpose of the current study, which was performed prospectively, was to determine whether ductoscopic findings were different in women with versus without SND, and to assess the implications of the differences in SND versus non-SND samples regarding the role of FD in assessing whether a woman has breast carcinoma. METHODS: Data were collected on the distance traveled by the ductoscope, visual observations, pathology, cytology, epithelial and foam cell quantity, and image analysis for ploidy, hypertetraploidy, and S-phase fraction. RESULTS: Of 100 FD specimens, 60 were from breasts without SND and 40 were from breasts with SND. Intraductal visual observations (P < or = 0.0002), pathologic findings in the resected specimen (P < or = 0.001), and quantity of epithelial cells (P=0.03) were influenced by the presence or absence of SND. Although one specimen from a benign breast was interpreted as cytologically malignant, every breast with both malignant cytology and aneuploidy contained cancer cells. A model incorporating cytology and SND was 92% sensitive and 60% specific in predicting which women had breast carcinoma. CONCLUSIONS: There were pronounced differences in FD samples from women with and without SND. FD biologic parameters can be chosen to optimize breast carcinoma predictive sensitivity and specificity. SND cytology can present a diagnostic problem, suggesting the need for histologic confirmation before the initiation of therapy.

Adult↗
PubMed2005

Reproducibility of cytologic atypia in repeat nipple duct lavage.

BACKGROUND: It is believed that atypical cells identified by nipple duct lavage (NDL) indicate an increased risk for breast carcinoma similar to atypical ductal hyperplasia diagnosed by tissue biopsy, but many basic performance characteristics of NDL currently are undefined. METHODS: NDL was performed in 108 patients unselected for breast carcinoma risk and then was repeated after 2-14 months (median, 8 months) if the initial lavage was classified as atypical. Breast magnetic resonance images (MRIs) were obtained from a subset of patients who had atypical lavage results. RESULTS: Marked atypia was diagnosed in 22% of 36 breasts with an incident carcinoma compared with 7% of 172 unaffected breasts (P = 0.01). After excluding breasts with an incident carcinoma, there were 32 patients (30%) with either mild or marked atypia. The lavage was repeated in 23 of these women, and the second lavage was classified as atypical in 48%. Neither marked atypia on the initial lavage nor a 5-year Gail risk > or = 1.7% predicted atypia on repeat lavage, but there was a trend for improved reproducibility when the atypia initially was diagnosed in a fluid-producing duct. MRIs were abnormal in 13% of 24 breasts with an atypical lavage, and ductal carcinoma in situ was diagnosed subsequently in 1 breast. CONCLUSIONS: Atypia frequently is diagnosed by NDL, but the reproducibility of repeat lavage is low. Lavage atypia may be physiologic or artifactual rather than pathologic in many instances. Marked atypia occasionally may represent mammographically occult ductal carcinoma in situ.

Adult↗
PubMed1993

Cytological diagnosis of Paget's disease of the nipple by scrape smears: a report of five cases.

Five cases of mammary Paget's disease were diagnosed by nipple scrape cytology. The neoplastic material obtained was abundant in two cases, moderate in one, but in two, only a few cell aggregates feature in three cases and this, together with dense tumour cell cytoplasm and the background of keratinous debris, may impart a squamous-like appearance; however, three-dimensional cell aggregates, papillary-like groups, acinar-like collections, and some cells with vacuolated cytoplasm and eccentric nuclei allowed glandular differentiation to be inferred in three cases. In four cases a combination of clinical evaluation, and cytological findings of malignant cells compatible with Paget's disease was used so that mastectomy could proceed, and in one case there was frozen section confirmation of an underlying invasive carcinoma. In the single case in which it was performed, there was positive immunoperoxidase staining for c-erb B2 oncoprotein. Demonstration of this protein, CEA, or mucin, helps distinguish Paget's disease from melanoma or squamous cell carcinoma in-situ.

Aged↗
PubMed1993

Cytologic detection of herpes simplex virus DNA in nipple discharge by in situ hybridization: report of two cases.

Cytologic changes in the smears from nipple discharge of two cases with herpes simplex virus (HSV) infections are described. The cytology revealed the ground-glass appearance of the nuclei with multinucleated syncytial cells. Subsequently, in situ hybridization (ISH) using a biotinylated DNA probe was applied to identify the HSV DNA in the Papanicolaou-destained specimens. Positive hybridization was found with intense staining for the HSV DNA in the nuclei of cells having a ground-glass appearance. Cytologic observation together with ISH procedure may be rapid and valuable tool for the detection and final demonstration of HSV infections. Similar investigations may be carried out in cellular samples from other body sites.

Adult↗