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Male ductal carcinoma in situ presenting as bloody nipple discharge: a case report and literature review.

Male breast carcinoma accounts for 1% of all diagnosed breast carcinoma. Pure ductal carcinoma in situ in men is extremely rare. Unfortunately, male breast cancer is often diagnosed at a late stage because of the minimal awareness of presenting symptoms by the patient and sometimes by the health care provider. Because of this late presentation, the overall prognosis is less favorable. This case is presented to emphasize the importance of recognizing bloody nipple discharge as a clinical sign of male ductal carcinoma in situ and an opportunity for early diagnosis.

Aged↗

[Oncoplastic techniques for immediate reconstruction with nipple-areolar preservation following radical resection of a centrally located breast cancer].

There are few breast-conserving therapies (BCT) for centrally located breast cancer. The present paper describes a BCT for breast cancers in such a location, which permits conservation of the nipple-areola complex (NAC), provided this has not been infiltrated. After histological detection of the breast cancer by punch biopsy, a central segmental mastectomy and an axillary dissection are performed. An immediate reconstruction of the subareolar defect is carried out by means of a local flap technique, thus conserving the NAC.

Adult↗

Leptin expression in breast nipple aspirate fluid (NAF) and serum is influenced by body mass index (BMI) but not by the presence of breast cancer.

While obesity is a known risk factor for postmenopausal breast cancer, the molecular mechanisms involved are unclear. Systemic levels of leptin, the product of the ob (obesity) gene, are increased in obese individuals (body mass index, BMI, over 25) and are higher in women than men. Leptin has been found to stimulate the growth of breast cancer cells in vitro. Our goal was to determine whether leptin was 1) present in nipple aspirate fluid (NAF), and 2) whether NAF leptin levels were associated with a) levels in serum, b) obesity, and c) breast cancer. We collected and evaluated NAF specimens from 83 subjects and serum specimens from 49 subjects. NAF leptin was detectable in 16/41 (39 %) of premenopausal and 21/42 (50 %) postmenopausal subjects. NAF leptin was significantly lower (p = 0.042) in premenopausal than postmenopausal women with a BMI < 25, but not in those with a higher BMI. NAF leptin was significantly associated with BMI in premenopausal (p = 0.011) but not in postmenopausal women. Serum leptin was associated with BMI in both premenopausal and postmenopausal women (p = 0.0001 for both). NAF and serum leptin were associated in premenopausal (p = 0.02) but not postmenopausal women. Neither NAF nor serum leptin was associated with premenopausal or postmenopausal breast cancer. Our findings include that 1) leptin is present in the breast and detectable in a subset of NAF samples, 2) NAF leptin in premenopausal but not postmenopausal women parallels serum leptin levels, and 3) neither NAF nor serum levels of leptin were associated with premenopausal or postmenopausal breast cancer.

Adult↗

[Anatomic considerations to improve vasculature of the nipple-areola complex in vertical mammaplasty].

AIM: This anatomic study is intended to point out the most regular and reproducible vessels supplying the nipple-areola complex (NAC) for use in vertical mammaplasty. BACKGROUND: The superior pedicle technique routinely performed within the context of vertical mammaplasty procedures bears some risk for vascular dependent complications of the NAC especially in large breasts. Concerning vasculature, the supposedly most eligible pedicle to use should meet equally the best vascular requirements and technical demands necessary for maintaining both viability of the NAC and plasticity of the entire breast tissue. METHODS: Based on an anatomic microdissection study of the thoracic vessel system of seven female corpses, a modification of the superior pedicle approach to carry the NAC was anatomically evaluated and tailored to vertical mammaplasty performed in the L-technique. RESULTS: Out of six vascular sources responsible for the blood supply to the breast the branches originating from the lateral thoracic artery and concomitant veins appeared to reflect the major source of blood supply to the NAC due to their regularity and reproducibility. Especially the full-thickness glandular-dermal superolaterally-based pedicle should safely enclose these dominant branches, as well as supplementary vessels deriving from minor important sources in this region, while keeping plasticity of the vertically reduced breast. CONCLUSION: The superolaterally-based full-thickness glandular-dermal pedicle mobilized epipectorally to carry the NAC proves to be anatomically a safe and reliable procedure eligible as an integral part of vertical mammaplasty.

Breast↗

Prolactin and plasma prostaglandin metabolite levels in patients undergoing nipple stimulation contraction stress tests.

Twenty-five patients undergoing nipple stimulation contraction stress tests were enrolled in this study. Plasma 13,14-dihydro, 15-keto prostaglandin F2 alpha and plasma prolactin concentrations were analyzed before and during the contraction stress tests. Prolactin concentrations were significantly higher (p less than 0.01) in patients who responded with a successful stress test versus those who did not. No significant changes were observed in the mean concentration of plasma 13,14-dihydro, 15-keto prostaglandin F2 alpha levels between the two groups.

Breast↗

Directed duct excision by using mammary ductoscopy in patients with pathologic nipple discharge.

BACKGROUND: Duct excision for pathologic nipple discharge (PND) often requires "blind" surgical resection. Intraoperative mammary ductoscopy can allow for direct visualization of intraductal abnormalities during surgical resection. METHODS: We reviewed our experience with 119 patients with PND undergoing ductoscopy-directed duct excision. The variables that could interfere with a successful procedure were analyzed. RESULTS: Cannulation of the discharging duct was successful in 105 of 119 (88%) of patients, and ductoscopy-directed duct excision could be performed in 104 of 119 (87%). A preoperative ductogram was obtained in 70 patients and was positive in 53 of 70 (76%). In this same group, ductoscopy was positive in 63 of 70 (90%). The pathologic diagnoses were as follows: cancer (5), papilloma (84), and hyperplasia (16), for an abnormal pathology yield of 88%. Hyperplasia and cancer were significant predictors of unsuccessful cannulation. In 22 patients, ductoscopy visualized multiple lesions or abnormalities beyond 4 cm. CONCLUSIONS: Mammary ductoscopy for PND is a safe, effective procedure that offers advantages of a high lesion localization rate and intraoperative guidance, therefore negating the need for a preoperative ductogram. Lesions deep within the ductal system can be identified and removed, which would likely have been missed by blind duct excision.

Adolescent↗

Nipple discharge in women. Is it cause for concern?

Nipple discharge is one of the most common breast complaints in women. Galactorrhea (milky discharge) may occur during pregnancy or breast-feeding or as a result of drug therapy, hypothyroidism, or hyperthyroidism. Nonbloody discharge is most common and is usually benign. Bloody discharge should be considered a sign of cancer until proved otherwise. Persistent galactorrhea and nonbloody discharge can be treated by transecting the mammary ducts. Simple mastectomy may be appropriate in patients with persistent bloody discharge who have a strong family history of breast cancer.

Adult↗

Mitochondrial DNA mutations in breast cancer tissue and in matched nipple aspirate fluid.

Unlike nuclear (n)DNA, of which there is one paired copy per cell, there are many copies of mitochondrial (mt)DNA per cell, making PCR amplification of mtDNA easier in samples of limited cellularity. The aims of this study were to (i) determine the mutation patterns of breast cancers through a comprehensive screen of mtDNA mutations, and (ii) assess if mutations in the cancers are also detectable in breast nipple aspirate fluid (NAF), a physiologic fluid which contains shed ductal epithelial cells. Fifteen breast cancers, matched benign tissues and NAF were collected. Nine overlapping primer sets were used to sequence the entire mitochondrial genome from tissue samples. For NAF samples, we focused on the 19 nucleotide positions (np) where mutations were found in a 3701 bp region (np 15331 to 2463), which includes the displacement (D)-loop, a mtDNA mutation hot spot. Fourteen of the fifteen (93%) cancer samples had > or =1 somatic mtDNA mutation for a total of 45 at 35 np (9 np reported previously, 26 new). Nine of fifteen tumors had > or =2 mutations. The D-loop contained 17 of 45 (38%) and non-D-loop (coding) regions contained 28 (62%) mutations. Of the 28 mutations in the coding loci, 11 led to an amino acid change. The frequency of mtDNA mutations was higher in the D-loop region (1.5 versus 0.18% of loci). 155 polymorphisms were identified (98 reported previously, 57 new). Sixteen of forty-five (36%) mutations were located at polymorphism sites. Four of nineteen mtDNA mutations in 10 cancers located between np 15331 and 2463 were found in matched NAF (two of eleven mutations in the D-loop and two of eight in non-D-loop regions). No mutations were found in five matched NAF samples from women whose cancers lacked a mutation in the same region. In conclusion, mtDNA mutations in breast cancer occur both within and outside of the D-loop, though the mutation rate in the D-loop is over 7-fold higher than in coding areas. We identified 26 new mutation loci (25 in regions sequenced by others, one in an area not). The high frequency of mtDNA mutations at polymorphic loci requires further investigation. Specific mtDNA mutations can be detected in a subset of NAF samples from women with breast cancer.

Base Sequence↗

Paget's disease of the nipple simulating malignant melanoma in a black woman.

A lesion of Paget's disease arising in the skin of the nipple in a black woman is reported. The lesion simulated histologically a malignant melanoma because of the abundance of melanin within neoplastic cells in the epidermis as well as within the underlying ductal carcinoma of the breast. It was only after differential staining that the diagnosis of Paget's disease could be substantiated unequivocally.

Aged↗

Transplantation of the cryopreserved nipple-areolar complex.

The full nipple-areolar complex of dogs has been successfully removed, cryopreserved using a controlled-rate freeze protocol, and reimplanted without loss of viability. The technique for reimplantation calls for the use of a new fixed double bolus technique that prevented dislodging or contamination in all but 2 cases. The feasibility of performing this procedure in humans is discussed.

Animals↗

Neurofibromas of the breast and nipple-areolar area.

Neurofibromas are common tumors that arise from elements in the peripheral nervous system. The vast majority occur in the trunk and are usually limited to the head and neck area. We present two cases involving the skin of the breast and nipple-areolar complex and the method of treatment.

Adult↗

Reduction mammoplasty with free-nipple transplantation: indications and technical refinements.

Multiple techniques for breast reduction have been proposed. For carefully selected women with macromastia, the technique of choice may be amputation mammoplasty with free nipple-areolar grafting. These select groups include the following: the poor-risk elderly, women with systemic disease that could affect the vascularity of the skin flaps or impair wound healing, women with previous operative procedures in the breast affecting skin flap or pedicle vascularity, and women with indications for removal of tissue in the region of the inferior pedicle. Our experience demonstrates that in these high-risk women, amputation mammoplasty with certain technical refinements provides an aesthetic safe result without significant perioperative surgical or medical complications. A clinical series is presented with an average follow-up of 2.75 years.

Breast↗

Technical modifications for on-site nipple-areola reconstruction.

There have been numerous techniques and refinements for nipple-areola reconstruction described that have required the use of distant donor sites. A further modification of the skate flap is described, whereby the entire reconstruction can be performed on site, thus avoiding a second scar and any subsequent morbidity. This technique is easy to perform and has all the advantages of the skate flap as described by Little.

Female↗

Nipple-areola reconstruction with a custom-made silicone ectoprosthesis.

The use of a custom-made silicone ectoprosthesis of the nipple-areola complex is presented. It is suggested, after completion of breast mound reconstruction, for those women who cannot undergo or refuse to undergo any further surgical procedure, or else for the interim until the final reconstruction is performed. It is convenient to use and the aesthetic appearance is pleasing.

Adult↗