Duct Ectasia Research Articles

Hemozoin "knobs" in Opisthorchis felineus infected liver.

BackgroundHemozoin is the pigment produced by some blood-feeding parasites. It demonstrates high diagnostic and therapeutic potential. In this work the formation of co-called hemozoin “knobs” – the bile duct ectasia filled up by hemozoin pigment - in Opisthorhis felineus infected hamster liver has been observed.MethodsThe O. felineus infected liver was examined by histological analysis and magnetic resonance imaging (MRI). The pigment hemozoin was identified by Fourier transform infrared spectroscopy and high resolution electrospray ionization mass spectrometry analysis. Hemozoin crystals were characterised by high resolution transmission electron microscopy.ResultsHemozoin crystals produced by O. felineus have average length 403 nm and the length-to-width ratio equals 2.0. The regurgitation of hemozoin from parasitic fluke during infection leads to formation of bile duct ectasia. The active release of hemozoin from O. felineus during in vitro incubation has also been evidenced. It has been shown that the hemozoin knobs can be detected by magnetic resonance imaging.ConclusionsIn the paper for the first time the characterisation of hemozoin pigment extracted from liver fluke O. felineus has been conducted. The role of hemozoin in the modification of immune response by opisthorchiasis is assumed.Electronic supplementary materialThe online version of this article (doi:10.1186/s13071-015-1061-5) contains supplementary material, which is available to authorized users.

Cone beam computed tomography (CBCT) sialography—an adjunct to salivary gland ultrasonography in the evaluation of recurrent salivary gland swelling

Cone beam computed tomography (CBCT) sialography could help improve the visualization of the ductal system of salivary glands. The aim of this retrospective investigation was to monitor the use of CBCT sialography for the diagnosis of pathologies within the intraglandular ductal system when ultrasonography was inconclusive. Fourteen consecutive patients suffering from recurrent swelling of a major salivary gland were evaluated. In 12 patients (8 female; 4 male; average age 46 years), a radiopaque contrast agent could be injected into the ductal system, followed by a routine CBCT. Four blinded examiners evaluated the acquired data sets retrospectively. CBCT revealed seven stenosis, two salivary stones, one complete duct atresia, one intraglandular duct ectasia, and one regular duct system. Three of the detected pathologies were strictly intraglandular. CBCT sialography shows promise as a supplementary noninvasive diagnostic tool for the visualization of the intraglandular ductal system of the major human salivary glands. Controlled studies to further validate this method should be undertaken.

A Review of Inflammatory Processes of the Breast with a Focus on Diagnosis in Core Biopsy Samples.

Inflammatory and reactive lesions of the breast are relatively uncommon among benign breast lesions and can be the source of an abnormality on imaging. Such lesions can simulate a malignant process, based on both clinical and radiographic findings, and core biopsy is often performed to rule out malignancy. Furthermore, some inflammatory processes can mimic carcinoma or other malignancy microscopically, and vice versa. Diagnostic difficulty may arise due to the small and fragmented sample of a core biopsy. This review will focus on the pertinent clinical, radiographic, and histopathologic features of the more commonly encountered inflammatory lesions of the breast that can be characterized in a core biopsy sample. These include fat necrosis, mammary duct ectasia, granulomatous lobular mastitis, diabetic mastopathy, and abscess. The microscopic differential diagnoses for these lesions when seen in a core biopsy sample will be discussed.

Sonographic Features and Diagnostic Analysis of Benign Chronic Inflammatory Breast Lesions in Nonlactating Women.

Sonographic Features and Diagnostic Analysis of Benign Chronic Inflammatory Breast Lesions in Nonlactating Women.

Spontaneous Pancreatitis Caused by Tissue-Specific Gene Ablation of Hhex in Mice.

Background & AimsPerturbations in pancreatic ductal bicarbonate secretion cause chronic pancreatitis. The physiologic mechanism of ductal secretion is known, but its transcriptional control is not. We determine the role of the transcription factor hematopoietically expressed homeobox protein (Hhex) in ductal secretion and pancreatitis.MethodsWe derived mice with pancreas-specific, Cre-mediated Hhex gene ablation to determine the requirement of Hhex in the pancreatic duct in early life and in adult stages. Histologic and immunostaining analyses were used to detect the presence of pathology. Pancreatic primary ductal cells were isolated to discover differentially expressed transcripts upon acute Hhex ablation on a cell autonomous level.ResultsHhex protein was detected throughout the embryonic and adult ductal trees. Ablation of Hhex in pancreatic progenitors resulted in postnatal ductal ectasia associated with acinar-to-ductal metaplasia, a progressive phenotype that ultimately resulted in chronic pancreatitis. Hhex ablation in adult mice, however, did not cause any detectable pathology. Ductal ectasia in young mice did not result from perturbation of expression of Hnf6, Hnf1β, or the primary cilia genes. RNA-seq analysis of Hhex-ablated pancreatic primary ductal cells showed mRNA levels of the G-protein coupled receptor natriuretic peptide receptor 3 (Npr3), implicated in paracrine signaling, up-regulated by 4.70-fold.ConclusionsAlthough Hhex is dispensable for ductal cell function in the adult, ablation of Hhex in pancreatic progenitors results in pancreatitis. Our data highlight the critical role of Hhex in maintaining ductal homeostasis in early life and support ductal hypersecretion as a novel etiology of pediatric chronic pancreatitis.

ESTUDIO DE LAS SECRECIONES MAMARIAS

Se estudia 200 pacientes afectas de telorrea, analizándose los resultados obtenidos con diferentes métodos y técnicas de diagnóstico en patología mamaria: mamografía, teletermografía, termografía en placa, citología y estudio anatomopatológico. Se resaltó el valor de la galactografía en el estudio de la patología ductal. Desde un punto de vista etiológico, la yatrogenia ocupó un lugar importante. La patología benigna (papilomas y ectasias ductales) fue la principal responsable de la secreción anómala por el pezón.

P122. An initial experience using a titanium-coated polypropylene mesh (TiLoop® Bra) for implant based breast reconstruction

P122. An initial experience using a titanium-coated polypropylene mesh (TiLoop® Bra) for implant based breast reconstruction

Abstract P6-10-14: Association between mammographic breast density and histologic features of benign breast disease

Abstract Background: Mammographic breast density (MBD) reflects the proportion of fibroglandular tissue in the breast, and is an established risk factor for breast cancer. Benign breast disease (BBD) is also a known risk factor for breast cancer. We previously showed an association between lobular involution (physiologic atrophy) and MBD in a large cohort study of women with BBD. We performed a comprehensive evaluation of the association of histologic features of BBD with MBD. Methods: The Mayo BBD cohort includes women, 18 to 85 years, who were diagnosed with BBD at Mayo Clinic in Rochester, MN between 01/01/1967 and 12/31/1991. For this study, we included women who had a mammogram within 6 months of BBD diagnosis, and diagnosed with BBD between 1985 and 1991 when parenchymal pattern of breast density was clinically recorded. Risk factor information such as age, and body mass index (BMI) was collected from medical records. Parenchymal pattern, assessed clinically and previously used in multiple studies of MBD and risk, classified breast density based on extent and type of density, into four categories: N1 (non-dense, no ducts visible); P1 (ductal prominence occupying <25% breast); P2 (prominent ductal pattern occupying >25% of the breast; DY (homogenous plaque-like areas of density). All assessments of benign breast tissue were performed by expert breast pathologists blinded to both MBD and BBD reports. Histologic characteristics included overall impression (non-proliferative disease (NPD), proliferative disease without atypia (PDWA), and atypical hyperplasia (AH)), proportion of normal lobules that were involuted (no (0%), partial (1 to 74%), or complete (≥75%)), type of AH (ADH or ALH), ductal and lobular hyperplasia, calcifications, sclerosing adenosis, columnar alteration, cyst, fibroadenoma, marked fibrosis, intra-ductal papilloma, radial scar (number and size), duct ectasia, and mucocele like tumors. Associations of parenchymal pattern with BBD characteristics were examined using multicategorical nominal logistic regression models. We first examined associations after adjustment for age and BMI. All variables statistically significant (p<0.05) in these models were then simultaneously included in a fully-adjusted model. Results: Of 2,257 women in the study, 14% were <40 years old, 52.7% between 40- 59 years, and 32.9% were ≥60 years. In this sample, 55.2% of women had NPD, 36% had PDWA, and AH in 8.8%. MBD was classified as N1 in 21.8%, P1 in 12.6%, P2 in 23.7% and DY in 41.9%. Age- and BMI-adjusted analyses showed that there was an association of parenchymal pattern with overall impression, lobular involution, ductal hyperplasia, sclerosing adenosis, columnar alteration, cyst, duct ectasia and fibrosis. Multivariate analyses found that women of younger age (p<0.001) and with lower BMI (p<0.001), presence of fibrosis (p<0.001) and no involution (p=0.016) were more likely to have P2 or DY parenchymal pattern than women without those characteristics. Conclusion: Among women with benign breast disease, higher MBD is associated with younger age, lower BMI, fibrosis, and lack of lobular involution. These findings, concordant with other studies of MBD, provide insight into underlying mechanisms by which MBD and BBD contribute to breast cancer risk. Citation Format: Karthik Ghosh, Robert A Vierkant, Ryan D Frank, Daniel W Visscher, Vernon S Pankratz, Christopher G Scott, Derek C Radisky, Marlene H Frost, Lynn C Hartmann, Amy C Degnim, Celine M Vachon. Association between mammographic breast density and histologic features of benign breast disease [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-10-14.

The prevalence of benign breast diseases in patients with nodular goiter and Hashimoto's thyroiditis.

The evidence regarding association between thyroid disorders and benign and malignant breast diseases is increasing. The studies exploring the relationship between thyroid and breast diseases usually have focused on thyroid autoimmunity and functions in patients with breast pathologies. In this study, we aimed to reveal the frequency of benign breast conditions in patients with nodular thyroid disease (NTD) and Hashimoto's thyroiditis (HT). Seventy-one women with NTD, ninety-five women with HT and seventy-two healthy people as a control group were included in the study. Serum thyroid-stimulating hormone, free triiodothyronine, free thyroxine, and thyroid peroxidase autoantibody levels were measured, and thyroid and breast ultrasonography were performed by a single operator in order to determine thyroid and breast pathology. Benign breast diseases were detected in 54.9% of patients with NTD, in 47.4% of those with HT, and 29.2% of control group in the study (p < 0.01 for nodular and Hashimoto groups versus control group). Simple cyst was found to be the most frequent pathology among benign breast diseases; fibrocystic changes, mixed lesions, benign solid mass, ductal ectasia, and complex cyst followed it. No significant relation was found regarding thyroid function and autoimmunity in patients diagnosed with benign breast disease (p > 0.05). The results of our study support the association between benign breast diseases and thyroid diseases. An important implication of this finding may be demonstration of the necessity of scanning for potential breast pathology in women with nodular or autoimmune thyroid disease in clinical practice.

Classification and Epidemiology of Mammary Tumours in Pet Rabbits (Oryctolagus cuniculus)

Mammary tumours are common in pet rabbits; however, published studies are predominantly derived from laboratory and meat rabbits. This study reports basic data on type and location of 119 separate tumours from 109 pet rabbits. The animals were aged 2-14 years (mean 5.5 years) and all 90 rabbits of known gender were female. Cranial and caudal mammary glands were affected equally. The majority of lesions (n=105) were classified as carcinomas with 32 tubular, 16 papillary, 12 tubulopapillary, 11 solid, nine adenosquamous, nine comedo type, five complex, four ductal, three cribriform, three anaplastic and one spindle -cell carcinoma. Twelve percent of the lesions were benign, with eight intraductal papillary adenomas, three simple tubular adenomas and one complex adenoma. One non-neoplastic lesion was found in the form of cystic duct ectasia.

A Rare Finding of Coexisting Fibroadenoma and Duct Ectasia in Axillary Ectopic Breast Tissue

Ectopic breast tissue (EBT) can present anywhere along the milk line from axilla to groin. It can harbor all the pathological conditions as that of the normal breast though incidence is very low. Fibroadenoma is rare in accessory breast and only a few cases have been reported in the literature. Here, we report a 30-year-old female presented with a firm and freely mobile right axillary lump measuring 6 cm × 4 cm. Fine-needle aspiration cytology revealed it as accessory breast tissue. However, the excision biopsy of the same showed fibroadenoma along with duct ectasia in EBT. This case has been reported due to its rarity and for consideration of fibroadenoma in differential diagnoses of axillary swellings.

Bilateral mammary duct ectasia induced by sulpiride-associated hyperprolactinemia: A case report.

A 32 year old female diagnosed with schizophrenia was treated with sulpiride, trihexyphenidyl and alprazolam for 6 years. A physical examination revealed bilateral nipple retraction and a non-tender mass in the left breast, with little nipple discharge. Tests revealed high levels of carbohydrate antigen 125, serum prolactin and testosterone levels, and ultrasound revealed a number of masses in the bilateral breasts; the largest mass (2.2×1.3 cm) was located in the left breast. A rich blood flow signal was identified around the nodule. The ducts in the bilateral breasts exhibited cystic ectasia. Multiple enlarged lymph nodes were found in the bilateral axillae. Mammography revealed thickened breast tissue without an evident mass, and calcification. A segmental mastectomy was performed and subsequent histological examination revealed multiple dilated ducts, the largest of which contained eosinophilic material. The pathological diagnosis was of breast duct dilatation. Bacterial culture and drug sensitivity analysis of the secretions from the cystic cavity revealed no bacterial growth, and an acid fast bacillus stain was negative. Extravasation of the surgical wound occurred 1 month later, and Staphylococcus epidermidis was observed using a bacterial culture. This was treated with moxifloxacin for 1 week. It was suggested that the patient should switch to a prolactin sparing antipsychotic in view of the hyperprolactinemia, however, the patient refused. After a clinical follow-up of 16 months, the wound had healed well and no palpable mass was found in the breast.

Imaging spectrum of von hippel–lindau disease

Von Hippel–Lindau (VHL) disease is a rare phakomatosis with autosomal dominant inheritance. It is the result of inactivation of tumor suppressor gene located on short arm of chromosome 3 and is characterized by the development of a variety of benign and malignant tumors of various organs. These include retinal and central nervous system hemangioblastomas, renal cysts and renal cell carcinoma, pheochromocytomas, pancreatic cysts and tumors, epididymal cystadenoma, and ductal ectasia of rete testis. Imaging plays a key role in the diagnosis of VHL disease. It is also useful for screening of patients with family history of VHL disease and in follow-up after treatment. This coupled with advanced surgical management helps in reducing the morbidity and mortality in VHL. The aim of this pictorial essay is to demonstrate the imaging spectrum of VHL disease.

Diagnostic dilemmas in Intraductal papillomas of the breast - Experience at Sultan Qaboos University Hospital in the Sultanate of Oman.

Objectives:The aim of this retrospective study was to correlate the significance and accuracy of the colour of nipple discharge and breast ultrasound imaging in the diagnosis of intraductal papilloma.Methods:This is a retrospective study of 34 patients who underwent 36 microdochectomies in Sultan Qaboos University Hospital (SQUH) in the Sultanate of Oman, over a 4 year period of January 2009 till December 2012. The confounders considered were patient age, physical examination findings, nipple discharge cytology result, ultrasound results and biopsy report following microdochectomy. Comparisons analysis, charts and graphs were made using the SPSS software (version 20).Results:The mean age of the patients was 44(27-73) years old. Twenty-seven out 36 (75%) patients had presented with nipple discharge, 14 out 27 (52%) had blood stained nipple discharge and 13(48%) with coloured discharge (yellow, brown and green), 9 patients had no discharge. The final histopathology showed intraductal papilloma 13 (36%), duct ectasia 18(50%), DCIS 1 (2.7%), fibrocystic disease 3(8.3%) and LCIS 1(2.7%). Thirteen out of 36 had intraductal papilloma on final histopathology. The correlation between blood stained discharge and final histopathology of intraductal papilloma was insignificant (p=0.44).Conclusion:Nipple discharge is irrelevant to the diagnosis of intraductal papilloma. Spontaneous nipple discharge regardless of color is to be referred to breast surgeon and to be assessed with triple assessment. Surgery remains the mainstay of treatment.

215. Colour inking of breast wide local excision specimens in theatre: Time economy for the surgeon looking to improve departmental pathology diagnostics

Background: Nipple discharge has a known association with breast cancer, determing which cases to identify as being at high risk is a complex task for the clinician. The current policy at West Herfordshire hospital NHS Trust is to offer microdochectomy to all women who present with unilateral single duct nipple discharge, dominant duct discharge, or persistent duct discharge. The aim of this study was to determine if on basis of the pattern of nipple discharge, patients could be subselected for microdochectomies, and to create a base line to allow future subselection of patients for surveillance only Methods: All patient with single duct unilateral spontaneous nipple discharge, who underwent microdochectomy, were assessed. Demographics, clinical presentation, radiological assessment, cytology, core biopsy. This group of patients was analysed and correlated with their final histological assessment. Results: 122 patients were analysed in this study. 7 ( 5.74%) were diagnosed with carcinomas. 4 patients had ductal carcinoma in situ, three patients had dutcal carcinoma in situ and invasive ductal carcinoma, of these two patients had blood stained nipple discharge. Two other patients had papillary carcinomas, one patient of these two had blood stained nipple discharge. 47 out of 122 patient presented with history of blood statined discharge, 30 were negative for cytology, two patients had (ductal carcinoma in situ with Invasive ductal carcinoma and papillary ca) at final histololgy. 17 of the 47 showed cellular cytology, and one patient had intermediate grade DCIS confirmed on final histology, whereas in the remaining sixteen patients histological features of papillomas, duct ectasia, and benign breast disease was noted. Of the 122 patient 42 patients had mammary duct ectasia (34%), 52 patients had papillomas (42%) at final histology. Conclusions: The negative predictive value (2/30), appears in this series appears to be more valuable than, the positive predictive value (1/17) in cellular smears to predict ductal carcinoma or invasive ductal carcinoma. Cytological assessment of nipple discharge is equivocal at its best. Microdochectomy perford for nipple discharge results in a low rate of malignancy on excision and is comparable with other series. No conflict of interest.

A call to action for evidence-based safer conception interventions for HIV-affected couples desiring children in Sub-Saharan Africa

resolved and the follow-up period was two months. Both adolescents had no history of diabetes, smoking, sexual activity, or corticosteroid/contraceptive use. The age of menarche in both girls was 11 years. Predisposing factors for mastitis and breast abscess include skin lesions, mammary duct ectasia, trauma related to sexual foreplay, nipple piercing, and shaving or plucking periareolar hair [3,4]. None of these factors was identified in the cases described. Breast malignancy, tuberculosis, and protozoal and fungal infections are differential diagnoses for mastitis [3]. In both cases, management with oral antibiotic therapy and ultrasound-guided needle aspiration was successful. Surgical drainage should be reserved for unresolved cases following aspiration. This is especially valid for adolescents as surgery may affect the breast bud, resulting in impaired breast development [3]. Conflict of interest

Magnetic resonance imaging in patients with unilateral bloody nipple discharge; useful when conventional diagnostics are negative?

Unilateral bloody nipple discharge (UBND) is mostly caused by benign conditions such as papilloma or ductal ectasia. However, in 7-33 % of all nipple discharge, it is caused by breast cancer. Conventional diagnostic imaging like mammography (MMG) and ultrasonography (US) is performed to exclude malignancy. Preliminary investigations of breast magnetic resonance imaging (MRI) assume that it has additional value. With an increasing availability of MRI, it is of clinical importance to evaluate this. We evaluated the additional diagnostic value of MRI in patients with UBND in the absence of a palpable mass, with normal conventional imaging. All women with UBND in the period November 2007-July 2012 were included. In addition to the standard work-up (patient's history, physical examination, MMG, and US), MRI was performed. Data from these examinations and treatment were collected retrospectively. A total of 111 women (mean age 52 years; range 23-80) were included. In nine (8 %) patients, malignancy was suspected on MRI while conventional imaging was normal. In eight (89 %) of these patients, histology was obtained, two by core biopsy and six by terminal duct excision. Benign conditions were found in six patients (86 %) and a (pre-) malignant lesion in two patients. In both cases, it concerned a ductal carcinoma in situ, which was treated with breast-conserving therapy. Moreover, in two cases of (pre)malignancy, the MRI was interpreted as negative. In patients with UBND who show no signs of a malignancy on conventional diagnostic examinations, the added value of a breast MRI is limited, since a malignancy can be demonstrated in <2 %.

Correlation of Fine Needle Aspiration Cytology and Histopathology Diagnosis in the Evaluation of Breast Lumps

Background: A large number of patients have been suffer from breast cancer worldwide and this trend is increasing. It is difficult to determine whether a lump is benign or malignant from clinical assessment; thus, the need for micropic and tissue analysis arises. Methods: This comparative retrospective cross sectional study was conducted in the Department of Pathology, Rehman Medical Institute, Peshawar, Pakistan from January 2006 to March 2013, to determine the value of fine needle aspiration cytology (FNAC) in the diagnosis of breast lump and to compare the result of FNAC with histological diagnosis to assess its accuracy. Results: Seventy-four cases with breast lumps were presented for FNAC. Of these, 32.4% were reported as a C2 lesion, 4.1% were reported as benign with atypical cells (C3), 8.1% cases were suspicious for malignancy (C4), and 55.4% were positive for malignancy (C5). On histopathology examination, out of 24 cases which were reported as C2 lesions, 95.8% were benign and 4.1% turned out to be invasive ductal carcinoma. Of the cases that presented as C3 lesions, one was diagnosed as benign duct ectasia, one with ductal carcinoma in situ, and one with invasive ductal carcinoma on histopathological examination. The cases that were diagnosed as C4 lesions all turned out to be carcinoma on histopathology. In this study, FNAC and histopathology diagnoses were strongly correlated [r 0.92, p &lt;0.001]. Conclusion: Diagnosis of breast lump based on FNAC should be practiced as there is high correlation with histopathological finding. FNAC should be used as a routine diagnostic procedure due to its cost effectiveness, thus maximizing the availability of effective health care to patients with breast lesions.

Duct Ectasia and Periductal Mastitis in Indian Women.

There is very little awareness of the general physicians and surgeons about the benign breast conditions such as duct ectasia (DE) and periductal mastitis (PDM) causing nipple discharge. Not only that these benign breast diseases ring a false alarm of cancer, they are also the second most common cause of benign breast diseases. The objective was to study the clinical and microbiological profiles of duct ectasia and periductal mastitis in Indian women for better understanding of the disease process, in order to be able to treat them well. Forty-one consecutive patients presenting to the Surgical Out-Patient Department with non-bloody nipple discharge with clinical and radiological features suggestive of DE or PDM were included. Microbial culture and cytopathological study of the nipple discharge were done. Histopathological studies and culture of the ductal tissue taken intraoperatively were carried out. There is no significant difference in the age distribution among women with DE and PDM. Smoking is not associated with DE and PDM of Indian patients in contrast to the Western literature evidence. Infective etiology was present in nearly 46% of the patients in the study population more so in the periductal mastitis cases. The most common isolated pathogens were Staphylococcus aureus and Staphylococcus epidermidis, unlike in Western population where nearly 50% were anaerobes. Since the isolated organisms were resistant to the routinely used antibiotics in high proportion of cases, culture and sensitivity should be done in all possible cases for appropriately treating the subareolar sepsis before proceeding with the definitive treatment in the form of duct excision.

Bloody Nipple Discharge in Infants: Case Series

Bloody nipple discharge very rarely occurs in infants and often is associated with benign mammary duct ectasia. Just because it is a rare symptom and frequently associated with adults’ mammary cancer, it is inadequately managed: inappropriate diagnostic tools are used, consequently inappropriate treatments are given. We here describe four cases of bloody nipple discharge, which resolved spontaneously within a few weeks of diagnosis and we present a review of the literature. In conclusion, a “wait and see” approach is enough and avoids unnecessary invasive diagnostic procedures.