Nipple Lesions Research Articles

The Great Mimicker: Unique Presentation of Epidermal Inclusion Cyst on The Breast

Epidermal inclusion cysts (EIC) are common cutaneous cysts that can occur nearly anywhere in the body with common locations being the face, scalp, neck, back, and scrotum. Only a few cases of EIC to the breast have been reported in literature to date, with most occurring after trauma to the breast. Here we present the case of a 35-year-old woman that presented with a nontraumatic nipple lesion that was later biopsy proven to be an EIC. Although not a primary consideration, EIC should be on the differential for skin lesions of the nipple.

Feasibility and Accuracy of Ultrasound-Guided Core Needle Biopsy for Nipple Lesions: A Pilot Study.

Due to the superficial location, suspicious findings of the nipple-areolar complex (NAC) are not amenable to stereotactic or MRI-guided sampling and have historically necessitated surgical biopsy or skin-punch biopsy. There are limited reports of US-guided core biopsy of the nipple (US-CBN). We report our nearly 3-year pilot experience with US-CBN at an academic breast imaging center. An institutional review board-exempt and HIPAA-compliant retrospective review was performed. We assessed patient demographics, breast imaging characteristics, procedural data, pathology, and outcomes. Nine female patients aged 27 to 64 underwent US-CBN from January 2021 to October 2023. Initial imaging abnormalities included abnormal MRI enhancement, mammographic calcifications, and sonographic masses. After initial or second-look US, all imaging findings had sonographic correlates for biopsy specimens, the majority of which were sonographic masses (8/9). US-CBN was performed by 6 breast radiologists using a variety of devices. All biopsy specimen results were concordant with sonographic abnormalities, although 1 was considered discordant from the initial abnormality seen on MRI. There were no complications, and discomfort during the procedure was well-treated. Two patients (22%, 2/9) were diagnosed with malignancy. This pilot study demonstrated that US-CBN can be performed by a breast radiologist for definitive diagnosis of suspicious nipple abnormalities seen on breast imaging, avoiding surgery, and maintaining nipple integrity. In our population, 22% (2/9) of US-CBNs revealed malignancy.

Mammary Paget's Disease Mimicking Benign and Malignant Dermatological Conditions: Clinical Challenges and Diagnostic Considerations.

Mammary Paget's disease (MPD) or Paget's disease of the breast is a rare dermatological malignancy of the nipple-areolar complex that manifests with a spectrum of symptoms spanning from itching and redness to more severe indications such as breast lump, nipple-areolar complex destruction, or nipple discharge. It is predominantly associated with an underlying ductal carcinoma in situ or invasive ductal carcinoma. MPDoften masquerades as other benign and malignant dermatological conditions, including eczema, atopic dermatitis, psoriasis, and squamous and basal cell carcinomas, leading to delayed diagnosis and inappropriate treatment. Only one-third of the patients present with a palpable lump; therefore, advanced age with chronic and unilateral lesions should raise concern for MPD. Our review article presents case reports of MPD imitating other skin conditions and underscores the key findings of clinical features and diagnostic workup to help differentiate the condition. A literature review revealed that studies emphasize caution regarding the sole use of mammography and ultrasound in diagnosing MPD, particularly in cases lacking a palpable lump. This highlights the MRI as a superior and more accurate imaging tool. However, any suspicious lesion must be biopsied to allow histopathological and immunohistochemical examination, since there are some cases where MRI findings were negative in the presence of a biopsy-proven MPD. This highlights the need for clinicians to investigate any suspicious lesion of the nipple or breast using the complete triple assessment approach to exclude an underlying malignancy. It is imperative to establish therapeutic guidelines to approach any nipple lesion to minimize the risk of misdiagnosing any underlying cancer, which can be potentially fatal if left alone.

Giant fibroepithelial breast polyp

Introduction: Fibroepithelial polyps are common benign skin lesionsrarely noted in the female nipple. In this location, they have the potentialto ulcerate and cause bloody discharge.Case history: A 55-year-old female patient presented to a breast clinicwith a left nipple lesion present since childhood. The patient self-reportedthat the lesion had increased in size. Clinical examination revealed a 9 ×7 cm lesion with a soft and pliable stem extending from the left nipple.Mammography from 2017 revealed this previously measured 6 × 6 cm.An excision biopsy under general anaesthetic preserving the nippleanatomy was undertaken on 18/8/23. There were no immediate or subsequentcomplications. The final histology demonstrated the excised specimenweighed 131 g and measured 90 × 70 × 60 mm with an 8 mm base.The specimen was processed and microscopically found to be a giantfibroepithelial polyp (FEP). The central core of the lesion was formed byexcessive collagen deposition. Normal dermal structures including bloodvessels were still present with no glandular component and there was noevidence of atypia or malignancy.Discussion: FEPs are benign dermal mesenchymal tumours also knownas acrochordons. They are noted most commonly on the neck, axilla,perineum, and thighs but have also been found in the vagina, vulva, orcervix and present in < 2% of cases in the nipple area.FEPs rarely grow larger than 5 cm, with larger lesions rarely reportedin medical literature worldwide. It is possible to excise these lesions andpreserve the nipple anatomy with careful surgical planning.

Intraductal Papilloma of the Breast: A Case Report

Intraductal papilloma of the breast is a rare benign tumour. The polypoid lesions arising from the nipple surface include papillomas and fibroepithelial stromal polyps. These lesions must be distinguished from malignant nipple lesions, such as Paget’s disease of the nipple or malignant breast conditions involving the nipple. Solitary papillomas (solitary intraductal papillomas) are single tumours that often grow in the large milk ducts near the nipple. They are a common cause of clear or bloody nipple discharge, especially when it comes from only one breast, and can be felt as a small lump behind or next to the nipple. Papillomas may also be found in small ducts in areas of the breast farther from the nipple. Multiple papillomas, which are growths that are less prone to generate nipple discharge, were present in this case. In papillomatosis, there are very small areas of cell growth within the ducts, but they aren’t as distinct as papillomas are. In order to distinguish between these disorders, a thorough clinical examination and imaging are essential. This case report describes a 36-year-old female who presented with swelling from the left nipple. Sonography of the left breast revealed a dilated duct in the left retro-areolar region with a focal isoechoic component within the duct {American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS 4B)}. The patient underwent core excision of the duct, and histopathological analysis confirmed the diagnosis of papilloma with changes of adenosis without atypia.

Galactorrhea in infant induced by maternal antidepressants use: case report

Breastfeeding is essential in nutrition, newborn development and for the mother-baby bond. Evidence of increased depressive disorders and growing need for drug use in the postpartum period has made the use of antidepressants during lactation an important issue to be discussed. The infant presented a nipple lesion with phlogistic signs and galactorrhea. Initially, the diagnosis of infection secondary to excessive handling was suggested and antibiotic therapy was prescribed with the resolution of the condition. However, 2 more episodes occurred, and the patient was referred to a mastologist who raised the hypothesis of galactorrhea due to maternal antidepressant use. present study is notable for showing, for the first time in the literature, a case report of infant galactorrhea induced by maternal use of antidepressants. Although the chances of occurrence of this condition are low, due to the drugs’ safety profile and the reduced concentration of these substances on breastmilk, it is important to consider this hypothesis in the presence of recurrent milk production with no other plausible explanation.

Second opinion (external specialist referral) practice of breast pathology: the Nottingham experience.

Breast pathology is a challenging field, and discrepancies in diagnoses exist and can affect patient management. This study aims to review a breast referral practice and assess the pattern and frequency of breast lesions sent for an external expert review and evaluate potential impacts on patients' care. Seven hundred and forty cases that were referred to Nottingham City Hospital for a second opinion between 2019 and 2022 which have slides and reports were retrieved and reviewed. Reasons for referral, initial diagnosis, proffered specialist opinion and any discrepancy or potential impacts of management were assessed. The most frequent entities were papillary lesions (19%), fibroepithelial lesions (17%), invasive carcinomas that were sent for confirmation of the invasive diagnosis or subtyping of the invasive tumour (17%), intraductal epithelial proliferation with atypia (9%) and spindle cell lesions (8%). Other entities included biphasic tumours such as adenomyoepithelioma, as well as vascular and nipple lesions. Few cases were sent for prognostic classification or comments on the management, and in occasional cases no initial diagnosis was offered. After reviewing the cases by the expert pathologists, the initial diagnosis was confirmed or one of the suggested diagnoses was preferred in 79% of cases, including 129 cases (17%) in which the opinion resulted minor changes in the management. Significant changes in the classification of lesions were made in 132 cases (18%) which resulted in significant change in the patient management recommendation. In 14 cases (2%) a final classification was not possible, and further specialist opinion was obtained. Comments on the differential diagnosis and advice on further patient management were provided in most cases. This study demonstrates the value of external referral of challenging, rare and difficult to classify breast lesions. It also highlights the most common breast lesions that are likely to be challenging, and specialist opinion can refine their classification to improve patient care.

Nipple adenoma: case report

Nipple adenoma is a very uncommon, benign neoplasm that involves the nipple. A palpable mass of the nipple associated with nipple discharge and erosion or ulceration is the common clinical presentation.1 This rare benign tumor can be mistaken for breast carcinoma, Paget's disease, or galactophoric ectasia.2 This case report describes a 35-year-old woman with a painful nipple lesion and serous discharge. Clinical examination revealed a hypertrophied left nipple with a well-defined, firm, bluish nodule. Biopsy confirmed the diagnosis of nipple adenoma. The patient underwent surgical excision and reconstruction of the nipple. Histological examination revealed simple florid ductal hyperplasia and no malignancy. Erosive nipple adenomatosis is a rare condition that should be considered in the presence of nipple erosion or tumor. Diagnosis is anatomo-pathological, and treatment is usually surgical. The prognosis is excellent.

Manejo de un tumor benigno del pezón infrecuente en un hospital terciario. El adenoma de pezón

Nipple adenoma is a benign tumor that originates in the milk ducts of the nipple. The objective of our study is to describe and compare the casuistry of nipple adenoma in our center between January 2009 and December 2019 with the literature. Our case series consists of 5 patients. They are all women, aged between 40 and 82 years. Two patients consulted for telorrhagia and the rest were referred from primary care for new-onset nipple lesions. Imaging tests did not present specific findings. The result of the preoperative biopsy was diagnostic of nipple adenoma in all cases. In all cases, simple exeresis of the lesion was performed. No patient presented recurrence or appearance of carcinoma with a mean follow-up of 31 months. One patient died for other reasons. In conclusion, the importance of the biopsy and the immunophenotypic study to perform the differential diagnóstico with other pathologies such as Paget's disease or nipple carcinoma should be highlighted. Surgical management shows no changes compared to the literature, preferring more conservative options such as local excision with excellent long-term results.

Unilateral Primary Localised Cutaneous Nodular Amyloidosis of the Nipple

Background: Amyloidosis is characterised by extracellular accumulation of an amorphous fibrillary protein and can affect any organ. It is classified into systemic and localised disease according to its sites of presentation and as primary or secondary according to aetiology. Breast amyloid was first described in 1973 and is extremely rare.Case Presentation: A 61-year-old woman presented in 2020 with a 1-year history of an enlarging tender left nipple with some associated bleeding. Clinical differential diagnoses included a nipple adenoma and an intraductal carcinoma; therefore, a punch biopsy was taken. A full set of screening blood tests were undertaken which were normal, showing no evidence of a plasma cell dyscrasia.The biopsy showed diffuse replacement of the dermis by acellular eosinophilic material showing fracturing. Congo Red stain was positive showing apple-green birefringence under polarised light. A diagnosis of primary localised cutaneous nodular amyloidosis of the nipple was made.Conclusion: We present a rare documented case of isolated primary localised cutaneous nodular amyloidosis of the nipple. This can be considered as a differential diagnosis for patients with a new nipple lesion alongside nipple adenoma and intraductal carcinoma.

Photobiomodulation therapy in the post-operative management of puerperal mastitis-associated breast abscess

Although phototherapies have been used to manage nipple lesions and pain in breastfeeding women, there is no information on alternative therapies treating puerperal mastitis-associated breast abscess. The current study aimed to present a case in which adjuvant photobiomodulation therapy was used for a breast abscess developed as a complication of puerperal mastitis. Despite receiving antibiotic therapy, exudate drainage, surgical cleaning, and drain placement, after 11 days, the patient was still experiencing pain and there were marked inflammation signs on the region. Fifteen sessions of photobiomodulation therapy were then proposed. Pain relief was achieved after 3 laser sessions and wound healing after 15 laser sessions. According to the current case, photobiomodulation therapy seems to be a valuable adjuvant therapeutic modality for puerperal mastitis-associated breast abscess.

Ulcerated nipple lesion mimicking breast cancer

Ulcerated nipple lesion mimicking breast cancer

Construction and validation of an instrument for classifying nipple and areola complex lesions resulting from breastfeeding

to construct and validate a classification of nipple and areola complex lesions resulting from breastfeeding, according to content and appearance. this is a methodological study, developed in four stages: operational definition, instrument construction, content and appearance validation. The Delphi technique and a Likert-type scale were used to validate content and appearance, through the participation of ten and sixteen judges, respectively. For analysis, Content Validity Index and Kappa Coefficient were applied. Content Validity Index obtained an overall value of 0.93 and, for appearance, 0.94. Kappa values ranged between 0.46 and 1. The high rates of agreement among judges demonstrated the quality of the proposed content validity. the Nipple and Areola Complex Lesions Classification Instrument developed obtained acceptable values of its indexes, proving to be valid in terms of content and appearance.

Symptomatic fibroepithelial polyp of the nipple in a pediatric patient

Skin tags are benign growths typically found on intertriginous areas of the body. The most common type of skin tag is the acrochordon, skin-colored papules with short, broad stalks. A rarer type of skin tag is the fibroepithelial polyp (FEP), which tend to be larger, with long, narrow stalks. We evaluated a pediatric patient with a nipple lesion that was intermittently painful and discolored. Simple excision and primary closure was performed with excellent results and relief of symptoms. Pathology revealed benign FEP with a few benign lactiferous ducts at the base of the specimen. While the differential for benign nipple lesions is long, with only 8 documented cases of FEP of the breast and none documented in the pediatric population, this poses a diagnostic challenge. Literature shows that FEPs can grow to a large size over time and become increasingly symptomatic. The benefits of simple excision and primary closure of FEP of the nipple include improved cosmesis, improvement in symptoms, and reassurance for patient and family with benign pathology. Given the rarity of this lesion in both location and patient population, it is important for clinicians to differentiate FEP of the nipple from other benign and malignant growths.

Prevalence of ankyloglossia in newborns and impact of frenotomy in a Baby-Friendly Hospital.

Ankyloglossia is a condition present in some newborns and can be associated with breastfeeding difficulties, leading to symptoms in the child and the mother. This study aimed to analyze the characteristics of newborns with tongue-tie and the symptoms reported by their mothers, and the short and long-term outcomes of frenotomy. We conducted a prospective and observational 7-month study in a Baby-Friendly Hospital (BFH). We included all the breastfed newborns without comorbidities that underwent a frenotomy. A total of 33 frenotomies were performed. The most common findings before the procedure were maternal breastfeeding pain (29/33), ineffective latch (18/33), and maternal nipple lesions (18/33). We observed that newborns surgically intervened later showed a high incidence of jaundice (p = 0.03), weight loss greater than 10% at hospital discharge (p = 0.004), and their mothers experienced pain more often (p = 0.004). At one month of age, there was an improvement in breastfeeding-related pain (p = 0.012) and its intensity (p = 0.016), the presence of maternal cracked nipples (p < 0.01), and latching on (p < 0.01). Ankyloglossia can prevent the correct establishment of breastfeeding. Frenotomy is associated with few complications, and when appropriately indicated, may have a positive impact on breastfeeding, reducing maternal pain, the presence of nipple lesions, and latching problems.

Pigmentary mammary Paget disease: Clinical, dermoscopical and histological challenge.

A very rare variant of mammary Paget disease (MPD) is the pigmented MPD, first described in 1956. It is very difficult to distinguish this variant from melanoma both clinically and dermoscopically. The diagnosis is confirmed by histopathology and immunohistochemistry. Correct diagnosis is crucial for surgical treatment, which is different for these two diseases. We report the case of a 92-year-old woman, who presented an asymptomatic pigmented lesion of the right nipple and areola. The lesion was arisen for about 6 months and was suspected for melanoma because of clinical and dersmoscopic characteristics. Incisional biopsy revealed tumor cells, that proliferate in the major mammary ducts, and tumor cells in the overlying epidermis of the nipple, thus diagnosing pigmented mammary Paget disease. The patient underwent radical mastectomy.

Eczematous Lesion of Nipple and Areola Treated with Individualised Homoeopathic Treatment

AbstractBreast and nipple–areolar complex has its own functional, sexual and cosmetic values. The skin around nipple and areola is prone to develop several kinds of infections during different stages of life ranging from mild-to-moderate dermatitis to neoplastic growths. Lack of knowledge of the patients about breast hygiene and the spectrum of the breast diseases among medical practitioners renders prompt diagnosis; hence, it develops several complications from its own array. Apparently, an uncommon presentation of dermatitis sometimes causes several complications at different stages of life and mostly during the period of lactation where the newborn suffers as a consequence of mother's illness. In this case, a female patient approached our outpatient department with complaints of itching and burning of nipple and areola with occasional discharge, which was diagnosed as eczema of nipple and areola after clinical examination. Initially, we started our treatment with Sulphur 30 and from then patient showed gradual improvement. Within a period of 1 month, patient showed promising improvement and it took 2 more months to subside other residual complaints. This case report not only portrays effectiveness of individualised homeopathy but also focuses on the cost-effectiveness of homeopathic treatments.

Lanolin and prenatal health education for prevention of nipple pain and trauma: Randomized clinical trial

ObjectiveTo investigate the effect of lanolin on nipple pain and trauma in breastfeeding after application of a health education. MethodRandomized controlled clinical trial, with two arms, open, with 66 participants during prenatal care in the primary health care network in Goiania – Goias, Brazil. Participants were randomized (1:1) using computer generated numbers in both experimental group (EG) and control group (CG). The EG received lanolin and health education on breastfeeding at two different times with clinical demonstration using cloth didactic breast and illustrative album as the intervention, while the CG received standard health education. Health education was carried out by the same researchers in both groups. Measurement of pain, nipple trauma, and breastfeeding technique occurred on postpartum day eight. The analysis included descriptive statistics and inferential analysis by means chi-square or Fisher test, and Student's t-test, significance level set at 0.05. ResultsA majority of the participants experienced no nipple trauma (59.1%) in both groups, and 60.6% of women experienced pain. In both groups, women showed favorable breastfeeding behaviors, except in the condition of the breasts. There were no significant differences between groups in pain prevention (p=0.61), nipple lesions (p=0.21), and breastfeeding technique (p>0.05). ConclusionIt is not clear whether the intervention, lanolin combined with health education, has a positive effect on the prevention of nipple pain and trauma. Further research is needed to elucidate this question.Registration number: RBR-7tvhq8.Registry website: http://www.ensaiosclinicos.gov.br/

Low- level laser: cost of therapy fornipple trauma

Abstract Objectives: to measure the micro-cost of local laser therapy (LL) and transcutaneous laser therapy application by Irradiation Laser Intravascular of Blood (ILIB) to treat nipple trauma and compare the most effective and efficient alternative treatment. Methods: a cross-sectional analytical and quantitative study with analysis on the micro absorption cost, implemented as a clipping, from a randomized clinical trial that used two types of laser therapy to treat nipple trauma due to breastfeeding. The sample consisted of 101 nipple lesions. Patients were randomized into three groups (Control - CG, Local Laser -LLG and ILIB-ILIBG). Materials used, direct labor (DL) and laser equipment were predictors of costs. The delta calculation (effect size) was the indicator for measuring effectiveness and efficiency. Results: after three sessions, the average final cost was R$ 40.04for CG, R$ 53.55for LLG and R$ 67.29for ILIBG. After three sessions of treatment, ILIBG showed a great reduction in the lesion area, but with a higher cost (p&lt;0.05). Conclusions: ILIBG had a better effect on healing the nipple trauma when compared to CG and LLG, even though it is more expensive, it suggests a positive cost-benefit and the most effective and efficient alternative treatment.

Lanolin and prenatal health education for prevention of nipple pain and trauma: Randomized clinical trial.

To investigate the effect of lanolin on nipple pain and trauma in breastfeeding after application of a health education. Randomized controlled clinical trial, with two arms, open, with 66 participants during prenatal care in the primary health care network in Goiania - Goias, Brazil. Participants were randomized (1:1) using computer generated numbers in both experimental group (EG) and control group (CG). The EG received lanolin and health education on breastfeeding at two different times with clinical demonstration using cloth didactic breast and illustrative album as the intervention, while the CG received standard health education. Health education was carried out by the same researchers in both groups. Measurement of pain, nipple trauma, and breastfeeding technique occurred on postpartum day eight. The analysis included descriptive statistics and inferential analysis by means chi-square or Fisher test, and Student's t-test, significance level set at 0.05. A majority of the participants experienced no nipple trauma (59.1%) in both groups, and 60.6% of women experienced pain. In both groups, women showed favorable breastfeeding behaviors, except in the condition of the breasts. There were no significant differences between groups in pain prevention (p=0.61), nipple lesions (p=0.21), and breastfeeding technique (p>0.05). It is not clear whether the intervention, lanolin combined with health education, has a positive effect on the prevention of nipple pain and trauma. Further research is needed to elucidate this question. Registration number: RBR-7tvhq8. Registry website: http://www.ensaiosclinicos.gov.br/.