Nipple Lesions Research Articles

Low-Level Laser Therapy (LLLT) Treatment for Breast-Feeding Women With Painful Nipple Lesions

Low-Level Laser Therapy (LLLT) Treatment for Breast-Feeding Women With Painful Nipple Lesions

Nipple Ultrasound: A Pictorial Essay

Ultrasound (US) is an attractive diagnostic approach to identify both common and uncommon nipple pathologies, such as duct ectasia, nipple abscess, nipple leiomyoma, nipple adenoma, fibroepithelial polyp, ductal carcinoma in situ (restricted to nipple), invasive carcinoma, and Paget's disease. US is the reliable first-line imaging technique to assess nipple pathologies. It is useful to identify and characterize nipple lesions. Additionally, we have presented the mammography and MRI outcomes correlated with histopathologic features for the relevant cases.

Atopic dermatitis of the nipple and areola

Atopic dermatitis of the nipple and areola is a minor manifestation of atopic dermatitis. We present a case of a 20-year-old Moroccan woman presented to the gynecology ward for a non-pruritic rash on her nipples. She is single with a history of atopy and asthma since her childhood. One year ago, she had scabies disease treated successfully. The nipple lesions began one month earlier as a small patch. She had no breast discharge. Physical exam revealed bilateral pruritic, erythematous, scaly, lichenified plaques of the nipples and the areolas. The lesions didn´t extends beyond the areola. There were no palpable breast masses or other similar skin plaques. The diagnosis of nipple eczema was made. The patient had dermocorticoid for two weeks. The follow up was marked by a regression of the lesions at the third day with a total healing at one month. The eczema of the nipple and areola is an atopic dermatitis that can be treated with several regimes and preventive measures. The breast and nipple skin are thin and the use of topical steroids should be limited because of the risk of atrophy.

Paget's disease of the nipple in a Her2-positive breast cancer xenograft model.

Paget's disease (PD) of the breast is an uncommon disease of the nipple usually accompanied by an underlying carcinoma, often HER2 + , and accounting for 0.5-5% of all breast cancer. To date, histogenesis of PD of the breast remains controversial, as two theories-transformation and epidermotropic-have been proposed to explain this disease. Currently, animal models recapitulating PD of the nipple have not been described. HER2-enriched DT13 breast cancer cells were injected into the mammary fat pad of NOD scid gamma null (NSG) female mice. Immunohistochemical staining and pathological studies were performed on tumor samples, and diagnosis of PD of the nipple was confirmed by expression of proteins characteristic of Paget cells (epidermal growth factor 2 (HER2), androgen receptor (AR), cytokeratin 7 (CK7), cytokeratin 8/18 (CK8/18), and mucin 1 (MUC1)). In addition, DT13 cells grown in 2D culture and in soft agar assays were sensitive to in vitro treatment with pharmacological inhibitors targeting Her2, adenylyl cyclase, mTOR, and PI3K signaling pathways. Mice developed tumors and nipple lesions that were detected exclusively on the tumor-bearing mammary fat pad. Tumor cells were positive for proteins characteristic of Paget cells. In vitro, DT13 cells were sensitive to inhibition of Her2, adenylyl cyclase, mTOR, and PI3K signaling pathways. Our results suggest that injection of HER2 + DT13 cells into the mammary fat pad of NSG mice recapitulates critical aspects of the pathophysiology of PD of the nipple, supporting the epidermotropic theory as the more likely to explain the histogenesis of this disease.

Adénomatose érosive du mamelon chez une adolescente : à propos d’un cas

Erosive adenomatosis of the nipple is a rare benign lesion arising from the lactiferous sinuses. A 14-year-old girl with a nipple-pricked, left nipple lesion that had been evolving for 15 days with purulent discharge was referred to breast consultation. An oozing eczema-like nipple lesion with a yellowish discharge which secondarily took on the appearance of an ulcerated tumor was observed. Breast ultrasound found no abnormality. An excision of the lesion was performed. The diagnosis of erosive adenomatosis of the nipple was given on histological examination. This rare benign proliferative lesion has an excellent prognosis and is important to recognize as its care differs from that of differential diagnostic entities.

Unilateral Erosive and Oozing Lesion of the Nipple

Unilateral Erosive and Oozing Lesion of the Nipple

Paget’s Disease of the Nipple Presenting as Non-Healing Ulcerative Lesion of Nipple: A Case Report and Review of Literature

Pagets disease of the nipple is a form of ductal carcinoma in situ. It involves subareolar ducts and skin of the nipple and areola.

Squamous Cell Carcinoma Arising within Verruca Vulgaris on the Nipple

Cutaneous squamous cell carcinoma (SCC) is a common form of skin cancer and often appears as a hard, scaly lump that occasionally ulcerates. It is usually associated with cumulative exposure to ultraviolet light, although prior scarring, chronic wounds, exposure to radiation, HPV infection, and immunosuppression are also associated risk factors. Primary SCC of the nipple is very rare and only a few cases have been reported. We present a case of a 49-year-old female with concerns of a right nipple lesion with erythema and pain. She was initially evaluated for Paget's disease with an underlying malignancy and cellulitis, but, after biopsy and investigation, she was found to have a well-differentiated SCC arising from a verruca vulgaris. Current literature does not provide distinct guidelines on management of SCC or its variants on the nipple, and the case was managed based off of SCC at other cutaneous sites as well as other cases of SCC on the nipple.

Sonographic visualization of nipple blood flow can help differentiate Paget disease from benign eczematous nipple lesions.

PurposePaget disease of the breast is a rare cancer that originates from the nipple–areolar complex. It is often overlooked and misdiagnosed as benign chronic eczema of the nipple. We aimed to retrospectively verify whether blood flow analysis using Doppler sonography was useful for detecting the presence of Paget disease.MethodsIn this retrospective study, 12 patients with pathologically proven unilateral nipple eczematous lesions (seven with Paget disease and five with simple dermatitis) were included. Nipple blood flow signal was observed using Doppler sonography, and the detected blood flow signals were quantified using digitally recorded images. Quantified blood flow ratio and pathologically examined capillary density were evaluated between affected and unaffected nipples. Findings of mammography, grayscale sonography, and contrast-enhanced magnetic resonance imaging (CE-MRI) were reviewed.ResultsIn patients with Paget disease, Doppler effects in the affected nipple were more clearly visible than those in the unaffected nipple. These effects were sufficiently visible to identify Paget disease. No obvious effects were observed in the affected and unaffected nipples of simple dermatitis. The quantified blood flow ratio and pathologically examined capillary density were significantly higher for the Paget lesion than those for the non-Paget lesion. The sensitivity of CE-MRI and Doppler sonography was markedly correlated, revealing blood flow changes in the nipple lesions of Paget disease.ConclusionDoppler sonography visualized the proliferation of blood vessels in Paget lesions. The visualization of increased nipple blood flow using Doppler sonography is a simple and low-cost method that provides useful data for identifying Paget disease during routine medical care.

Efficacy of Low-Level Laser Therapy in Relieving Nipple Pain in Breastfeeding Women: A Triple-Blind, Randomized, Controlled Trial

Pain accruing from nipple lesions caused by inadequate latching by the baby is a common complaint among breastfeeding women and an important obstacle to successful breastfeeding. Nipple pain occurs during the first days after delivery and is considered one of the main causes for early weaning. To investigate the efficacy of low-level laser therapy as a treatment for nipple pain due to breastfeeding. A triple-blind, randomized, clinical study. A university-affiliated hospital in São Paulo, Brazil. Fifty-nine women with nipple lesions at the time of their admission. Thirty women (intervention group) received three sessions of laser therapy (InGaAIP laser, 660 nanometer, 40 milliwatts of power, 5 Joules per square centimeter of energy density for 5 seconds each, total energy = 0.6 Joules) in the region of the nipples at three different points in time (0 hour, 24 hours, and 48 hours after diagnosis of nipple lesion). Twenty-nine women with similar clinical conditions were randomly assigned to the control group. Self-reported pain was recorded before and after laser therapy using a visual analogue scale. The intervention group experienced a decrease of 2.0 centimeters in intensity of pain (p = .016) 24 hours after the first intervention and also presented lower levels of pain compared with the control group. Low-level laser therapy was considered effective for treating nipple lesions in breastfeeding women with pain, providing relief and prolonging exclusive breastfeeding. More clinical trials with different laser dosimetry and parameters are necessary to optimize laser therapy protocols for breastfeeding women.

The Rightful Role of MRI after Negative Conventional Imaging in the Management of Bloody Nipple Discharge.

Nipple discharge is a frequent presenting complaint at breast clinics. Bloody nipple discharge (BND) has the highest risk of malignancy, albeit low. If mammogram and ultrasound are unrevealing, central duct excision (CDE) has been considered the gold standard in its management. Magnetic resonance imaging (MRI) has been widely confirmed as a highly sensitive test for detection of breast cancer, with an accompanying high negative predictive value. This article presents a retrospective review of patients with BND and negative conventional imaging, comparing outcome of patients who went directly to CDE without MRI to those patients who underwent preoperative MRI. Of 115 patients who underwent mammography and US alone prior to CDE, eight cancers were detected (seven ductal carcinoma in situ [DCIS] and 1 IDC, 7 mm [T1b]; incidence: 7%). Of 85 patients who underwent conventional imaging followed by MRI prior to surgery, eight cancers were detected (all DCIS; incidence: 9.4%), seven of which were identified by MRI. The one false-negative MRI had subtle findings which, in retrospect, were misinterpreted; however, a clinically apparent nipple lesion prompted surgical biopsy. Of 56 patients with a negative or benign MRI, CDE was negative for malignancy in all but that one patient. Sensitivity and specificity were 87.5%/71.4%. Positive predictive value and negative predictive value (NPV) were 24.1%/98.2%. MRI should be performed in all patients with BND and negative conventional imaging. The extremely high NPV of MRI suggests that a negative study could obviate CDE in most patients unless overriding clinical factors prevail.

Clinical abnormalities of the nipple-areola complex: The role of imaging.

Clinical examination of the nipple is part of normal breast screening procedures. Abnormal processes of benign or malignant nature may be reflected by erythema, erosion, swelling or acquired inversion. In patients presenting with a persistent unilateral nipple lesion, it is advisable to collect a sample to exclude Paget's disease of the nipple, a rare form of ductal carcinoma in situ (DCIS). Imaging should be performed to detect breast cancer, which is found in more than 80% of cases, and determine its possible multifocal nature. Breast MRI is indicated if breast-conserving surgery is planned. The main differential diagnoses are erosive adenomatosis and eczema of the nipple. Acquired inverted nipple is generally of inflammatory origin. It is usually diagnosed by conventional breast examination but breast MRI can be helpful when in doubt about possible underlying neoplasia.

Tumor and tumor-like lesion of nipple

胚胎发育第8个月末,乳线胸段的乳腺始基表面上皮开始下陷,形成乳凹.胎儿出生前后,乳凹深层的间充质增生,致使乳凹逐渐消失并凸出于体表,形成乳头.此外,胚胎发育过程中,从腋下到腹股沟的乳线均可有副乳的发育形成,这些副乳同样可包括镜下可见的正常乳头结构、乳管、平滑肌,在真皮深部也可能包含乳腺腺体组织.本文主要介绍发生在乳腺乳头部的肿瘤及瘤样病变。

Invasive Paget Disease of the Nipple

Although Paget disease of the nipple (PDN) is a well-established clinical and pathological neoplastic process, invasive PDN (IPDN) is a relatively newly described disease. The latter entity is characterized by invasive carcinoma that is localized to the nipple and is associated with PDN as well as with either intraductal and/or invasive carcinoma in the underlying breast. To our knowledge, only 17 cases of IPDN, all node negative, have been reported. Here, we report the case of a 68-year-old woman with invasive Paget disease of the left nipple. The patient had a history of intraductal carcinoma, treated by lumpectomy alone. She presented 6 years later with "eczematous" lesion of the ipsilateral nipple, a punch biopsy of which showed a superficially IPDN as well as conventional PDN. The subsequently performed wide excision of the nipple, areola, and underlying breast tissue showed the invasive carcinoma to span 0.6 cm. Then, 3 months later, the patient presented with ipsilateral palpable axillary lymphadenopathy. Axillary dissection revealed metastatic carcinoma in 7 of 19 lymph nodes. This case of IPDN not only represents the deepest extent of invasion reported thus far but also the only one known to be node positive.

Primary leiomyosarcoma of the nipple-areola complex with an unusual clinical presentation: A case report

Primary leiomyosarcoma of the nipple is a rare disease that accounts for less than 0.1% of all malignant tumors of the breast. About 35 cases have been described in English literature. We report a case of a 46-year-old female presenting with a two-year suppurative squamous plaque-type lesion of the right nipple at first considered as an unusual Paget’s disease presentation. No adenopathies or associated lesions were identified. Core biopsy was informed as a possible leiomyosarcoma. It was decided to remove the lesion surgically by wide excision of the nipple-areola complex with adequate surgical margins with no lymph node dissection or adjuvant radiochemotherapy. Histopathology and immunohistochemistry confirmed the diagnosis of leiomyosarcoma. One year after the surgery there are no recurrences or distant metastasis. More data and long-term follow-up is necessary to understand prognosis and develop an adequate treatment protocol for this type of neoplasms.

Association between persistent nipple lesions and breastfeeding conditions

Association between persistent nipple lesions and breastfeeding conditions

Pigmented lesion of the left nipple in a 49-year-old woman

JDDG: Journal der Deutschen Dermatologischen GesellschaftVolume 11, Issue 12 p. 1206-1208 Case for Diagnosis Pigmented lesion of the left nipple in a 49-year-old woman Georg Isbary, Corresponding Author Georg Isbary Department of Dermatology, Allergology and Environmental Medicine, Hospital Schwabing, Munich Municipal Hospital GmbH Dr. med. Georg Isbary Department of Dermatology, Allergology and Environmental Medicine Hospital Schwabing Munich Municipal Hospital GmbH Kölner Platz 1 80804 Munich, Germany E-mail: [email protected]Search for more papers by this authorBrigitte Coras-Stepanek, Brigitte Coras-Stepanek Department of Dermatology, Allergology and Environmental Medicine, Hospital Schwabing, Munich Municipal Hospital GmbHSearch for more papers by this authorWilhelm Stolz, Wilhelm Stolz Department of Dermatology, Allergology and Environmental Medicine, Hospital Schwabing, Munich Municipal Hospital GmbHSearch for more papers by this author Georg Isbary, Corresponding Author Georg Isbary Department of Dermatology, Allergology and Environmental Medicine, Hospital Schwabing, Munich Municipal Hospital GmbH Dr. med. Georg Isbary Department of Dermatology, Allergology and Environmental Medicine Hospital Schwabing Munich Municipal Hospital GmbH Kölner Platz 1 80804 Munich, Germany E-mail: [email protected]Search for more papers by this authorBrigitte Coras-Stepanek, Brigitte Coras-Stepanek Department of Dermatology, Allergology and Environmental Medicine, Hospital Schwabing, Munich Municipal Hospital GmbHSearch for more papers by this authorWilhelm Stolz, Wilhelm Stolz Department of Dermatology, Allergology and Environmental Medicine, Hospital Schwabing, Munich Municipal Hospital GmbHSearch for more papers by this author First published: 23 July 2013 https://doi.org/10.1111/ddg.12139AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Volume11, Issue12December 2013Pages 1206-1208 RelatedInformation

Lymphoma and metastatic breast cancer presenting with palpable axillary and inguinal lymphadenopathy in a 40-year-old man with rheumatoid arthritis on anti-tumor necrosis factor α therapy: a case report

IntroductionWe present the case of a 40-year-old man with severe rheumatoid arthritis being treated with high-dose anti-tumor necrosis factor α therapy (adalimumab), who developed simultaneous lymphoma and breast cancer with lymph node metastases. We describe strategies for investigations and management of this presentation.Case presentationA 40-year-old Caucasian man with severe rheumatoid arthritis being treated with high-dose adalimumab presented to our facility with a swollen leg and palpable left groin and left axillary lumps and a left nipple lesion. Left lower limb ultrasound, computed tomography and positron emission tomography scans showed extensive lymphadenopathy. Core biopsies of the left groin, axilla and nipple lesion showed this to be concurrent diffuse B-cell lymphoma and locally metastatic invasive ductal carcinoma of the breast. He underwent a left mastectomy with axillary clearance, and adjuvant fluorouracil, epirubicin and cyclophosphamide chemotherapy with rituximab, and the adalimumab was stopped.ConclusionsThe findings from our patient’s case should increase awareness that patients with severe rheumatoid arthritis, especially if they are on high-dose biological treatments, have the potential to develop lymphoma, which in turn increases the risk of developing other primary tumors, so that in rare cases a patient may have concurrent tumors. Assessment and management of these patients is challenging and should include computed tomography scans of the of neck, thorax, abdomen and pelvis, including a fludeoxyglucose positron emission tomography/computed tomography scan, bone marrow testing and appropriate core biopsies and discussion at multidisciplinary team meetings about treatment of the separate tumors in the presence of hematologists, oncologists, surgeons and rheumatologists.

LED Phototherapy Improves Healing of Nipple Trauma: A Pilot Study

The purpose of this study was to evaluate the clinical effectiveness of a LED phototherapy prototype apparatus in the healing of nipple trauma in breastfeeding women. There is no scientific evidence of an effective treatment for nipple trauma. The experimental group was treated with orientation on nipple care and adequate breastfeeding techniques in addition to active LED phototherapy. The control group was treated with orientation on nipple care and adequate breastfeeding techniques in addition to placebo LED phototherapy. Participants were treated twice a week, for a total of eight sessions. Healing of the nipple lesions was measured by a reduction in their area, and decrease in pain intensity was measured in accordance with an 11-point Pain Intensity Numerical Rating Scale and a standard 7-point patient global impression of change. Statistically significant reductions in measured nipple lesion area (p<0.001) were observed for both the experimental and control groups with an increase in the number of treatment sessions. A significant difference between the experimental and control groups was observed for the healing of nipple lesions (p<0.001). The pain intensity was significantly reduced only in the experimental group (p<0.001). Preliminary results demonstrated the prototype apparatus for LED phototherapy to be an effective tool in accelerating the healing of nipple trauma.

Breastfeeding: More Than Just Good Nutrition

Breastfeeding: More Than Just Good Nutrition