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Nipple Discharge [keywords]
- Microdochectomy assisted by ultrasound-guided indigo carmine staining of intraductal lesions: a case report. [Journal Article]
- J Breast Cancer 2014 Jun; 17(2):184-7.
Spontaneous bloody nipple discharge from a single duct is a significant clinical problem. When performing preoperative marking of the discharging duct, it is sometimes difficult to identify the duct owing to intermittent discharge. Precise preoperative marking of the discharging duct and intraductal lesions is very important to avoid unnecessary wide excision of breast tissue or failure to remove the cause of nipple discharge. We herein present a case of preoperative ultrasound-guided indigo carmine staining in a patient with no discharge on the day of surgery. When a dilated duct is visualized on ultrasound, the targeted duct can be localized using indigo carmine staining, and it is possible to perform a precise minimal volume microdochectomy.
- The role of breast ductoscopy in evaluation of nipple discharge: a chinese experience of 419 patients. [Journal Article]
- Breast J 2014 Jul; 20(4):388-93.
The aim of this study is to report our experience with ductoscopic evaluation for screening patients with nipple discharge and evaluate any potential indications and benefits of ductoscopy. From January 2010 to December 2012, 419 female patients with nipple discharge were enrolled in this study. All patients involved in this study showed no mass in ultrasound and mammography. Data concerning age, clinical characteristics of nipple discharge, nipple discharge cytology, ductoscopic and postsurgical diagnosis, and complications were statistically analyzed. Ductoscopy examinations were completed in 405 patients (96.66%). For these 405 patients, there were 519 ductoscopic investigations. 112 (27.65%) patients were found to have intraductal papillary lesions of which 62 were operated in our hospital. Postsurgical diagnosis showed 8 (12.9%) malignancy including 6 DCIS and 2 invasive ductal carcinomas. All of the 8 patients meet at least two criteria of pathologic nipple discharge (single duct, spontaneous, bloody nipple discharge). The other patients with nonpapillary lesions are still under surveillance. By univariate analysis, patients with unilateral, single duct, spontaneous and bloody nipple discharge were more likely to have intraductal papillary lesions. By multivariate analysis, unilateral, spontaneous, and bloody nipple discharge showed statistically significant correlations with intraductal papillary lesions revealed by ductoscopy. Ductoscopy is a safe and efficient investigation in preoperative screening of the patients with nipple discharge. Clinical characteristics have predictive value in selection of patients for ductoscopical investigation. Patients with clinical characteristics of unilateral, spontaneous, and bloody nipple discharge were more likely to have intraductal papillary lesions revealed by ductoscopy.
- Phyllodes tumour of the nipple presenting with nipple discharge. [JOURNAL ARTICLE]
- Pathology 2014 Jun 20.
- Diagnosis and surgical treatment of nipple adenoma. [JOURNAL ARTICLE]
- ANZ J Surg 2014 Jun 27.
Nipple adenoma is a rare and benign type of breast tumour. Because of the lack of proper understanding, it is easily overlooked and misdiagnosed by doctors. The aim of the study is to improve clinicians' awareness of the disease.Evaluation of the complaints such as blood discharge or nodules on the nipple was done with physical examination, ultrasonography and cytologic evaluation (discharge cytology and curettage cytology). Resection of part of the nipple containing the tumour was performed in 11 of the 12 patients included in this study.Physical examination revealed nodules palpable inside the nipples in all 12 cases. However, a hypoechoic nodule was detected unilaterally inside the nipple only in three of 11 patients examined by ultrasonography. It was worth noting that six patients had cytology performed (one case on nipple discharge and five cases on curettage) and that all six had abnormal results. Cytology is often atypical or suspicious but the ultimate pathology is benign. No post-operative recurrence was observed in any of the patients.Physical examination and diagnostic studies are important part of the diagnostic workup, but since cytological assessment often yields atypical cells, surgical treatment and pathologic evaluation are the only approach for definitive diagnosis to rule out a potential malignancy.
- Awareness of Breast Cancer Warning Signs and Screening Methods among Female Residents of Pokhara Valley, Nepal. [Journal Article]
- Asian Pac J Cancer Prev 2014; 15(11):4723-6.
Background:Breast cancer is the second most common cancer in the world and by far the most frequent cancer among women.
Objective:The present study was undertaken to assess the awareness of breast cancer warning signs and screening methods among the women of Pokhara valley, Nepal. Materials and
Methods:A cross-sectional questionnaire survey was carried out in a community setting with the female population. The questionnaire was administered in face-to-face interviews by trained research assistants.
Results:Nepalese women demonstrated poor awareness of warning signs like a breast lump, lump under the armpit, bleeding or discharge from the nipple, pulling of the nipple, changes in the position of the nipple, nipple rash, redness of the breast skin, changes in the size of the breast or nipple, changes in the shape of the breast or nipple, pain in the breast or armpit, and dimpling of the breast skin. While 100% of nurses were aware about breast self- examination (BSE), mammography and warning signs of breast cancer. Levels of knowledge were significantly poorer in women with other occupations. Graduates were more aware about BSE, mammogram and warning signs of breast cancer compared to those with other educational levels.
Conclusions:The findings indicated that the level of awareness of breast cancer, including knowledge of warning signs and BSE, is sub-optimal among Nepalese women.
- Rusty Pipe Syndrome, a Cause of Bloody Nipple Discharge: Case Report. [JOURNAL ARTICLE]
- Breastfeed Med 2014 Jun 25.
Abstract Breastfeeding has universally known advantages to the mother and child that include nutritional and immunological benefits but also involve reasons of ecological and economic order. Initiation and maintenance of breastfeeding can be associated with common problems. The beginning of milk production may course with bloody nipple discharge, which, after exclusion of pathological entities, concerns a self-resolving physiological syndrome called rusty pipe. We present a case of rusty pipe syndrome and discuss the implications.
- Reporting a Rare Case of Pleomorphic Adenoma of the Breast. [JOURNAL ARTICLE]
- Case Rep Med 2014.:387183.
Pleomorphic adenoma (PA) is the most common tumor type in the salivary gland. PA is uncommon in the breast tissue. Only 73 cases of PA of the breast have been reported in the world literature. We are reporting the 74th case of PA of the breast. A 61-year-old woman was referred to Shahid Beheshti Hospital Obstetric Clinic with bloody painless discharge from the right nipple. A bean size mass was detected immediately below the right nipple. After an excisional biopsy, the pathologist found proliferation in epithelial and myoepithelial cells that had small and multiple nuclei, myxoid and chondroid stroma. Immunohistochemistry stain was positive for S-100 and patchy for GFAP in tumor cells and for SMA around the tubule-glandular and tumor cell aggregates and suggested PA of the breast. It is essential for the pathologists to consider PA of the breast as a differential diagnosis of a rounded circumscribed mass in the juxta-areolar areas. Careful paraffin sections should be performed to avoid an unnecessary mastectomy.
- Nipple Discharge of CA15-3, CA125, CEA and TSGF as a New Biomarker Panel for Breast Cancer. [JOURNAL ARTICLE]
- Int J Mol Sci 2014; 15(6):9546-9565.
Breast cancer is the second leading cause of cancer death in women. Serum biomarkers such as cancer antigen 15-3 (CA15-3), cancer antigen 125 (CA125), and carcinoembryonic antigen (CEA) can be used as diagnostic and prognostic factors and can also provide valuable information during follow-up. However, serum protein biomarkers show limited diagnostic sensitivity and specificity in stand-alone assays because their levels reflect tumor burden. To validate whether biomarkers in nipple discharge may serve as novel biomarkers for breast cancer, we composed a panel of potential cancer biomarkers, including CA15-3, CA125, CEA, and malignant tumor-specific growth factor (TSGF), and evaluated their expression in both serum and nipple discharge in order to explore the expression and significance of estrogen receptor (ER), progestrone receptor (PR), epidermal growth factor receptor type 2 (HER2/neu), CA15-3, CA125, CEA, and TSGF expression for their combined predictive value for breast cancer and in judging the prognosis of breast cancer. Univariate analysis revealed that combined detection of CA15-3, CA125, CEA, and TSGF in nipple discharge served as novel biomarkers for the diagnosis and prognosis of breast cancer, but in the multivariate analyses the adverse effects of the four biomarkers combination in nipple discharge positivity on overall survival were lost. Multivariate analysis revealed that the positivity of the combined detection of the four biomarkers in both nipple discharge and serum was significantly higher than that of other detection methods. Thus, the combined detection of these four biomarkers both in serum and nipple discharge was retained as an independent prognostic variable in breast cancer patients. Our results indicate that CA15-3, CA125, CEA, and TSGF in nipple discharge can serve as novel biomarkers in the diagnosis and prognosis of breast cancer.
- Cytomorphologic patterns of breast lesions in sudanese patients: lessons learned from fine needle aspiration cytology. [Journal Article]
- Asian Pac J Cancer Prev 2014; 15(8):3411-3.
Background:Cytology for breast lesions is a safe, rapid and cost-effective with a high specificity and sensitivity.
Objective:To determine the cytomorphologic patterns of breast lesions identified among a group of Sudanese patients. Materials and
Methods:This study included 759 patients undergoing either a fine needle aspiration FNA, nipple discharge (ND) smears or breast skin scraping (SS) at a cytology clinic in Khartoum. Clinical and demographic data were reviewed. Stained smears were categorized into: inadequate sample, normal breast, benign lesion, suspicious, or malignant neoplasm.
Results:of the 759 cases, 734 (96.71%) were FNA, 18 (2.37%) ND and 7 cases (0.92%) SS. For 28 cases, FNA was done under ultrasound guidance. Females were 720 (94.86%). Benign lesions were 423(55.75%) and 248 (32.67%) were malignant and 77 (10.14%) of smears were normal without any detected abnormality. Ten (1.31%) cases were suspicious for malignancy, and only one case (0.13%) was reported as inadequate. Most lesions were observed among the age group 30 years and above.
Conclusion:Most patients investigated have benign lesions, one third of cytological smears were malignant. FNAC is a useful tool for investigating breast lesions in limited-resource settings.
- Use of ductoscopy as an additional diagnostic method and its applications in nipple discharge. [Journal Article]
- Minerva Chir 2014 Apr; 69(2):65-73.
About 1/10 of the patients apply to breast clinics with the complaint of nipple discharge (ND). Surgery is the most frequently preferred treatment method in case of suspicious ND. The contribution of ductoscopy to identify the patients who are candidates for surgery was evaluated and its role to limit the surgery was assessed.From November 2005 to December 2010 430 patients with ND were assessed by 456 ductoscopic investigations and the results were analyzed. Complete ductoscopic evaluation was achieved in 84% of cases and 28 patients were offered surgery but did not accept (N.=355). Patients with bloody or serous discharges from a single duct were investigated by ductoscopy under local anesthesia as an office procedure. The patients were grouped according to discharge characteristics and the ductoscopic diagnoses.A total of 223 patients had all three criteria of pathologic ND (PND: single duct, spontaneous and bloody/serous discharge). Twenty-two potential neoplastic or malignant lesion (PNML) and 79 papillomatous lesion (solitary or multiple papilloma) were identified. In 132 patients with just two of the PND criteria, 5 PNML and 18 papillomatous lesions were identified. Twenty-three patients with solitary papilloma that were removed by ductoscopic papillomectomy (DP) are followed up without surgery.Ductoscopy helped to identify the patients who required surgical treatment and decreased the number of operations. DP was successfully performed in select group of patients who otherwise would have required surgical resection. Patients with normal ductoscopy findings and patients who were treated with DP successfully can be followed up without the need of surgery.