MOHS micrographic surgery for treating erosive adenoma of the nipple: a case report and review of the literature

Management of nipple adenomas during pregnancy: a case report

BACKGROUND

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. Generally, complete surgical excision of the nipple is the main treatment, alternative therapeutic methods such as Mohs micrographic surgery, nipple splitting enucleation, and cryotherapy can be considered. Disorders of the breast in young women are generally benign. Even if the management during pregnancy is usually conservative and surgical excision is reserved for very strong malignancy suspicion, benign lesions can cause the impossibility to breastfeed after giving birth when involving the nipple.

CASE PRESENTATION

We present the case of a 28-year-old female, who was referred to the Breast Unit of the University Hospital of Modena (Italy) in May 2020 with a 12-months history of enlargement of the left nipple with associated erythema, serohemorrhagic discharge, and pain in the left nipple region. The diagnostic assessment came out in favor of a nipple adenoma. After surgical treatment was recommended, the patient got pregnant. Taking into account the major risks of surgery during pregnancy, a multidisciplinary discussion was conducted, to consider whether to proceed with surgery or postpone it after pregnancy. Because of the volume and the position of the adenoma, the indication for surgical excision was confirmed, to allow regular lactation and breastfeeding immediately after giving birth and to avoid potential obstructive complications. Surgical excision of nipple adenoma without complete resection of the nipple was performed after her first trimester of pregnancy under local anesthesia. A histopathological examination confirmed the diagnosis. No recurrence occurred after 12 months. The patient gave birth, had no deficit in lactation, and successfully breastfed.

CONCLUSIONS

Therefore, we consider that nipple adenoma enucleation might be a safe treatment even during pregnancy. Moreover, conservative local treatment of nipple adenomas can preserve the nipple aesthetically and functionally, thus allowing regular lactation and breastfeeding in young women.

Pathological and imaging features of Paget's disease and nipple adenoma: a comparative study

BACKGROUND

Both Paget's disease (PD) and nipple adenoma (NA) are rare lesions occurred on nipple and share some similarities in clinical manifestations, but there are have different pathological manifestations and imaging findings. This study analyzed the clinicopathological and imaging features of PD in nipple and NA to improve our knowledge about these two diseases and to provide guidance for clinical diagnosis and treatment.

METHODS

Retrospectively analyzed 99 female patients confirmed by surgery and pathology from January 2014 to December 2018. The features of imaging examination included 95 cases of breast ultrasound, 83 cases of breast X-ray and 24 cases of magnetic resonance imaging (MRI) were analyzed and compered the detection rate and diagnostic accuracy.

RESULTS

The 99 patients consisted of 76 patients with PD and 23 patients with NA. Despite the similarity of clinical manifestations between PD and NA, the pathological features of these diseases were completely different. Differences in various imaging manifestations were found to facilitate differential diagnosis. Breast X-ray and ultrasound can discover the nipple areola changes such as mass and calcification, but some cases still show negative. Breast MRI can clearly show the areola lesions of nipple PD and NA, accurately evaluate the degree and size of breast lesions, and help clinicians choose appropriate and personalized diagnosis and treatment methods.

CONCLUSIONS

The combination of multiple breast imaging examinations (including X-ray, ultrasound, and MRI) can improve the diagnosis of PD and NA and play a guiding role in the options for clinical treatment.

State of the art of Mohs surgery for rare cutaneous tumors in the Spanish Registry of Mohs Surgery (REGESMOHS)

BACKGROUND

The use of Mohs micrographic surgery (MMS) for rare cutaneous tumors is poorly defined. We aim to describe the demographics, tumor presentation and topography, surgery characteristics and complications of MMS for rare cutaneous tumors in a national registry.

METHODS

Prospective cohort study of patients treated with MMS in Spain between July 2013 and June 2018. The inclusion criteria were patients with cutaneous tumors with final diagnosis different from basal cell carcinoma, squamous cell carcinoma, dermatofibrosarcoma protuberans, or any kind of melanoma.

RESULTS

Five thousand and ninety patients were recorded in the registry, from which only 73 tumors (1.4%) fulfilled the inclusion criteria: atypical fibroxanthoma (18), microcystic adnexal carcinoma (10), extramammary Paget's disease (7), Merkel cell carcinoma (5), dermatofibroma (4), trichilemmal carcinoma (4), desmoplastic trichoepithelioma (4), sebaceous carcinoma (3), leiomyosarcoma (2), porocarcinoma (2), angiosarcoma (2), trichoblastoma (1), superficial acral fibromyxoma (1), and others (10). No intra-surgery morbidity was registered. Postsurgery complications appeared in six patients (9%) and were considered mild. Median follow-up time was 0.9 years during which three Merkel cell carcinomas, one angiosarcoma, one microcystic adnexal carcinoma, and four others recurred (12.3%).

CONCLUSION

This national registry shows that rare cutaneous tumors represent a negligible part of the total MMS performed in our country with a low complication rate.