1
|
Guirguis MS, Arribas EM, Kapoor MM, Patel MM, Perez F, Nia ES, Ding Q, Moseley TW, Adrada BE. Multimodality Imaging of Benign and Malignant Diseases of the Nipple-Areolar Complex. Radiographics 2024; 44:e230113. [PMID: 38483829 DOI: 10.1148/rg.230113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
The nipple-areolar complex (NAC), a unique anatomic structure of the breast, encompasses the terminal intramammary ducts and skin appendages. Several benign and malignant diseases can arise within the NAC. As several conditions have overlapping symptoms and imaging findings, understanding the distinctive nipple anatomy, as well as the clinical and imaging features of each NAC disease process, is essential. A multimodality imaging approach is optimal in the presence or absence of clinical symptoms. The authors review the ductal anatomy and anomalies, including congenital abnormalities and nipple retraction. They then discuss the causes of nipple discharge and highlight best practices for the imaging workup of pathologic nipple discharge, a common condition that can pose a diagnostic challenge and may be the presenting symptom of breast cancer. The imaging modalities used to evaluate and differentiate benign conditions (eg, dermatologic conditions, epidermal inclusion cyst, mammary ductal ectasia, periductal mastitis, and nonpuerperal abscess), benign tumors (eg, papilloma, nipple adenoma, and syringomatous tumor of the nipple), and malignant conditions (eg, breast cancer and Paget disease of the breast) are reviewed. Breast MRI is the current preferred imaging modality used to evaluate for NAC involvement by breast cancer and select suitable candidates for nipple-sparing mastectomy. Different biopsy techniques (US -guided biopsy and stereotactic biopsy) for sampling NAC masses and calcifications are described. This multimodality imaging approach ensures an accurate diagnosis, enabling optimal clinical management and patient outcomes. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
Collapse
Affiliation(s)
- Mary S Guirguis
- From the Departments of Breast Imaging (M.S.G., E.M.A., M.M.K., M.M.P., F.P., E.S.N., T.W.M., B.E.A.), Pathology-Anatomical (Q.D.), and Breast Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| | - Elsa M Arribas
- From the Departments of Breast Imaging (M.S.G., E.M.A., M.M.K., M.M.P., F.P., E.S.N., T.W.M., B.E.A.), Pathology-Anatomical (Q.D.), and Breast Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| | - Megha M Kapoor
- From the Departments of Breast Imaging (M.S.G., E.M.A., M.M.K., M.M.P., F.P., E.S.N., T.W.M., B.E.A.), Pathology-Anatomical (Q.D.), and Breast Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| | - Miral M Patel
- From the Departments of Breast Imaging (M.S.G., E.M.A., M.M.K., M.M.P., F.P., E.S.N., T.W.M., B.E.A.), Pathology-Anatomical (Q.D.), and Breast Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| | - Frances Perez
- From the Departments of Breast Imaging (M.S.G., E.M.A., M.M.K., M.M.P., F.P., E.S.N., T.W.M., B.E.A.), Pathology-Anatomical (Q.D.), and Breast Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| | - Emily S Nia
- From the Departments of Breast Imaging (M.S.G., E.M.A., M.M.K., M.M.P., F.P., E.S.N., T.W.M., B.E.A.), Pathology-Anatomical (Q.D.), and Breast Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| | - Qingqing Ding
- From the Departments of Breast Imaging (M.S.G., E.M.A., M.M.K., M.M.P., F.P., E.S.N., T.W.M., B.E.A.), Pathology-Anatomical (Q.D.), and Breast Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| | - Tanya W Moseley
- From the Departments of Breast Imaging (M.S.G., E.M.A., M.M.K., M.M.P., F.P., E.S.N., T.W.M., B.E.A.), Pathology-Anatomical (Q.D.), and Breast Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| | - Beatriz E Adrada
- From the Departments of Breast Imaging (M.S.G., E.M.A., M.M.K., M.M.P., F.P., E.S.N., T.W.M., B.E.A.), Pathology-Anatomical (Q.D.), and Breast Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| |
Collapse
|
2
|
Kang YJ, Woo OH, Kim A. Nipple Schwannoma: A Case Report and Literature Review on Nipple Mass. J Breast Cancer 2024; 27:72-77. [PMID: 37985385 PMCID: PMC10912579 DOI: 10.4048/jbc.2023.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/12/2023] [Accepted: 11/12/2023] [Indexed: 12/20/2023] Open
Abstract
Schwannomas are slow-growing benign tumors originating from the Schwann cells of the peripheral nerve sheaths. Herein, we report the first documented case of a schwannoma presenting as a painful nipple mass in a 32-year-old woman. This mass initially developed six years ago following a period of breastfeeding. Breast magnetic resonance imaging (MRI) scans revealed an iso-intense mass, with an approximate size of 2.2 cm, on a T1-weighted image with internal cystic changes. The mass exhibited heterogeneously delayed enhancement and restricted diffusion. Surgical excision was performed, and the diagnosis of cutaneous plexiform nipple schwannoma was confirmed histopathologically. A literature review revealed that the MRI findings of the nipple mass in our case were consistent with the common features of a schwannoma.
Collapse
Affiliation(s)
- Ye Ju Kang
- Department of Radiology, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Ok Hee Woo
- Department of Radiology, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Korea.
| | - Aeree Kim
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
| |
Collapse
|
3
|
Turashvili G, Li X. Inflammatory Lesions of the Breast. Arch Pathol Lab Med 2023; 147:1133-1147. [PMID: 37196345 DOI: 10.5858/arpa.2022-0477-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 05/19/2023]
Abstract
CONTEXT.— Inflammatory lesions of the breast are rare but not infrequently pose problems both clinically and morphologically, particularly on needle core biopsies. These lesions range from acute inflammatory conditions to chronic lymphoplasmacytic and lymphohistiocytic to granulomatous inflammatory diseases. OBJECTIVE.— To provide a comprehensive overview of inflammatory lesions of the breast, with etiopathogenesis and clinical, radiologic, and pathologic features as well as differential diagnostic considerations, clinical management, and prognosis. DATA SOURCES.— The existing literature in the English language, including original research articles and review articles describing inflammatory lesions of the breast. CONCLUSIONS.— Inflammatory lesions of the breast are characterized by a wide variety of clinical, radiologic, and morphologic features. The histopathologic differential diagnosis often includes a neoplastic process requiring ancillary studies and correlation with clinical and radiologic findings. Although most specimens display nonspecific findings precluding a definitive pathologic diagnosis, pathologists have a unique opportunity to play a crucial role in identifying key histologic features suggestive of certain entities, such as cystic neutrophilic granulomatous mastitis, immunoglobulin (Ig) G4 mastitis, or squamous metaplasia of lactiferous ducts, in the right clinical and radiologic context, and thereby guiding optimal and timely clinical management. The information presented herein will be helpful to practicing anatomic pathologists and pathology trainees in becoming more familiar with specific morphologic features and overcoming differential diagnostic challenges related to pathology reporting of inflammatory lesions of the breast.
Collapse
Affiliation(s)
- Gulisa Turashvili
- From the Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia
| | - Xiaoxian Li
- From the Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia
| |
Collapse
|
4
|
Byon JH, Hwang S, Choi H, Choi EJ. Diagnostic Accuracy of Magnetic Resonance Imaging Features and Tumor-to-Nipple Distance for the Nipple-Areolar Complex Involvement of Breast Cancer: A Systematic Review and Meta-Analysis. Korean J Radiol 2023; 24:739-751. [PMID: 37500575 PMCID: PMC10400374 DOI: 10.3348/kjr.2022.0846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 05/02/2023] [Accepted: 05/19/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE This systematic review and meta-analysis evaluated the accuracy of preoperative breast magnetic resonance imaging (MRI) features and tumor-to-nipple distance (TND) for diagnosing occult nipple-areolar complex (NAC) involvement in breast cancer. MATERIALS AND METHODS The MEDLINE, Embase, and Cochrane databases were searched for articles published until March 20, 2022, excluding studies of patients with clinically evident NAC involvement or those treated with neoadjuvant chemotherapy. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Two reviewers independently evaluated studies that reported the diagnostic performance of MRI imaging features such as continuity to the NAC, unilateral NAC enhancement, non-mass enhancement (NME) type, mass size (> 20 mm), and TND. Summary estimates of the sensitivity and specificity curves and the summary receiver operating characteristic (SROC) curve of the MRI features for NAC involvement were calculated using random-effects models. We also calculated the TND cutoffs required to achieve predetermined specificity values. RESULTS Fifteen studies (n = 4002 breast lesions) were analyzed. The pooled sensitivity and specificity (with 95% confidence intervals) for NAC involvement diagnosis were 71% (58-81) and 94% (91-96), respectively, for continuity to the NAC; 58% (45-70) and 97% (95-99), respectively, for unilateral NAC enhancement; 55% (46-64) and 83% (75-88), respectively, for NME type; and 88% (68-96) and 58% (40-75), respectively, for mass size (> 20 mm). TND had an area under the SROC curve of 0.799 for NAC involvement. A TND of 11.5 mm achieved a predetermined specificity of 85% with a sensitivity of 64%, and a TND of 12.3 mm yielded a predetermined specificity of 83% with a sensitivity of 65%. CONCLUSION Continuity to the NAC and unilateral NAC enhancement may help predict occult NAC involvement in breast cancer. To achieve the desired diagnostic performance with TND, a suitable cutoff value should be considered.
Collapse
Affiliation(s)
- Jung Hee Byon
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Seungyong Hwang
- Department of Genetics, Stanford University, Stanford, CA, USA
| | - Hyemi Choi
- Department of Statistics and Institute of Applied Statistics, Jeonbuk National University, Jeonju, Republic of Korea.
| | - Eun Jung Choi
- Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Republic of Korea.
| |
Collapse
|
5
|
Wu C, Jia QN, Fang K, Zeng YP. Skin diseases of the nipple and areola complex: A case series study from China. Front Med (Lausanne) 2023; 10:1136482. [PMID: 37056737 PMCID: PMC10086167 DOI: 10.3389/fmed.2023.1136482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/09/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundSkin diseases of the nipple and areola complex (NAC) are numerous and difficult to diagnose, which is a great challenge for clinicians. A better understanding of the clinical features of NAC skin diseases is of great value for the correct diagnosis.MethodsTo investigate the clinical characteristics of skin diseases of the NAC, we retrospectively analyzed the demographic data, disease constitution, rash characteristics, inconsistency between the clinical and pathological diagnosis from 260 patients with NAC lesions that were confirmed by histopathology at Peking Union Medical College Hospital, China from 2012 to 2022.ResultsThe patients’ average age was 43.6 (8 to 82) years, and the ratio of females to males was 13.4:1. Out of the 260 patients biopsied, the most common diseases were eczema, Paget’s disease (PD), adenoma of the nipple (AN), seborrheic keratosis (SK), cutaneous metastasis of breast cancer, wart, soft fibroma, and hyperkeratosis of the nipple and areola. There were 77 (29.6%) patients with inconsistency between the clinical impressions and pathological diagnoses. AN was the most clinically misdiagnosed condition, most commonly presumed to be PD or eczema.ConclusionEczema and PD are the most common biopsied NAC skin diseases. Late onset, unilateral involvement, and predilection for the nipple are several characteristics of PD, which are different from eczema. NAC skin diseases are easily misdiagnosed clinically, especially AN.
Collapse
|
6
|
Fu WD, Wang XH, Lu KK, Lu YQ, Zhou JY, Huang QD, Guo GL. Real-world outcomes for Chinese breast cancer patients with tumor location of central and nipple portion. Front Surg 2022; 9:993263. [PMID: 36263089 PMCID: PMC9574339 DOI: 10.3389/fsurg.2022.993263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022] Open
Abstract
Background The association between tumor location and breast cancer prognosis has been controversial. We sought to explore the relationship between tumors located in central and nipple portion (TCNP) and Chinese breast cancer. Patients and methods A total of 1,427 breast cancer patients were recruited. There were 328 cases of TCNP and 1,099 cases of tumors in the breast peripheral quadrant (TBPQ). The chi-square test was used to compare different variables between TCNP and TBPQ groups. A one-to-one propensity score matching (PSM) was applied to construct a matched sample consisting of pairs of TCNP and TBPQ groups. Kaplan–Meier curves were used for survival analysis of disease-free survival (DFS), breast cancer-specific survival (BCSS) and overall survival (OS). The Cox proportional hazards regression model was applied to identify prognostic risk factors. Results The median follow-up time was 58 months. Compared to TBPQ, TCNP patients had significantly larger tumor size, more frequent metastasis to lymph nodes (LN) and more proportions of TNM stage II–III. DFS, OS and BCSS rates were markedly lower in the TCNP group as compared to the TBPQ group before and after PSM (all p < 0.05). Multivariate Cox analysis showed that TCNP was an independent prognostic factor for breast cancer. Subgroup analysis indicated that for breast molecular subtypes and TNM stage II-III breast cancer, TCNP were related to worse prognosis. Multivariate logistic regression revealed that TCNP was an independent contributing factor for LN metastasis. Conclusion In Chinese breast cancer, compared to TBPQ, TCNP is associated with more LN metastasis and poorer prognosis.
Collapse
Affiliation(s)
- Wei-Da Fu
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiao-Hui Wang
- Department of Breast / Thyroid Surgery, Jinhua Municipal Central Hospital, Jinhua, China
| | - Kang-Kang Lu
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yi-Qiao Lu
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jie-Yu Zhou
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qi-Di Huang
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China,Correspondence: Qi-Di Huang Gui-Long Guo
| | - Gui-Long Guo
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China,Correspondence: Qi-Di Huang Gui-Long Guo
| |
Collapse
|
7
|
Luu Thi TH, Eichner A, Wohlrab J. Therapeutische Besonderheiten bei Erkrankungen der Mamillenhaut. DIE DERMATOLOGIE 2022; 73:873-879. [PMID: 35925215 PMCID: PMC9592625 DOI: 10.1007/s00105-022-05031-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/25/2022]
Abstract
Die Mamillenregion ist durch besondere anatomische Verhältnisse charakterisiert und lässt sich aus dermatologischer Perspektive in Brusthaut, Haut des Brustwarzenhofes (Areola) und Haut der Brustwarze (Papilla mammae) unterteilen. Im klinischen Zusammenhang sind die Brustwarzen häufig während der Stillzeit durch mechanische Beanspruchung, Milieuänderung mit Mazeration durch den Milchfluss sowie durch mikrobielle Erreger alteriert. Zudem besteht hier die Gefahr der Entwicklung einer Mastitis puerperalis. Außerhalb der Schwangerschaft und Stillzeit finden sich gelegentlich an der Mamillenhaut Ekzemerkrankungen, häufig bei atopischer Disposition (atopisches Mamillenekzem) oder als irritatives Kontaktekzem („joggers nipple“). Seltener werden allergische Kontaktekzeme auf Konservierungsstoffe von Topika oder Metallen (Piercings) beobachtet. Auch im Rahmen einer Skabiesinfestation wird eine Beteiligung der Mamillen, insbesondere bei Frauen, regelmäßig beobachtet. Von großer klinischer Bedeutung sind seltene, präinvasive Läsionen eines Mammakarzinoms oder der Morbus Paget der Mamille vom extramammären Typ. Durch die besonderen anatomischen Gegebenheiten ist es naheliegend, dass bei der Anwendung von Topika sich auch spezifische Penetrationsbedingungen ableiten. Experimentelle Untersuchungen an Humanhaut ex vivo legen nahe, dass in Abhängigkeit von der Molmasse und der Löslichkeit des Arzneistoffs sowie des eingesetzten Vehikelsystems eine deutliche Zunahme der kutanen Bioverfügbarkeit, insbesondere an der Brustwarze selbst durch den transpapillären Diffusionsweg, auftreten kann. Dies sollte insbesondere bei der topischen Anwendung von Arzneistoffen mit bekanntem dosisabhängigem Nebenwirkungspotenzial (z. B. Glukokortikoiden) beachtet werden. Allerdings fehlt dafür bisher eine klinische Evidenz.
Collapse
Affiliation(s)
- Thanh Huong Luu Thi
- Universitätsklinik für Dermatologie und Venerologie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06097, Halle (Saale), Deutschland
| | - Adina Eichner
- Institut für angewandte Dermatopharmazie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Johannes Wohlrab
- Universitätsklinik für Dermatologie und Venerologie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06097, Halle (Saale), Deutschland.
- Institut für angewandte Dermatopharmazie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland.
| |
Collapse
|
8
|
Leo ME, Carter GJ, Waheed U, Berg WA. Nipple Adenoma: Correlation of Imaging Findings and Histopathology. JOURNAL OF BREAST IMAGING 2022; 4:408-412. [PMID: 35915844 PMCID: PMC9334779 DOI: 10.1093/jbi/wbac019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Indexed: 11/13/2022]
Abstract
Abstract
Nipple adenomas (NAs) are benign neoplasms composed of papillary hyperplasia of the epithelium of the major lactiferous ducts. Patients with NA may report bloody nipple discharge and clinically may resemble Paget disease, raising concern for malignancy. Mammographically, NAs are often occult. US can show a hypervascular circumscribed mass centered within the nipple with varying echogenicity. Diagnosis is usually made on punch biopsy or excision, but breast radiologists should be aware of this entity. Malignancy can be found elsewhere in the ipsilateral or contralateral breast, or very rarely may directly extend to involve an NA, but published experience with concurrent malignancies is small. We describe the radiologic-pathologic correlation of NAs.
Collapse
Affiliation(s)
- Madeline E Leo
- University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA, USA
| | - Gloria J Carter
- Magee-Womens Hospital of UPMC, Department of Pathology, Pittsburgh, PA, USA
| | - Uzma Waheed
- University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Department of Radiology, Pittsburgh, PA, USA
- Stanford University School of Medicine, Department of Radiology, Palo Alto, CA, USA
| | - Wendie A Berg
- University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Department of Radiology, Pittsburgh, PA, USA
| |
Collapse
|
9
|
Jha A, Shrivastav S, Kasyap AK. Calciphylaxis and Ulcerative Lesions of Bilateral Nipple–Areolar Complex Due to Alcoholic Liver Disease. Indian J Radiol Imaging 2022; 32:142-144. [PMID: 35722637 PMCID: PMC9200483 DOI: 10.1055/s-0041-1739385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
When faced with eczematous lesions involving the nipple–areolar complex (NAC), Paget's disease is assumed to be the diagnosis, anything else being considered a “Zebra” necessitating its exclusion on pathology. A middle-aged lady presented with synchronous asymmetrical ulceration of bilateral NAC with pleomorphic calcifications on mammography and simultaneous extensive vascular calcification in bilateral breasts that suggested systemic cause. Calciphylaxis is a rare diagnosis occurring usually due to underlying end-stage renal disease or hyperparathyroidism. There are very few case reports of calciphylaxis due to alcoholic liver disease and no cases to the best of our knowledge involving NAC. We report an extremely rare case of breast and NAC calciphylaxis due to alcoholic liver disease, highlighting need to consider benign etiology when bilateral involvement is present.
Collapse
Affiliation(s)
- Anamika Jha
- Department of Radiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Shreya Shrivastav
- Department of Pathology, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Akhilesh K. Kasyap
- Department of Gastroenterology and Hepatology, Grande International Hospital, Dhapasi, Kathmandu, Nepal
| |
Collapse
|
10
|
Nissan N, Bauer E, Moss Massasa EE, Sklair-Levy M. Breast MRI during pregnancy and lactation: clinical challenges and technical advances. Insights Imaging 2022; 13:71. [PMID: 35397082 PMCID: PMC8994812 DOI: 10.1186/s13244-022-01214-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/21/2022] [Indexed: 12/12/2022] Open
Abstract
The breast experiences substantial changes in morphology and function during pregnancy and lactation which affects its imaging properties and may reduce the visibility of a concurrent pathological process. The high incidence of benign gestational-related entities may further add complexity to the clinical and radiological evaluation of the breast during the period. Consequently, pregnancy-associated breast cancer (PABC) is often a delayed diagnosis and carries a poor prognosis. This state-of-the-art pictorial review illustrates how despite currently being underutilized, technical advances and new clinical evidence support the use of unenhanced breast MRI during pregnancy and both unenhanced and dynamic-contrast enhanced (DCE) during lactation, to serve as effective supplementary modalities in the diagnostic work-up of PABC.
Collapse
Affiliation(s)
- Noam Nissan
- Radiology Department, Sheba Medical Center, 5265601, Tel Hashomer, Israel. .,Sackler Medicine School, Tel Aviv University, Tel Aviv, Israel.
| | - Ethan Bauer
- Sackler Medicine School, New-York Program, Tel Aviv University, Tel Aviv, Israel
| | - Efi Efraim Moss Massasa
- Joint Medicine School Program of Sheba Medical Center, St. George's, University of London and the University of Nicosia, Sheba Medical Center, Tel Hashomer, Israel
| | - Miri Sklair-Levy
- Radiology Department, Sheba Medical Center, 5265601, Tel Hashomer, Israel.,Sackler Medicine School, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
11
|
Lee SC, Mendez-Broomberg K, Eacobacci K, Vincoff NS, Gupta E, McElligott SE. Nipple-sparing Mastectomy: What the Radiologist Should Know. Radiographics 2022; 42:321-339. [PMID: 35179983 DOI: 10.1148/rg.210136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Nipple-sparing mastectomy (NSM) is increasingly offered to patients undergoing treatment of breast cancer and prophylaxis treatment for reduction of breast cancer risk. NSM is considered oncologically safe for appropriately selected patients and is associated with improved cosmetic outcomes and quality of life. Accepted indications for NSM have expanded in recent years, and currently only inflammatory breast cancer or malignancy involving the nipple is considered an absolute contraindication. Neoplasms close to and involving the nipple areolar complex are common, and cancer of the lactiferous ducts can spread to the nipple. Therefore, accurate determination of nipple involvement at imaging examinations is critical to identifying appropriate candidates for NSM and preventing local recurrence. Multiple imaging features have been described as predictors of nipple involvement, with tumor to nipple distance, enhancement between the index malignancy and the nipple, and nipple retraction demonstrating the highest predictive values. These features can be assessed at multimodality breast imaging, particularly at breast MRI, which demonstrates high specificity and negative predictive value for determining nipple involvement in malignancy. Online supplemental material is available for this article. ©RSNA, 2022.
Collapse
Affiliation(s)
- Samantha C Lee
- From the Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health System, 300 Community Dr, Manhasset, NY 11030
| | - Karen Mendez-Broomberg
- From the Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health System, 300 Community Dr, Manhasset, NY 11030
| | - Katherine Eacobacci
- From the Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health System, 300 Community Dr, Manhasset, NY 11030
| | - Nina S Vincoff
- From the Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health System, 300 Community Dr, Manhasset, NY 11030
| | - Ekta Gupta
- From the Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health System, 300 Community Dr, Manhasset, NY 11030
| | - Suzanne E McElligott
- From the Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health System, 300 Community Dr, Manhasset, NY 11030
| |
Collapse
|
12
|
Restrepo R, Cervantes LF, Swirsky AM, Diaz A. Breast development in pediatric patients from birth to puberty: physiology, pathology and imaging correlation. Pediatr Radiol 2021; 51:1959-1969. [PMID: 34236480 DOI: 10.1007/s00247-021-05099-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 03/01/2021] [Accepted: 05/02/2021] [Indexed: 10/20/2022]
Abstract
Breast tissue undergoes a series of changes from birth to puberty. The majority of the changes are transient, related to physiological hormonal changes. Although the breast is identical in both sexes at birth, its histology and development will eventually differ. It is important for radiologists to have a basic understanding of endocrinological changes and appearance on imaging to avoid potential pitfalls, particularly on ultrasound, which is the primary modality used to evaluate the breast.
Collapse
Affiliation(s)
- Ricardo Restrepo
- Department of Radiology, Nicklaus Children's Hospital, 3100 SW 62nd Ave., Miami, FL, 33155, USA.
| | - Luisa F Cervantes
- Department of Radiology, Nicklaus Children's Hospital, 3100 SW 62nd Ave., Miami, FL, 33155, USA
| | | | - Alejandro Diaz
- Division of Pediatric Endocrinology, Nicklaus Children's Hospital, Miami, FL, USA
| |
Collapse
|
13
|
Holen ÅS, Larsen M, Moshina N, Wåade GG, Sechopoulos I, Hanestad B, Tøsdal L, Hofvind S. Visualization of the Nipple in Profile: Does It Really Affect Selected Outcomes in Organized Mammographic Screening? JOURNAL OF BREAST IMAGING 2021; 3:427-437. [PMID: 38424798 DOI: 10.1093/jbi/wbab042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To investigate whether having the nipple imaged in profile was associated with breast characteristics or compression parameters, and whether it affected selected outcomes in screening with standard digital mammography or digital breast tomosynthesis. METHODS In this IRB-approved retrospective study, results from 87 450 examinations (174 900 breasts) performed as part of BreastScreen Norway, 2016-2019, were compared by nipple in profile status and screening technique using descriptive statistics and generalized estimating equations. Unadjusted and adjusted odds ratios with 95% confidence intervals (95% CIs) were estimated for outcomes of interest, including age, breast volume, volumetric breast density, and compression force as covariates. RESULTS Achieving the nipple in profile versus not in profile was associated with lower breast volume (845.1 cm3 versus 1059.9 cm3, P < 0.01) and higher mammographic density (5.6% versus 4.4%, P < 0.01). Lower compression force and higher compression pressure were applied to breasts with the nipple in profile (106.6 N and 11.5 kPa) compared to the nipple not in profile (110.8 N and 10.5 kPa, P < 0.01 for both). The adjusted odds ratio was 0.95 (95% CI: 0.88-1.02; P = 0.15) for recall and 0.92 (95% CI: 0.77-1.10; P = 0.36) for screen-detected cancer for nipple in profile versus not in profile. CONCLUSION Breast characteristics and compression parameters might hamper imaging of the nipple in profile. However, whether the nipple was in profile or not on the screening mammograms did not influence the odds of recall or screen-detected cancer, regardless of screening technique.
Collapse
Affiliation(s)
- Åsne S Holen
- Cancer Registry of Norway, Section for Breast Cancer Screening, Oslo, Norway
| | - Marthe Larsen
- Cancer Registry of Norway, Section for Breast Cancer Screening, Oslo, Norway
| | - Nataliia Moshina
- Cancer Registry of Norway, Section for Breast Cancer Screening, Oslo, Norway
| | - Gunvor G Wåade
- Oslo Metropolitan University, Department of Life Sciences and Health, Oslo, Norway
| | - Ioannis Sechopoulos
- Radboud University Medical Center, Department of Medical Imaging, Nijmegen, the Netherlands
- Dutch Expert Centre for Screening (LRCB), Nijmegen, the Netherlands
| | - Berit Hanestad
- Haukeland University Hospital, Department of Radiology, Bergen, Norway
| | - Linn Tøsdal
- Stavanger University Hospital, Department of Radiology, Stavanger, Norway
| | - Solveig Hofvind
- Cancer Registry of Norway, Section for Breast Cancer Screening, Oslo, Norway
- Oslo Metropolitan University, Department of Life Sciences and Health, Oslo, Norway
| |
Collapse
|
14
|
Coşkun Bilge A, Aydın H, Bostancı IE, Tanişman Ö, Saygılı Öz D. Comparison of the Magnetic Resonance Imaging Findings of Paget's Disease of the Breast and Malignant Tumor Invasion of the Nipple-Areola Complex. Eur J Breast Health 2021; 17:265-273. [PMID: 34263155 DOI: 10.4274/ejbh.galenos.2021.6091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/30/2021] [Indexed: 12/01/2022]
Abstract
Objective We aimed to investigate the distinction between Paget's disease of the breast (PDB) and malignant tumor invasion of nipple-areolar complex (MTION) with Magnetic resonance imaging (MRI) findings without the need for skin punch biopsy. Materials and Methods MRI findings of 16 patients with pathologically proven PDB and 11 patients with pathologically proven MTION were reviewed retrospectively. MRI images were assessed for nipple morphological changes; areolar-periareolar skin changes; thickness, classification, and kinetic characteristics of the nipple-areolar complex (NAC) enhancement; morphological pattern, size, and pathological diagnosis of concomitant malignant lesions; kinetic characteristics of the concomitant malignant lesions enhancement; continuity of enhancement between the nipple and closest concomitant malignant lesion; similarity of enhancement kinetics of the NAC and concomitant malignant lesions; and nipple-to-malignant lesion distance in both patient groups. Results Areolar-periareolar skin thickening was statistically different between the patient groups. Enhancement kinetic pattern was classified as persistent in four patients with MTION and plateau in seven patients with PDB. Moreover, NAC enhancement kinetic characteristics were statistically different between the groups. Invasive ductal carcinoma was detected in three patients with PDB and five patients with MTION. A statistically significant difference in malignant lesion pathological types was detected between the patient groups. Conclusion The significant MRI findings in patients with MTION diagnosed as invasive ductal carcinoma were areolar-periareolar skin thickening and asymmetric NAC enhancement with persistent kinetics pattern. In patients diagnosed with ductal carcinoma in situ, a plateau pattern of asymmetric NAC enhancement without any areolar-periareolar skin changes on MRI may indicate PDB.
Collapse
Affiliation(s)
- Almila Coşkun Bilge
- Department of Radiology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Hale Aydın
- Department of Radiology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Işıl Esen Bostancı
- Department of Radiology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Özge Tanişman
- Department of Radiology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Diba Saygılı Öz
- Department of Radiology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
15
|
Samreen N, Madsen LB, Chacko C, Heller SL. Magnetic resonance imaging in the evaluation of pathologic nipple discharge: indications and imaging findings. Br J Radiol 2021; 94:20201013. [PMID: 33544650 DOI: 10.1259/bjr.20201013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pathologic nipple discharge (PND) is typically unilateral, spontaneous, involves a single duct, and is serous or bloody in appearance. In patients with PND, breast MRI can be helpful as an additional diagnostic tool when conventional imaging with mammogram and ultrasound are negative. MRI is able to detect the etiology of nipple discharge in 56-61% of cases when initial imaging with mammogram and ultrasound are negative. Advantages to using MRI in evaluation of PND include good visualization of the retroareolar breast and better evaluation of posterior lesions which may not be well evaluated on mammograms and galactograms. It is also less invasive compared to central duct excision. Papillomas and nipple adenomas are benign breast masses that can cause PND and are well visualized on MRI. Ductal ectasia, and infectious etiologies such as mastitis, abscess, and fistulas are additional benign causes of PND that are well evaluated with MRI. MRI is also excellent for evaluation of malignant causes of PND including Paget's disease, ductal carcinoma in-situ and invasive carcinoma. MRI's high negative predictive value of 87-98.2% is helpful in excluding malignant etiologies of PND.
Collapse
Affiliation(s)
- Naziya Samreen
- New York University Long Island Division, Long Island, NY, USA
| | | | - Celin Chacko
- New York University Long Island Division, Long Island, NY, USA
| | | |
Collapse
|
16
|
Yoon MH, Kim HJ, Kim WH, Lee J, Park JY, Kim JY. Syringomatous Adenoma of the Nipple on Screening Mammography: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:1565-1569. [PMID: 36238890 PMCID: PMC9431981 DOI: 10.3348/jksr.2020.0184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/16/2021] [Accepted: 03/08/2021] [Indexed: 11/24/2022]
Abstract
Syringomatous adenoma of the nipples, first reported in 1983, is an extremely rare benign tumor extending to the subareolar area and, pathologically, has a shape similar to that of sweat gland tumors. Radiologically, infiltrating patterns and calcifications can cause misdiagnosis of malignant tumors. The authors report a case of syringomatous adenoma that shows only calcifications of the nipple in a screening mammography.
Collapse
Affiliation(s)
- Min Hyeok Yoon
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Hye Jung Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Won Hwa Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Jeeyeon Lee
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Ji-Young Park
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | | |
Collapse
|
17
|
Diagnosis, Management, and Percutaneous Sampling of Nipple-Areolar Calcifications: How Radiologists Can Help Patients Avoid the Operating Room. AJR Am J Roentgenol 2020; 216:48-56. [PMID: 33170739 DOI: 10.2214/ajr.20.23046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Both benign and malignant causes of calcifications in the nipple-areolar complex exist. BI-RADS terminology applies to the description and classification of nipple-areolar calcifications in the same way it does to calcifications elsewhere in the breast. Minimally invasive sampling can be performed safely and accurately with ultrasound-guided techniques, with a few technical modifications. CONCLUSION This article provides insight regarding the management algorithm and image-guided interventional techniques for sampling nipple-areolar calcifications as an essential competency for breast imaging practices.
Collapse
|
18
|
Chiorean A, Pintican RM, Szep M, Feier D, Rogojan L, Fetica B, Dindelegan G, Vlad B, Duma M. Nipple Ultrasound: A Pictorial Essay. Korean J Radiol 2020; 21:955-966. [PMID: 32677380 PMCID: PMC7369201 DOI: 10.3348/kjr.2019.0831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/07/2020] [Accepted: 03/09/2020] [Indexed: 11/15/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Angelica Chiorean
- Department of Radiology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Medimages Breast Center, Cluj-Napoca, Romania
| | - Roxana Maria Pintican
- Department of Radiology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Radiology and Medical Imaging, County Clinical Emergency Hospital, Cluj-Napoca, Romania.
| | - Madalina Szep
- Department of Radiology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Medimages Breast Center, Cluj-Napoca, Romania
| | - Diana Feier
- Department of Radiology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Medimages Breast Center, Cluj-Napoca, Romania
| | - Liliana Rogojan
- Department of Pathology, County Clinical Emergency Hospital, Cluj-Napoca, Romania
| | - Bogdan Fetica
- Department of Pathology, County Clinical Emergency Hospital, Cluj-Napoca, Romania.,Department of Pathology, Ion Chiricuţă, Oncology Institute, Cluj-Napoca, Romania
| | - George Dindelegan
- Department of Surgery, County Clinical Emergency Hospital, Cluj-Napoca, Romania
| | - Bura Vlad
- Department of Radiology and Medical Imaging, County Clinical Emergency Hospital, Cluj-Napoca, Romania
| | - Magdalena Duma
- Department of Radiology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Medimages Breast Center, Cluj-Napoca, Romania.,Department of Radiology, Micromedica Clinic, Piatra Neamt, Romania
| |
Collapse
|
19
|
Lyons D, Wahab RA, Vijapura C, Mahoney MC. The nipple-areolar complex: comprehensive imaging review. Clin Radiol 2020; 76:172-184. [PMID: 33077158 DOI: 10.1016/j.crad.2020.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
The nipple-areolar complex can be affected by a variety of benign and malignant entities that can present with non-specific symptoms. Benign pathologies commonly affecting the nipple-areolar complex include nipple calcifications, nipple adenoma, abscess of Montgomery tubercles, ductal ectasia, periductal mastitis, and papilloma. Malignant pathologies that affect the nipple-areolar complex include Paget's disease of the breast, ductal carcinoma in-situ, and invasive ductal carcinoma. Clinical history and examination, imaging, and tissue sampling when appropriate are co-dependent factors that guide the assessment of nipple-areolar pathologies. This article provides a review of the normal anatomy, common anatomical variants, benign and malignant pathologies, and imaging techniques to guide the diagnostic assessment of the nipple-areolar complex.
Collapse
Affiliation(s)
- D Lyons
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, ML 0772, Cincinnati, OH, 45219-0772, USA.
| | - R A Wahab
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, ML 0772, Cincinnati, OH, 45219-0772, USA
| | - C Vijapura
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, ML 0772, Cincinnati, OH, 45219-0772, USA
| | - M C Mahoney
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, ML 0772, Cincinnati, OH, 45219-0772, USA
| |
Collapse
|
20
|
Ayres VJ, Ramalho LC, Fernandes CE, Fleury EFC, Pompei LM. Solitary dilated duct visualised by mammography: ultrasound and anatomopathological correlation. Clin Radiol 2020; 75:962.e9-962.e15. [PMID: 32928498 DOI: 10.1016/j.crad.2020.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 08/11/2020] [Indexed: 11/19/2022]
Abstract
AIM To correlate solitary dilated ducts (SDDs) detected by mammography with ultrasound and histopathological findings of intraductal lesions and evaluate the association with invasive or in situ breast carcinoma. The secondary goal was to evaluate the prevalence of SDDs in screening and diagnostic mammography. MATERIALS AND METHODS This prospective study of consecutive screening and diagnostic mammograms from March 2016 to March 2017 at a referral centre for the diagnosis and treatment of breast cancer was registered at clinicatrials.gov (NCT03161392). SDDs were recorded prospectively on mammography, and regardless of the findings' stability, the participants were recalled for targeted ultrasound to evaluate the intraductal content, which was submitted to histopathological analysis when heterogeneous content or masses were found. SDD stability was evaluated for 2 years. The categorical data are shown as frequency and percentage, and the comparisons were conducted using the chi-squared test. RESULTS A total of 9,035 mammograms were evaluated. SDDs were identified in 130 (1.43%) mammograms and 94 targeted ultrasound were conducted. In 22 cases, histological analysis were performed, and the main findings were fibrocystic changes (n = 14) and papilloma (n = 8). The main clinical and imaging characteristics associated with statistical significance (p < 0.05) were the presence of nipple discharge, intraductal masses, and calcifications on mammography. CONCLUSION SDDs visualised using mammography and without other associated findings should be complemented with targeted ultrasound to evaluate the intraductal content that shows benign histopathological results when papilloma is the most relevant finding. No cases of invasive or in situ breast carcinoma were found in this study.
Collapse
Affiliation(s)
- V J Ayres
- Department of Obstetrics and Gynecology of Faculdade de Medicina Do ABC, Av Lauro Gomes, 2000, 09060-870, Santo André, SP, Brazil; Department of Radiology of Instituto Brasileiro de Controle Do Câncer, Av. Alcantara Machado, 2576, 03102-002, São Paulo, SP, Brazil.
| | - L C Ramalho
- Department of Radiology of Instituto Brasileiro de Controle Do Câncer, Av. Alcantara Machado, 2576, 03102-002, São Paulo, SP, Brazil
| | - C E Fernandes
- Department of Obstetrics and Gynecology of Faculdade de Medicina Do ABC, Av Lauro Gomes, 2000, 09060-870, Santo André, SP, Brazil
| | - E F C Fleury
- Department of Radiology of Instituto Brasileiro de Controle Do Câncer, Av. Alcantara Machado, 2576, 03102-002, São Paulo, SP, Brazil
| | - L M Pompei
- Department of Obstetrics and Gynecology of Faculdade de Medicina Do ABC, Av Lauro Gomes, 2000, 09060-870, Santo André, SP, Brazil
| |
Collapse
|
21
|
Del Riego J, Pitarch M, Codina C, Nebot L, Andreu FJ, Aparicio O, Medina A, Martín A. Multimodality approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Insights Imaging 2020; 11:89. [PMID: 32757082 PMCID: PMC7406635 DOI: 10.1186/s13244-020-00896-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/16/2020] [Indexed: 12/29/2022] Open
Abstract
The anatomic and histologic characteristics of the nipple-areolar complex make this breast region special. The nipple-areolar complex can be affected by abnormal development and a wide spectrum of pathological conditions, many of which have unspecific clinical and radiological presentations that can present a challenge for radiologists. The nipple-areolar complex requires a specific imaging workup in which a multimodal approach is essential. Radiologists need to know the different imaging modalities used to study the nipple-areolar complex, as well as their advantages and limitations. It is essential to get acquainted with the acquisition technique for each modality and the spectrum of findings for the different conditions. This review describes and illustrates a combined clinical and radiological approach to evaluate the nipple-areolar complex, emphasizing the findings for the normal morphology, developmental abnormalities, and the most common benign and malignant diseases that can affect this region. We also present a diagnostic algorithm that enables a rapid, practical approach to diagnosing condition involving the nipple-areolar complex.
Collapse
Affiliation(s)
- Javier Del Riego
- Department of Radiology, Women's Imaging, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, 1 Parc Tauli, Sabadell, Barcelona, Spain. .,Women's Imaging, Grup Duran Diagnòstic per la Imatge, Sabadell, Barcelona, Spain.
| | - Mireia Pitarch
- Department of Radiology, Women's Imaging, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, 1 Parc Tauli, Sabadell, Barcelona, Spain
| | - Clara Codina
- Department of Radiology, Women's Imaging, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, 1 Parc Tauli, Sabadell, Barcelona, Spain
| | - Laura Nebot
- Department of Pathology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Oscar Aparicio
- Department of Surgery, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, Barcelona, Spain
| | - Alexandra Medina
- Department of Gynecology and Obstetrics, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, Barcelona, Spain
| | - Amaya Martín
- Department of Radiology, Women's Imaging, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, 1 Parc Tauli, Sabadell, Barcelona, Spain.,Women's Imaging, Grup Duran Diagnòstic per la Imatge, Sabadell, Barcelona, Spain
| |
Collapse
|
22
|
Sharma S, Blaudeau E, Sharma S. A Case of Asymmetric Nipple Enhancement as an Imaging Precursor to Invasive Ductal Carcinoma. Cureus 2020; 12:e9514. [PMID: 32884870 PMCID: PMC7462649 DOI: 10.7759/cureus.9514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
On multidetector computed tomography (CT), it is important to scrutinize the imaged portions of the breasts. In recent years, the dramatic rise in CT imaging has led to the increased detection of incidental breast lesions. We describe a case of invasive ductal carcinoma that presented as stage IV cancer, and retrospective review of prior imaging study revealed asymmetric nipple enhancement on a trauma protocol CT chest acquired three years earlier. This report highlights the importance of being attentive to breast abnormalities on CT performed for indications other than breast disease and additionally focuses on the approach to address abnormal enhancement of the nipple areolar complex (NAC).
Collapse
|
23
|
Abdulwaasey M, Tariq MU, Minhas K, Kayani N. Invasive Breast Carcinoma Arising in a Nipple Adenoma After 15 Years: Report of a Rare Case and Literature Review. Cureus 2020; 12:e8586. [PMID: 32670721 PMCID: PMC7358932 DOI: 10.7759/cureus.8586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Nipple adenoma (NA) is a rare benign breast neoplasm that seldom co-exists with breast carcinoma (BC). Majority of these BC are separate from NA, and their origin from NA is an extremely rare event. We herein describe a case of 65-year-old female who had a painless lump for 15 years which increased in size and ulcerated for last six months. Microscopic examination of the wedge biopsy of nipple showed features of NA at superficial aspect and invasive carcinoma from it at the deeper aspect. The patient underwent mastectomy and axillary clearance, which revealed a 4-cm invasive breast carcinoma, no special type with axillary lymph node involvement. The patient received adjuvant chemotherapy, radiotherapy and adjuvant hormonal therapy. The patient is alive and disease-free after 36 months. NA should be carefully evaluated for co-existent BC because it completely changes the treatment plan and prognosis.
Collapse
Affiliation(s)
- Muhammad Abdulwaasey
- Histopathology, Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, PAK
| | - Muhammad Usman Tariq
- Histopathology, Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, PAK
| | - Khurram Minhas
- Histopathology, Aga Khan University Hospital, Karachi, PAK
| | - Naila Kayani
- Pathology and Laboratory Medicine/Histopathology, Aga Khan University Hospital, Karachi, PAK.,Pathology and Microbiology, Aga Khan University Hospital, Karachi, PAK
| |
Collapse
|
24
|
Comparison of radial and meander-like breast ultrasound with respect to diagnostic accuracy and examination time. Arch Gynecol Obstet 2020; 301:1533-1541. [PMID: 32363545 PMCID: PMC7246244 DOI: 10.1007/s00404-020-05554-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 04/20/2020] [Indexed: 12/03/2022]
Abstract
Purpose To prospectively compare the diagnostic accuracy of radial breast ultrasound (r-US) to that of conventional meander-like breast ultrasound (m-US), patients of a consecutive, unselected, mixed collective were examined by both scanning methods. Methods Out of 1948 dual examinations, 150 revealed suspicious lesions resulting in 168 biopsies taken from 148 patients. Histology confirmed breast cancers in 36 cases. Sensitivity, specificity, accuracy, PPV, and NPV were calculated for r-US and m-US. The examination times were recorded. Results For m-US and r-US, sensitivity (both 88.9%), specificity (86.4% versus 89.4%), accuracy (86.9% versus 89.3%), PPV (64.0% versus 69.6%), NPV (both 98.3%), false-negative rate (both 5.6%), and rate of cancer missed by one method (both 5.6%) were similar. The mean examination time for r-US (14.8 min) was significantly (p < 0.01) shorter than for m-US (22.6 min). Conclusion Because the diagnostic accuracy of r-US and m-US are comparable, r-US can be considered an alternative to m-US in routine breast US with the added benefit of a significantly shorter examination time.
Collapse
|
25
|
Abstract
BACKGROUND The aim of this study was to present several cases of benign and malignant nipple lesions and contribute to diagnosis and differential diagnosis. METHODS A retrospective study was conducted on 13 patients. All of the patients were evaluated by ultrasonography, and 11 of them had pathological results. We analyzed the clinical and sonographic features. RESULTS There were 3 malignant lesions, 7 benign lesions, and 3 congenital nipple dysplasia, listed as follows:Malignant lesions (n = 3, 23%): Paget's disease (PD, n = 3, 23%). All of the patients with PD showed unilateral nipple erosion, discharge, and pain. The ultrasound showed abundant blood flow (n = 3, 23%); 2 patients (n = 2, 15%) had microcalcifications.Benign lesions (n = 7, 54%): Adenoma of the nipple (n = 2, 15%). One patient (n = 1, 8%) had nipple erosion and discharge. Two patients (n = 2, 15%) had a palpable nodule in the nipple. The ultrasound of both patients (n = 2, 15%) showed regular-shaped, clear border nodule with abundant blood flow (n = 2, 15%).Leiomyoma of the nipple (n = 1, 8%): This male patient was characterized by unilateral nipple enlargement and pain. The ultrasound showed a regular nodule with absent blood flow.Plasma cell mastitis (n = 2, 15%): Two patients showed unilateral nipple inversion and pain. One patient (n = 1, 8%) showed swollen and redness. The 2 patients showed a lesion in the gland around the nipple present as an irregular shape and unclear boundary hypoechoic mass.Nipple wart (n = 2, 15%): Two patients showed a unilateral soft exogenous neoplasm. Both of the patients showed a hypoechoic wart; the echo was similar to the nipple, the border was clear, and had no blood flow in the wart.Nipple Dysplasia (n = 3, 23%): Accessory nipple (n = 3, 23%). Two patients (n = 2, 15%) had accessory nipples in the subcoastal area, 1 patient (n = 1, 8%) in the areolar. All of the patients' sonographic features were the same as the nipple.The positive predict value (PPV) of the clinical symptoms: Erosion and discharge are both 75% (P < 0.05). The PPV of the US manifestations: irregular shape, indictinct margin, abundant blood flow, microcalcification, thicken skin in diagnosing malignant lesions are 60%,60%,60%,100%,100%, respectively (P < 0.05). CONCLUSIONS The characteristic sonographic features together with clinical symptoms contribute to the diagnosis of nipple lesions.
Collapse
Affiliation(s)
| | | | | | | | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | | |
Collapse
|
26
|
Chi NTB. Case report: Malignant-type calcification of the nipple with histologic correlation. Radiol Case Rep 2019; 15:82-84. [PMID: 31737152 PMCID: PMC6849431 DOI: 10.1016/j.radcr.2019.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 10/13/2019] [Accepted: 10/14/2019] [Indexed: 11/06/2022] Open
Abstract
Malignant-type calcification of the nipple is a rare lesion, with only 2 cases reported in literature. We present a case of a 48-year-old female who came to us because of noncycle breast pain, where malignant-type calcification of the nipple was incidentally seen on mammography. The final pathology is fibrocystic change with benign calcium in connective tissue. Different diagnosis of malignant and benign histology of malignant-type calcification with no associated mass is difficult or even not eligible so that wedge excision the nipple without making the deformity needs to perform to diagnose the histology.
Collapse
Affiliation(s)
- Nguyen Tran Bao Chi
- Breast Unit-Out patient Department, Hung Vuong Hospital, 128 Hong Bang Street, Ward 12, District 5, Ho Chi Minh city, Vietnam
| |
Collapse
|
27
|
Lim S, Park G, Choi HJ, Kwon WJ, Kang BS, Bang M. Use of preoperative mammography, ultrasonography, and MRI to predict nipple areolar complex involvement in breast cancer. Br J Radiol 2019; 92:20190074. [PMID: 31317763 DOI: 10.1259/bjr.20190074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To identify the predictive factors of cancer invading into the nipple. METHODS Patients with breast cancer undergoing mastectomy between May 2009 and March 2019 were reviewed retrospectively. Of these, those with breast cancer within 2 cm of the nipple areolar complex on ultrasonography were included in this study. Clinicopathological data of the primary tumor and imaging findings from mammography, ultrasonography, and MRI were compared between cases with and without nipple involvement by cancer. RESULTS In total, 156 of the 821 patients identified were included in the analysis. Of them, 29 had nipple involvement by cancer. Univariate analysis revealed that the following imaging results were significantly associated with nipple involvement: perineural invasion, lymphovascular invasion, lymph node metastasis; relation type between the tumor and the nipple on ultrasonography; periareolar skin thickening on mammography; and short tumor-nipple distance, continuous enhancement between the nipple and tumor, skin enhancement, and nipple enhancement on MRI. However, on multivariate logistic regression analysis, only invasion type of tumor on ultrasonography and nipple enhancement and short tumor-nipple distance on MRI were significantly correlated with nipple involvement by cancer. CONCLUSION Imaging findings on preoperative mammography, ultrasonography and MRI are effective predictors for nipple involvement by cancer. ADVANCES IN KNOWLEDGE Preoperative mammography, ultrasonography, and MRI help predict nipple involvement by breast cancer.
Collapse
Affiliation(s)
- Soyeoun Lim
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Gyeongmin Park
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Hye-Jeong Choi
- Department of Pathology, Ulsan University Hosptial, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Woon Jung Kwon
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Byeong Seong Kang
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Minseo Bang
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| |
Collapse
|
28
|
Ferre R, Mesurolle B. Sonoelastography of retroareolar carcinomas. J Gynecol Obstet Hum Reprod 2018; 48:165-170. [PMID: 30355505 DOI: 10.1016/j.jogoh.2018.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/13/2018] [Accepted: 10/17/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To review the sonographic and elastographic features of retroareolar carcinomas. MATERIALS Institutional review board approval was obtained. Among 967 sonographically guided biopsies (2013-2014) (14-gauge cores), 53 yielded the diagnosis of retroareolar carcinoma (located less than 2cm from the nipple on mammograms). Out of these 53 lesions, 30 were assessed additionally with strain elastography prior to the biopsy in addition to conventional sonographic analysis. Imaging features were analyzed in consensus by two radiologists. Elasticity score was evaluated by the score defined by Itoh (Tsukuba score). Descriptive analysis was performed. RESULTS A total of 30 lesions were included (30 patients; mean age, 66.03 (±12.88)). The mean size of the lesions at diagnosis was 23.97mm (±13.64). Sonographically, most of lesions appeared as hypoechoic masses (96.5%, 28/29) displaying an irregular shape (75.9%, 22/29), non parallel orientation (58.6%, 17/29), non circumscribed margins (86.2%, 25/29), posterior attenuation (93.3%, 28/29). Among the 30 lesions, 3.3% (1/30) of lesions appeared as an attenuation and distortion without discrete mass. Most of the lesions were categorized as BI-RADS category 5 (76.7%, 23/30). Approximately half of lesions (53.3%, 16/30) appeared as firm and larger than 2D mode with strain elastography according to the Tsukuba score. CONCLUSION Retroareolar carcinoma displayed malignant features at US and elastographic examination. In our study population, the addition of elastography to breast US in this location did not improve diagnostic accuracy.
Collapse
Affiliation(s)
- Romuald Ferre
- Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, 687 Pine Ave West, Montreal, PQ H3H 1A1, Canada.
| | - Benoit Mesurolle
- Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, 687 Pine Ave West, Montreal, PQ H3H 1A1, Canada
| |
Collapse
|
29
|
Ustbas B, Kilic D, Bozkurt A, Aribal ME, Akbulut O. Silicone-based composite materials simulate breast tissue to be used as ultrasonography training phantoms. ULTRASONICS 2018. [PMID: 29525227 DOI: 10.1016/j.ultras.2018.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
A silicone-based composite breast phantom is fabricated to be used as an education model in ultrasonography training. A matrix of silicone formulations is tracked to mimic the ultrasonography and tactile response of human breast tissue. The performance of two different additives: (i) silicone oil and (ii) vinyl-terminated poly (dimethylsiloxane) (PDMS) are monitored by a home-made acoustic setup. Through the use of 75 wt% vinyl-terminated PDMS in two-component silicone elastomer mixture, a sound velocity of 1.29 ± 0.09 × 103 m/s and an attenuation coefficient of 12.99 ± 0.08 dB/cm-values those match closely to the human breast tissue-are measured with 5 MHz probe. This model can also be used for needle biopsy as well as for self-exam trainings. Herein, we highlight the fabrication of a realistic, durable, accessible, and cost-effective training platform that contains skin layer, inner breast tissue, and tumor masses.
Collapse
Affiliation(s)
- Burcin Ustbas
- Faculty of Engineering and Natural Sciences, Sabanci University, Istanbul, Turkey
| | - Deniz Kilic
- Surgitate Medikal Arge Sanayi ve Ticaret A.Ş., Kocaeli, Turkey
| | - Ayhan Bozkurt
- Faculty of Engineering and Natural Sciences, Sabanci University, Istanbul, Turkey
| | - Mustafa Erkin Aribal
- Marmara University Pendik Research and Application Hospital, Radiology Department, Istanbul, Turkey
| | - Ozge Akbulut
- Faculty of Engineering and Natural Sciences, Sabanci University, Istanbul, Turkey.
| |
Collapse
|
30
|
Pluguez-Turull CW, Nanyes JE, Quintero CJ, Alizai H, Mais DD, Kist KA, Dornbluth NC. Idiopathic Granulomatous Mastitis: Manifestations at Multimodality Imaging and Pitfalls. Radiographics 2018. [DOI: 10.1148/rg.2018170095] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Cedric W. Pluguez-Turull
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Jennifer E. Nanyes
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Cristina J. Quintero
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Hamza Alizai
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Daniel D. Mais
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Kenneth A. Kist
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Nella C. Dornbluth
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| |
Collapse
|
31
|
Shinn L, Woodward C, Boddu S, Jha P, Fouroutan H, Péley G. Nipple Adenoma Arising in a Supernumerary Mammary Gland: A Case Report. TUMORI JOURNAL 2018; 97:812-4. [DOI: 10.1177/030089161109700622] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Nipple adenoma, a benign tumour of the breast, is a relatively rare occurrence. This report describes an even rarer case of nipple adenoma arising within a supernumerary mammary gland. The presenting symptoms were a lump and throbbing pain in the axilla. Ultrasound scan and core biopsy proved inconclusive so surgical excision was undertaken, thus allowing a histological diagnosis. The patient made a full and uneventful recovery. Physicians must be aware that diseases of the breast and nippleareola complex may also arise in accessory mammary tissue and accessory nipples should not be discounted as a common congenital anomaly. Instead they must be regarded, examined and treated as normal breast tissue.
Collapse
Affiliation(s)
- Louise Shinn
- Department of General Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Claudia Woodward
- Department of General Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Samyukta Boddu
- Department of Radiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Pankaj Jha
- Department of General Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Hutan Fouroutan
- Department of Histopathology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Gábor Péley
- Department of General Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| |
Collapse
|
32
|
Abstract
Nipple discharge is a common symptom in clinical practice, representing the third leading breast complaint, after pain and lumps. It is usually limited and has a benign etiology. The risk of malignancy is higher when the discharge is uniductal, unilateral, spontaneous, persistent, bloody, or serous, as well as when it is accompanied by a breast mass. The most common causes of pathologic nipple discharge are papilloma and ductal ectasia. However, there is a 5% risk of malignancy, mainly ductal carcinoma in situ. The clinical examination is an essential part of the patient evaluation, allowing benign nipple discharge to be distinguished from suspicious nipple discharge, which calls for imaging. Mammography and ultrasound should be used together as first-line imaging methods. However, mammography has low sensitivity in cases of nipple discharge, because, typically, the lesions are small, are retroareolar, and contain no calcifications. Because the reported sensitivity and specificity of ultrasound, it is important to use the correct technique to search for intraductal lesions in the retroareolar region. Recent studies recommend the use of magnetic resonance imaging in cases of suspicious nipple discharge in which the mammography and ultrasound findings are normal. The most common magnetic resonance imaging finding is non-mass enhancement. Surgery is no longer the only solution for patients with suspicious nipple discharge, because short-time follow-up can be safely proposed.
Collapse
Affiliation(s)
- Ivie Braga de Paula
- MSc, Member of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), MD, Radiologist at Conrad Diagnóstico por Imagem, Belo Horizonte, MG, Brazil
| | - Adriene Moraes Campos
- Member of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), MD, Radiologist at Conrad Diagnóstico por Imagem, Belo Horizonte, MG, Brazil
| |
Collapse
|
33
|
Ferre R, Pare M, Mesurolle B. Ultrasound features of retroareolar breast carcinoma. Diagn Interv Imaging 2017; 98:409-413. [DOI: 10.1016/j.diii.2017.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 02/26/2017] [Accepted: 02/27/2017] [Indexed: 10/19/2022]
|
34
|
Retroareolar Carcinomas in Breast Ultrasound: Pearls and Pitfalls. Cancers (Basel) 2016; 9:cancers9010001. [PMID: 28042819 PMCID: PMC5295772 DOI: 10.3390/cancers9010001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 12/26/2016] [Accepted: 12/26/2016] [Indexed: 11/17/2022] Open
Abstract
Breast Ultrasound (US) is an important tool for both screening and diagnostic examinations. Although breast US has benefitted from significant recent technical improvements, its use for the retroareolar region is known to be more challenging than for other locations. The retroareolar location was defined by Giess et al. in 1998 as the region where any lesion is situated at less than two cm from the nipple and/or involves the nipple-areolar complex on mammogram. Understanding of the complex anatomy and physiology of the nipple-areolar region is important to avoid misinterpretation and misdiagnosis. The ability for the breast imager to manage difficulties related to the retroareolar area is paramount by adjusting settings (compounding, frequency, Doppler) and utilizing specific manoeuvers. Cases illustrating difficulties encountered in diagnosis of retroareolar carcinomas are presented.
Collapse
|
35
|
Medeiros MM, Graziano L, de Souza JA, Guatelli CS, Poli MRB, Yoshitake R. Hyperechoic breast lesions: anatomopathological correlation and differential sonographic diagnosis. Radiol Bras 2016; 49:43-8. [PMID: 26929460 PMCID: PMC4770396 DOI: 10.1590/0100-3984.2014.0032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hyperechoic lesions are not a frequent finding at breasts ultrasonography, and
most of times are associated with benign pathologies that do not require further
evaluation. However, some neoplasms such as invasive breast carcinomas and
metastases may present with hyperechogenicity. Thus, the knowledge about
differential diagnoses and identification of signs of lesion aggressiveness are
of great relevance to avoid unnecessary procedures or underdiagnosis, and to
support the correct clinical/surgical approach. On the basis of such concepts,
the present essay describes and illustrates the main features of hyperechoic
lesions at breast ultrasonography in different cases, with anatomopathological
correlation.
Collapse
Affiliation(s)
- Marcelo Menezes Medeiros
- MD, Resident in Radiology, Department of Radiology and Imaging Diagnosis - A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | - Luciana Graziano
- Physicians, Department of Radiology and Imaging Diagnosis - A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | - Juliana Alves de Souza
- Physicians, Department of Radiology and Imaging Diagnosis - A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | - Camila Souza Guatelli
- Physicians, Department of Radiology and Imaging Diagnosis - A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | - Miriam Rosalina B Poli
- Physicians, Department of Radiology and Imaging Diagnosis - A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | - Rafael Yoshitake
- Physicians, Department of Radiology and Imaging Diagnosis - A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| |
Collapse
|
36
|
Can preoperative 3-T MRI predict nipple–areolar complex involvement in patients with breast cancer? Clin Imaging 2016; 40:119-24. [DOI: 10.1016/j.clinimag.2015.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 07/20/2015] [Accepted: 08/04/2015] [Indexed: 11/19/2022]
|
37
|
Lee C, Boughey J. Case Report of a Synchronous Nipple Adenoma and Breast Carcinoma with Current Multi-modality Radiologic Imaging. Breast J 2015; 22:105-10. [PMID: 26548327 DOI: 10.1111/tbj.12531] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This case report presents the first reported molecular breast imaging appearance of a nipple adenoma coexisting with an ipsilateral breast malignancy. Conventional multi-modality radiologic imaging, including mammography, ultrasonography, and magnetic resonance imaging are also shown, and a brief review of the literature is provided.
Collapse
Affiliation(s)
- Christine Lee
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | |
Collapse
|
38
|
Boulanger L, Demetz J. [How to explore breast skin lesion?: Guidelines]. ACTA ACUST UNITED AC 2015; 44:921-6. [PMID: 26527029 DOI: 10.1016/j.jgyn.2015.09.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 09/18/2015] [Indexed: 11/30/2022]
Abstract
A change in the shape or appearance of the nipple-areola complex, especially if it is unilateral and recent appearance, is a sign of underlying breast tumor. Breast imaging is then required (grade C). Any erythematous lesion of the nipple or nipple-areola can be a Paget's disease, an adenoma of the nipple or a nipple eczema. Clinical course and pattern can point to a diagnosis without sufficient specificity (LE4). If nipple eczema is suspected, it is recommended to perform a test treatment with topical corticosteroids. In case of failure or if a Paget's disease of the breast is suspected, a biopsy must be done. When indicated, it is not possible to recommend a biopsy modality (scrape cytology, punch biopsy, nipple core biopsy and surgical excision) compared to another. When imaging exploration of the nipple-areola complex is necessary, ultrasound and mammography are recommended as first-line. In the absence of signal, an MRI is recommended as second-line (grade C).
Collapse
Affiliation(s)
- L Boulanger
- Service de chirurgie gynécologique, cancérologie gynécologique et mammaire, clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France.
| | - J Demetz
- Service de chirurgie gynécologique, cancérologie gynécologique et mammaire, clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France
| |
Collapse
|
39
|
Stone K, Wheeler A. A Review of Anatomy, Physiology, and Benign Pathology of the Nipple. Ann Surg Oncol 2015; 22:3236-40. [PMID: 26242366 DOI: 10.1245/s10434-015-4760-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Indexed: 11/18/2022]
Abstract
The nipple and areola are pigmented areas of modified skin that connect with the underlying gland of the breast via ducts. The fairly common congenital anomalies of the nipple include inversion, clefts, and supernumerary nipples. The anatomy of the nipple areolar complex is discussed as a foundation to review anatomical variants, and the physiologic development of the nipple, including changes in puberty and pregnancy, as well as the basis of normal physiologic discharge, are addressed. Skin conditions affecting the nipple include eczema, which, while similar to eczema occurring elsewhere on the body, poses unique aspects in terms of diagnosis and treatment. This article concludes with discussion on the benign abnormalities that develop within the nipple, including intraductal papilloma and nipple adenoma.
Collapse
Affiliation(s)
- Kimberly Stone
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | | |
Collapse
|
40
|
Rummel S, Hueman MT, Costantino N, Shriver CD, Ellsworth RE. Tumour location within the breast: Does tumour site have prognostic ability? Ecancermedicalscience 2015; 9:552. [PMID: 26284116 PMCID: PMC4531129 DOI: 10.3332/ecancer.2015.552] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Indexed: 11/06/2022] Open
Abstract
Introduction Tumour location within the breast varies with the highest frequency in the upper outer quadrant (UOQ) and lowest frequency in the lower inner quadrant (LIQ). Whether tumour location is prognostic is unclear. To determine whether tumour location is prognostic, associations between tumour site and clinicopathological characteristics were evaluated. Materials and Methods All patients enrolled in the Clinical Breast Care Project whose tumour site—UOQ, upper inner quadrant (UIQ), central, LIQ, lower outer quadrant (LOQ)—was determined by a single, dedicated breast pathologist were included in this study. Patients with multicentric disease (n = 122) or tumours spanning multiple quadrants (n = 381) were excluded from further analysis. Clinicopathological characteristics were analysed using chi-square tests for univariate analysis with multivariate analysis performed using principal components analysis (PCA) and multiple logistic regression. Significance was defined as P < 0.05. Results Of the 980 patients with defined tumour location, 30 had bilateral disease. Tumour location in the UOQ (51.5%) was significantly higher than in the UIQ (15.6%), LOQ (14.2%), central (10.6%), or LIQ (8.1%). Tumours in the central quadrant were significantly more likely to have higher tumour stage (P = 0.003) and size (P < 0.001), metastatic lymph nodes (P < 0.001), and mortality (P = 0.011). After multivariate analysis, only tumour size and lymph node status remained significantly associated with survival. Conclusions Evaluation of tumour location as a prognostic factor revealed that although tumours in the central region are associated with less favourable outcome, these associations are not independent of location but rather driven by larger tumour size. Tumours in the central region are more difficult to detect mammographically, resulting in larger tumour size at diagnosis and thus less favourable prognosis. Together, these data demonstrate that tumour location is not an independent prognostic factor.
Collapse
Affiliation(s)
- Seth Rummel
- Clinical Breast Care Project, Windber Research Institute, Windber, Pennsylvania 15963, USA
| | - Matthew T Hueman
- Clinical Breast Care Project, Murtha Cancer Centre, Walter Reed National Military Medical Centre, Bethesda, Maryland 20889, USA
| | - Nick Costantino
- Clinical Breast Care Project, Windber Research Institute, Windber, Pennsylvania 15963, USA
| | - Craig D Shriver
- Clinical Breast Care Project, Murtha Cancer Centre, Walter Reed National Military Medical Centre, Bethesda, Maryland 20889, USA
| | - Rachel E Ellsworth
- Clinical Breast Care Project, Murtha Cancer Centre, Walter Reed National Military Medical Centre, Bethesda, Maryland 20889, USA
| |
Collapse
|
41
|
Sripathi S, Ayachit A, Kadavigere R, Kumar S, Eleti A, Sraj A. Spectrum of Imaging Findings in Paget's Disease of the Breast-A Pictorial Review. Insights Imaging 2015; 6:419-29. [PMID: 26142549 PMCID: PMC4519816 DOI: 10.1007/s13244-015-0415-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/08/2015] [Accepted: 06/12/2015] [Indexed: 11/29/2022] Open
Abstract
PURPOSE We aimed to demonstrate imaging features of Paget's disease of breast, which is an extremely uncommon malignancy that presents with changes in the nipple-areolar region that may or may not be associated with an underlying in situ component or invasive cancer. METHODS AND RESULTS Mammography is the initial investigation of choice, having a high sensitivity especially in cases where a palpable mass is present. The addition of ultrasound improves the accuracy of mammography. When both mammography and ultrasound are negative, MRI may detect an underlying mass or ductal carcinoma in situ (DCIS). CONCLUSION The surgical management of Paget's disease includes mastectomy with or without axillary dissection, though breast conservation surgery in the form of wide local excision can also be done in a selected group of patients. Management should be based on both clinical and imaging findings, including mammography and ultrasound, with MRI playing a crucial role in defining the extent of involvement. Teaching Points • To differentiate Paget's disease from other chronic skin conditions. • Mammographic and ultrasound findings of histopathologically established Paget's disease. • When ultrasound and mammogram are negative, MRI may detect underlying malignancy.
Collapse
Affiliation(s)
- Smiti Sripathi
- Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal, Karnataka, India,
| | | | | | | | | | | |
Collapse
|
42
|
Margolis NE, Morley C, Lotfi P, Shaylor SD, Palestrant S, Moy L, Melsaether AN. Update on imaging of the postsurgical breast. Radiographics 2015; 34:642-60. [PMID: 24819786 DOI: 10.1148/rg.343135059] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Oncologic, reconstructive, and cosmetic breast surgery has evolved in the last 20 years. Familiarity with cutting-edge surgical techniques and their imaging characteristics is essential for radiologic interpretation and may help avert false-positive imaging findings. Novel surgical techniques include skin- and nipple-sparing mastectomies, autologous free flaps, autologous fat grafting, and nipple-areola-complex breast reconstruction. These techniques are illustrated and compared with conventional surgical techniques, including modified radical mastectomy and autologous pedicled flaps. The role of magnetic resonance (MR) imaging in surgical planning, evaluation for complications, and postsurgical cancer detection is described. Breast reconstruction and augmentation using silicone gel-filled implants is discussed in light of the Food and Drug Administration's recommendation for MR imaging screening for "silent" implant rupture 3 years after implantation and every 2 years thereafter. Recent developments in skin incision techniques for reduction mammoplasty are presented. The effects of postsurgical changes on the detection of breast cancer are discussed by type of surgery.
Collapse
Affiliation(s)
- Nathaniel E Margolis
- From the Department of Radiology, Breast Imaging Section, New York University School of Medicine, Langone Medical Center, 550 First Ave, New York, NY 10016
| | | | | | | | | | | | | |
Collapse
|
43
|
AlSharif S, Tremblay F, Omeroglu A, Altinel G, Sun S, Mesurolle B. Infiltrating syringomatous adenoma of the nipple: Sonographic and mammographic features with pathologic correlation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:427-429. [PMID: 24648330 DOI: 10.1002/jcu.22150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 01/20/2014] [Accepted: 02/20/2014] [Indexed: 06/03/2023]
Abstract
We report the case of a 39-year-old woman complaining of painless unilateral nipple enlargement for 3 weeks. She had no family history of breast cancer. Clinical examination revealed left nipple enlargement without pain, erythema, or skin changes m no associated palpable breast or axillary masses. Ultrasound showed several bright foci in the left nipple suggestive of microcalcifications. Neither solid nor cystic masses were detected. The mammogram performed subsequently confirmed the presence of multiple pleomorphic microcalcifications within the nipple. Wedge biopsy showed a syringomatous adenoma. Wide local excision of the nipple was performed. The postoperative course was uneventful.
Collapse
Affiliation(s)
- Shaza AlSharif
- McGill University Health Center, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, Quebec, H3H 1A1, Canada
| | | | | | | | | | | |
Collapse
|
44
|
DI Bonito M, Cantile M, Collina F, D'Aiuto M, Liguori G, DE Cecio R, Botti G. Adenoma of the nipple: A clinicopathological report of 13 cases. Oncol Lett 2014; 7:1839-1842. [PMID: 24932244 PMCID: PMC4049716 DOI: 10.3892/ol.2014.2000] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 12/06/2013] [Indexed: 11/06/2022] Open
Abstract
Adenoma of the nipple (AN) represents a rare benign mammary proliferation of lactiferous ducts. It appears as an erosive or ulcerative lesion, which in a number of cases is associated with a serous/hematic secretion. AN may be clinically confused with Paget's disease and histologically with invasive breast carcinoma or breast cancer precursor lesions. Therefore, the histological and immunophenotypic analysis is essential for the differential diagnosis. The present study describes the histopathological characteristics of a first case series of AN.
Collapse
Affiliation(s)
- Maurizio DI Bonito
- Department of Pathology, National Cancer Institute, Fondazione Pascale Hospital, Naples I-80131, Italy
| | - Monica Cantile
- Department of Pathology, National Cancer Institute, Fondazione Pascale Hospital, Naples I-80131, Italy
| | - Francesca Collina
- Department of Pathology, National Cancer Institute, Fondazione Pascale Hospital, Naples I-80131, Italy
| | - Massimiliano D'Aiuto
- Department of Senology, National Cancer Institute, Fondazione Pascale Hospital, Naples I-80131, Italy
| | - Giuseppina Liguori
- Department of Pathology, National Cancer Institute, Fondazione Pascale Hospital, Naples I-80131, Italy
| | - Rossella DE Cecio
- Department of Pathology, National Cancer Institute, Fondazione Pascale Hospital, Naples I-80131, Italy
| | - Gerardo Botti
- Department of Pathology, National Cancer Institute, Fondazione Pascale Hospital, Naples I-80131, Italy
| |
Collapse
|
45
|
|
46
|
Malignant Invasion of the Nipple-Areolar Complex of the Breast: Usefulness of Breast MRI. AJR Am J Roentgenol 2013; 201:448-55. [DOI: 10.2214/ajr.12.9186] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
47
|
An Unusual Case of Mammary Paget's Disease Diagnosed Using Dynamic Contrast-Enhanced MRI. Case Rep Radiol 2013; 2013:206235. [PMID: 23607031 PMCID: PMC3625544 DOI: 10.1155/2013/206235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 03/05/2013] [Indexed: 11/18/2022] Open
Abstract
Mammary Paget's disease is a rare presentation of breast cancer. At clinical examination, it is characterized by skin lesions of the nipple-areola complex, almost always a sign of malignancy. In fact, it is often associated with an underlying mammary ductal carcinoma in situ (DCIS) or invasive carcinoma. An underlying carcinoma is also common in women with negative mammography and ultrasound (US); in these cases, magnetic resonance imaging (MRI) is a diagnostic tool useful in the detection of occult cancer. We described an unusual case of mammary Paget's disease with underlying DCIS, in a patient without nipple-areola complex alterations and/or palpable lump. On suspicion of Paget's disease, the patient underwent MRI examination that proved useful for an accurate diagnosis. Biopsy confirmed dynamic MRI findings.
Collapse
|
48
|
Ferris-James DM, Iuanow E, Mehta TS, Shaheen RM, Slanetz PJ. Imaging approaches to diagnosis and management of common ductal abnormalities. Radiographics 2012; 32:1009-30. [PMID: 22786991 DOI: 10.1148/rg.324115150] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ductal disease is an important, often overlooked, and poorly understood issue in breast imaging that results in delays in diagnosis and patient care. The differential diagnosis for an intraductal mass is broad and includes inspissated secretions, infection, hemorrhage, solitary or multiple papillomas, and malignancy. Each breast is composed of eight or more ductal systems, with most disease arising in the terminal ductal-lobular unit. Imaging evaluation of the ductal system usually entails a combination of mammography, galactography, ultrasonography (US), and in some cases magnetic resonance (MR) imaging. The most common finding with all modalities is ductal dilatation with a focal or diffuse abnormality. Benign diseases of the ducts include duct ectasia, blocked ducts, inflammatory infiltrates, periductal mastitis, apocrine metaplasia, intraductal papillomas, and papillomatosis. Malignant diseases of the ducts include ductal carcinoma in situ, invasive ductal carcinoma, and Paget disease. Most commonly performed with US or MR imaging guidance, percutaneous biopsy methods are helpful in diagnosis and management of ductal findings. Because most findings are smaller than 1 cm, located within a duct, and thus sometimes not visible after a single pass, vacuum-assisted devices help improve the accuracy of sampling.
Collapse
Affiliation(s)
- Diana M Ferris-James
- Department of Radiology, Division of Breast Imaging, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA.
| | | | | | | | | |
Collapse
|
49
|
Lim HS, Jeong SJ, Lee JS, Park MH, Kim JW, Shin SS, Park JG, Kang HK. Paget disease of the breast: mammographic, US, and MR imaging findings with pathologic correlation. Radiographics 2012; 31:1973-87. [PMID: 22084182 DOI: 10.1148/rg.317115070] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Paget disease is a rare malignancy of the breast characterized by infiltration of the nipple epidermis by adenocarcinoma cells. The clinical features of Paget disease are characteristic and should increase the likelihood of the diagnosis being made. An important point is that more than 90% of cases of Paget disease are associated with an additional underlying breast malignancy. Paget disease is frequently associated with ductal carcinoma in situ (DCIS) in the underlying lactiferous ducts of the nipple-areolar complex; it may even be associated with DCIS or invasive breast cancer elsewhere in the breast, at least 2 cm from the nipple-areolar complex. Nevertheless, mammographic findings may be negative in up to 50% of cases. Magnetic resonance (MR) imaging can be useful in patients with Paget disease for evaluation of the nipple-areolar complex and identification of an additional underlying malignancy in the breast. The appropriate surgical treatment must be carefully selected and individualized on the basis of radiologic findings, especially those obtained with breast MR imaging.
Collapse
Affiliation(s)
- Hyo Soon Lim
- Department of Radiology, Chonnam National University Medical School, 8 Hack Dong, Dong Ku, Gwangju 501-757, South Korea.
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Cho HJ, Kim SH, Kang BJ, Kim H, Song BJ, Lee AW. Leiomyoma of the nipple diagnosed by MRI. Acta Radiol Short Rep 2012; 1:10.1258_arsr.2012.120025. [PMID: 23986851 PMCID: PMC3738360 DOI: 10.1258/arsr.2012.120025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 09/13/2012] [Indexed: 11/28/2022] Open
Abstract
Leiomyoma of the nipple is a rare, benign, non-epithelial tumor that is thought to arise from smooth muscle fibers in the subareolar tissue of the breast. We report an unusual case of leiomyoma of the nipple in a 32-year-old woman in whom the diagnosis was made by ultrasound-guided core needle biopsy. She came to our hospital complaining of a recently enlarged nipple with discharge and erosion in the region of the left nipple-areolar complex. This mass was evaluated by mammography, ultrasonography, and magnetic resonance imaging (MRI). To the best of our knowledge, this is the first case of a leiomyoma of the nipple examined by MRI. MRI showed an oval mass with circumscribed margins that appeared as an intermediate signal intensity on both T1- and T2-weighted images. A dynamic MRI study showed a rim-enhancing oval mass with delayed persistent enhancement. Ultrasound-guided core needle biopsy revealed spindle cell proliferation consistent with leiomyoma of the nipple.
Collapse
|