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1.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 47(4): 161-163, oct.-dic. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-197644

RESUMO

Los neurofibromas son crecimientos exuberantes del tejido nervioso periférico que aparecen en pacientes afectos de neurofibromatosis tipo 1. Los neurofibromas a nivel mamario son raros, y cuando aparecen suelen localizarse a nivel areolar. Presentamos el caso de una paciente de 31 años en la que se llevó a cabo la extirpación de un neurofibroma areolar


Neurofibromas are exuberant growths of peripheral nervous tissue that appear in patients with neurofibromatosis type 1. Neurofibromas of the breast are rare, but they are usually located in the nipple-areola complex. We present the case of a 31-year-old patient who underwent excision of a neurofibroma of the areola


Assuntos
Humanos , Feminino , Adulto , Neurofibroma/diagnóstico , Neurofibroma/cirurgia , Neoplasias da Mama/patologia , Neurofibroma/patologia , Mamilos/patologia , Imuno-Histoquímica/métodos
2.
Niger J Clin Pract ; 23(9): 1324-1327, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32913175

RESUMO

Infiltrating syringomatous adenoma of the nipple (SAN) is a rare benign neoplasm of the breast that is often misdiagnosed. SAN may present with a subareolar lesion and clinical, mammographic, and ultrasonographic findings associated with malignancy. We present the case of a 60-year-old woman with a painful, firm, solid tumor in her left breast and deformation of the left nipple-areolar complex (NAC). Histopathological test results were conflicting. The tumor, including the NAC were locally excised. Postsurgical immuno-histochemical tests revealed squamous histology, whereas myoepithelial cells were present in the resected specimen, a feature consistent with SAN. The pathologist noted microscopically positive surgical margins. Three months after surgery, tumor recurrence occurred. The patient underwent revision surgery with wide excision of the skin and gland around the lesion, followed by immediate breast reconstruction, using a pedicled myocutaneous latissimus dorsi (pLD) flap. Extreme care should be taken when diagnosing SAN to ensure proper treatment and prevent recurrence.


Assuntos
Adenoma/cirurgia , Erros de Diagnóstico/efeitos adversos , Recidiva Local de Neoplasia/cirurgia , Mamilos/cirurgia , Siringoma/cirurgia , Adenoma/patologia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mamoplastia , Mamografia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Mamilos/patologia , Papiloma/patologia , Papiloma/cirurgia , Siringoma/diagnóstico , Siringoma/patologia , Resultado do Tratamento
3.
Rev. senol. patol. mamar. (Ed. impr.) ; 33(3): 121-124, jul.-sept. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-197297

RESUMO

INTRODUCCIÓN: El cáncer de mama masculino representa <1% de todas las neoplasias malignas en hombres, y aunque comparte muchas similitudes con el cáncer de mama en las mujeres, tiene diferencias importantes. CASO CLÍNICO: Paciente masculino de 68años, de raza mestiza, que acude con cuadro clínico de 5meses de evolución caracterizado por lesión nodular en la región areolar de la mama izquierda acompañada de dolor ocasional y crecimiento progresivo. El ultrasonido evidenció lesión heterogénea de bordes irregulares con calcificaciones, BIRADSV. Se decidió hacer mastectomía más biopsia de ganglio centinela, con positividad en el transoperatorio, por lo que se completó la linfadenectomía axilar. El reporte de histopatología confirmó carcinoma ductal infiltrante, ganglio centinela y satélite positivo para carcinoma metastásico. CONCLUSIÓN: Varias incógnitas permanecen sobre el cáncer de mama en hombres. Es de importancia comprender mejor la biología de la enfermedad para lograr identificar las diferencias entre ambos géneros y así determinar si estas tienen implicaciones terapéuticas


INTRODUCTION: Male breast cancer accounts for <1% of all malignancies in men, and although it shares many similarities with breast cancer in women, it has important differences. CASE REPORT: A 68-year-old male patient presented with a 5-month history of a nodular lesion in the areolar region of the left breast accompanied by occasional pain and progressive growth. An ultrasound scan showed a heterogeneous lesion with irregular edges and calcifications, BIRADSV. It was decided to perform a mastectomy and sentinel lymph node biopsy, with positivity in the transoperative period, and axillary lymphadenectomy was completed. The histopathology report confirmed infiltrating ductal carcinoma, sentinel lymph node- and satellite-positive for metastatic carcinoma. CONCLUSION: Several questions remain unanswered about breast cancer in men. It is important to enhance understanding of the biology of the disease to identify the differences between the two sexes and thus determine if they have therapeutic implications


Assuntos
Humanos , Masculino , Idoso , Neoplasias da Mama Masculina/patologia , Biópsia de Linfonodo Sentinela/métodos , Excisão de Linfonodo/métodos , Mamilos/patologia , Carcinoma Ductal de Mama/patologia , Metástase Linfática/patologia , Fatores de Risco
4.
Cir. plást. ibero-latinoam ; 46(3): 259-269, jul.-sept. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-196912

RESUMO

INTRODUCCIÓN Y OBJETIVO: Después de recorrer las diferentes técnicas para la reparación de la mama tuberosa desde los años 70 hasta ahora, concluimos que no existe un procedimiento fácil y sin complicaciones tanto por la técnica en sí como por el uso de implantes aloplásticos. Comparamos las desventajas y ventajas, indicaciones y complicaciones, del trasplante de grasa frente al implante aloplástico, con el fin de que el cirujano plástico tenga en consideración la técnica de transferencia grasa a la hora de llevar a cabo el procedimiento de reconstrucción de una mama tuberosa, puesto que se trata de una técnica que puede reportar mejores resultados que la mera utilización de implantes. MATERIAL Y MÉTODO: Estudio retrospectivo sobre 40 pacientes con mamas tuberosas corregidas mediante autoinjerto graso y con seguimiento postoperatorio medio de 23.4 meses. RESULTADOS: El total de pacientes operadas fue de 40, cada una en 2 tiempos. La técnica habitual fue la de Coleman para la infiltración del injerto graso. Presentamos 8 casos, 2 por cada grado de tuberosidad según la clasificación de Von-Heigburg, y su resolución. CONCLUSIONES: En nuestra experiencia en el tratamiento de la mama tuberosa con este método, el implante graso es la técnica de elección porque produce cicatrices mínimas, proporciona una forma más natural al seno y excluye las complicaciones del material aloplástico. Es un procedimiento sencillo, con una curva de aprendizaje rápida. Además, la lipoescultura asociada es un valor importante, la atención postoperatoria es simple y las complicaciones son poco frecuentes


BACKGROUND AND OBJECTIVE: After touring the different techniques for the repair of the tuberous breast from the 70`s until now, we conclude that there is no easy procedure and free of complications both by the technique itself and by the use of alloplastic implants. We compare the disadvantages and advantages, indications and complications of fat transplantation versus alloplastic implants in order for the plastic surgeon to take into consideration the fat transfer technique when carrying out the reconstruction procedure of a tuberous breast, since this technique can yield better results than the sole use of implants. METHODS: A retrospective study was carried out on 40 patients with tuberous breasts corrected by using a fat autograft and with a postoperative follow-up of 23.4 months. RESULTS: Total number of operated patients was 40, each one operated on in 2 stages. The usual technique was that of Coleman for infiltration of the fat graft. We present 8 cases, 2 for each degree in relation to the Von-Heigburg classification, and its resolution. CONCLUSIONS: In our experience, fat implant is the technique of choice in this process because the scars are minimal, the breast shape is more natural, excludes complications of alloplastic material and it's a simple procedure with a quick learning curve. Besides, associated liposculpture is an important value, postoperative care is simple, and complications are uncommon


Assuntos
Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Mama/anormalidades , Mama/cirurgia , Autoenxertos/cirurgia , Mamoplastia/métodos , Doenças Mamárias/diagnóstico , Implantes de Mama , Tecido Adiposo/transplante , Estudos Retrospectivos , Cuidados Pós-Operatórios , Mamoplastia/instrumentação , Doenças Mamárias/cirurgia , Transplante Autólogo/métodos , Mamilos/patologia , Mamilos/cirurgia , Antibacterianos/administração & dosagem
5.
Adv Exp Med Biol ; 1252: 133-136, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816273

RESUMO

Paget's disease of the breast (PDB) is a rare breast carcinoma believed to arise from an underlying in situ or invasive ductal cancer that migrates through the epidermis causing characteristic skin changes including scaling, redness, and itching of the nipple, areola, and sometimes the surrounding skin. Although Paget's may mimic benign conditions such as contact or allergic eczema and mastitis, it should remain a strong consideration in the differential diagnosis , especially in peripartum women for whom benign conditions such as bacterial mastitis from breastfeeding are common. The workup of Paget's should focus on both making the diagnosis with nipple/skin scrape cytology or punch biopsy as well as evaluating any underlying mass with mammogram, breast ultrasound , and also a core needle biopsy , if required. Treatment focuses on management of the underlying breast cancer as usual. The purpose of this chapter is to describe the presentation of PDB as well as outline an approach to its diagnosis and management, especially in the setting of pregnancy and lactation.


Assuntos
Neoplasias da Mama , Lactação , Doença de Paget Mamária , Complicações Neoplásicas na Gravidez , Diagnóstico Diferencial , Feminino , Humanos , Mamilos/patologia , Gravidez
6.
Medicine (Baltimore) ; 99(32): e21461, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769875

RESUMO

The present study aimed to investigate the prognostic implication of distance from tumor to nipple according to clinicopathological factors with known prognostic value.We retrospectively identified 961 patients of invasive breast cancer from January 2000 to April 2016. Clinicopathological information was extracted from hospital database and distance from tumor to nipple was objectively measured during surgeries. Overall survival (OS) and disease-free survival (DFS) were compared among patients with tumor-nipple distance ≤2, 2 to 5, and >5 cm. Subgroup analyses were performed according to age at diagnosis (≤35 vs >35), tumor size, histological features, treatment, axillary nodal metastasis and lymphovascular invasion.A total of 627 cases were included in statistical analysis. There was no difference detected in OS or DFS among patients with different tumor-nipple distance. Better OS was associated with greater tumor-nipple distance in old patients (HR = 0.582, 95%CI: 0.345-0.982, P = 0.042), while the association between OS and tumor-nipple distance was not observed in young patients. DFS was influenced by tumor-nipple distance in both young (HR = 5.321, 95%CI: 1.151-24.595, P = 0.032) and old (HR = 0.593, 95%CI: 0.385-0.913, P = 0.018) patients with opposite effects.Tumor-nipple distance can be adopted as a prognostic factor of breast cancer and it functions oppositely in young and old patients. Multicenter prospective studies with larger sample size are needed to validate the result.


Assuntos
Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Mamilos/patologia , Adulto , Fatores Etários , Neoplasias da Mama/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Gradação de Tumores , Invasividade Neoplásica , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
7.
Dermatol Online J ; 26(3)2020 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-32609452

RESUMO

Paget disease of the nipple is a rare presentation of breast cancer. It is sometimes mistaken for a benign skin condition of the nipple and surrounding areola, which can significantly delay the diagnosis and treatment. In over 90% of cases there is an underlying carcinoma, either ductal carcinoma in situ (DCIS) or invasive breast cancer. We present a rare case of Paget disease of the nipple without the typical characteristics, detected by simple nipple scraping technique. A 62-year-old woman presented with a small fissure on the left nipple with scant clear nipple discharge. There were no other changes to the nipple-areola complex. The mammography and ultrasound were unremarkable. However, nipple scraping provided the immediate cytological diagnosis of Paget disease. Breast MRI with core biopsy showed high grade ductal carcinoma in situ with suggestion of microinvasion, confirmed histologically after mastectomy. Nipple scraping is a simple and inexpensive technique, which can be used in the office without anesthesia and with minimal discomfort to the patient. It could allow for significantly earlier cancer detection and treatment at the earliest stage of breast cancer. However, if the results are negative, full thickness biopsy may be needed if clinically indicated.


Assuntos
Neoplasias da Mama/patologia , Mamilos/patologia , Doença de Paget Mamária/patologia , Patologia Clínica/métodos , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mastectomia , Pessoa de Meia-Idade , Doença de Paget Mamária/cirurgia
8.
Korean J Radiol ; 21(8): 955-966, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32677380

RESUMO

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.


Assuntos
Adenoma/diagnóstico por imagem , Neoplasias da Mama/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Mamilos/diagnóstico por imagem , Doença de Paget Mamária/diagnóstico por imagem , Papiloma/diagnóstico por imagem , Ultrassonografia/métodos , Adenoma/patologia , Adulto , Idoso , Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/patologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Mamografia/métodos , Pessoa de Meia-Idade , Mamilos/patologia , Doença de Paget Mamária/diagnóstico , Doença de Paget Mamária/patologia , Papiloma/patologia
9.
Pathologe ; 41(4): 393-399, 2020 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-32405655

RESUMO

The classical Paget's disease of the nipple is histologically characterized by tumor cell infiltration originating in intraductal or invasive breast carcinoma, immunohistologically by a frequent overexpression of HER2 and clinically by eczema-like changes of the nipple and areola. Variants with different histological, immunohistological, and clinical features are observed in nonclassical forms of Paget's disease, such as isolated Paget's disease of the nipple, anaplastic Paget's disease, Paget's disease with invasion, and pigmented Paget's disease of the nipple. In the differential diagnosis of Paget's disease, benign changes have to be considered, including Toker cell hyperplasia, nipple eczema, and rare dermatoses.


Assuntos
Neoplasias da Mama , Doença de Paget Mamária , Neoplasias da Mama/patologia , Diagnóstico Diferencial , Humanos , Hiperplasia/patologia , Mamilos/patologia , Doença de Paget Mamária/diagnóstico , Doença de Paget Mamária/patologia
10.
Pathologe ; 41(5): 515-522, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32458047

RESUMO

The nipple-areola complex is the origin of various morphologically distinct tumors and tumor-like lesions, which can be delineated from the special structures of the nipple, in particular the intramammary ducts, skin-appendages, and the intramammary stroma. Benign tumors are most frequent and this includes epithelial tumors such as mammary adenoma and syringomatous tumor of the nipple. Less commonly observed are benign mesenchymal tumors such as leiomyoma of the nipple, or tumor-like lesions like pseudo-lymphoma. With excess formations of the nipple, the different forms of polythelia and polymastia have to be considered.


Assuntos
Adenoma , Neoplasias da Mama , Leiomioma , Mamilos , Adenoma/diagnóstico , Neoplasias da Mama/diagnóstico , Humanos , Leiomioma/diagnóstico , Mamilos/patologia , Pele
11.
J Plast Reconstr Aesthet Surg ; 73(7): 1299-1305, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32430266

RESUMO

BACKGROUND: In most breast reduction techniques, the pedicle of the nipple-areola complex (NAC) is de-epithelialized to preserve the subdermal plexus, thereby decreasing the risk of NAC necrosis. However, deskinning the pedicle is faster and makes it more pliable, which potentially improves the aesthetic outcome. There is no scientific evidence regarding the beneficial effects of de-epithelialization. In this study, we present data from patients undergoing breast reduction with deskinning of a superomedial pedicle. METHODS: In the period June 2013 to March 2019, a single surgeon performed all breast reductions using a superomedial glandular pedicle. The patients were included retrospectively and data were collected by reviewing the medical records. The NAC necrosis rate was compared with data from the literature through a systematic review. RESULTS: The cohort consisted of 142 consecutive patients. The median resection weight was 287 g (interquartile range (IQR), 197-399) per breast. No complete NAC necroses occurred during the follow-up period, but two patients (1.4%) developed partial NAC necrosis. In the literature, the rate of NAC necrosis (complete or partial) was 1.5% of patients undergoing breast reduction with de-epithelialization. CONCLUSION: The rate of NAC necrosis after breast reduction with deskinning of the pedicle was comparable with breast reductions with de-epithelialization that has been reported in the literature. Our findings support that the pedicle in breast reduction surgery can be deskinned safely in patients with low resection weights.


Assuntos
Mamoplastia/métodos , Adulto , Estudos de Coortes , Procedimentos Cirúrgicos Dermatológicos , Feminino , Humanos , Pessoa de Meia-Idade , Necrose , Mamilos/patologia , Mamilos/cirurgia , Complicações Pós-Operatórias/patologia , Estudos Retrospectivos
12.
Anticancer Res ; 40(4): 2185-2190, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32234913

RESUMO

BACKGROUND/AIM: The study aimed at investigating the correlation between ductoscopic and histopathological findings and clarify whether the former allow for accurate prediction of malignancy. PATIENTS AND METHODS: The prospective national multi-center study covered a sample of 224 patients with pathologic nipple discharge. A total of 214 patients underwent ductoscopy with subsequent extirpation of the mammary duct. The ductoscopic findings were categorized according to shape, number, color and surface structure of lesions and vascularity and compared to the histological results and analyses. RESULTS: Ductoscopy revealed lesions in 134 of 214 patients (62.2%). The criteria "multiple versus solitary lesion" differed significantly between malignant and benign lesions. All other criteria were not statistically significant. Malignant tumors were more frequently presented as multiple lesions, benign lesions or masses as solitary lesions (80% vs. 24.8%; p=0.018). CONCLUSION: The ductoscopic criterion "solitary vs. multiple lesion" appears to have a low diagnostic prediction of malignancy or benignity.


Assuntos
Doenças Mamárias/diagnóstico , Neoplasias da Mama/diagnóstico , Carcinoma Intraductal não Infiltrante/diagnóstico , Endoscopia/métodos , Derrame Papilar , Mamilos/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Mamárias/metabolismo , Doenças Mamárias/patologia , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/metabolismo , Carcinoma Intraductal não Infiltrante/patologia , Diagnóstico Diferencial , Feminino , Alemanha , Humanos , Pessoa de Meia-Idade , Mamilos/metabolismo , Estudos Prospectivos , Adulto Jovem
13.
Ann R Coll Surg Engl ; 102(5): 369-374, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32233847

RESUMO

INTRODUCTION: Between 16,000 and 48,000 women are estimated to present to UK breast clinics with nipple discharge each year. The incidence of malignancy in these women is 2.7-24.2%. Currently, there is no consensus on the best way to investigate and manage these women. The aim of this study was to assess the rate of malignancy in women presenting with unilateral nipple discharge, and to evaluate the role of examination, imaging and cytology in reliably predicting outcome. METHODS: Breast units were asked to prospectively collect data on all new patients with unilateral nipple discharge. Data collected included discharge colour, whether it was uniductal or multiductal, examination and imaging findings, cytology results and outcome. RESULTS: Complete datasets were submitted by 5 units on 228 patients. The incidence of malignancy was 4.4%. Clinical examination was valuable in detecting malignancy and multiductal discharge was not related to malignancy. The positive predictive value for detecting malignancy for an abnormality found on mammography was 53.5% and for ultrasonography, it was 65.2%. The role of cytology in detecting malignancy was inconclusive with positive predictive values of the presence of red blood cells and epithelial cells at 6.1% and 10.7% respectively. CONCLUSIONS: A large number of women are investigated for nipple discharge (with huge resource implications) but there is little reliable evidence on the best way to investigate and manage these patients. A larger study is needed to evaluate the role of investigations in nipple discharge to produce guidelines on optimal management.


Assuntos
Neoplasias da Mama/epidemiologia , Derrame Papilar/citologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/complicações , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Conjuntos de Dados como Assunto , Inglaterra/epidemiologia , Feminino , Humanos , Incidência , Mamografia , Pessoa de Meia-Idade , Derrame Papilar/diagnóstico por imagem , Mamilos/diagnóstico por imagem , Mamilos/patologia , Valor Preditivo dos Testes , Estudos Prospectivos , Ultrassonografia , Adulto Jovem
14.
Medicine (Baltimore) ; 99(15): e19728, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282731

RESUMO

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.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Mamilos/irrigação sanguínea , Mamilos/diagnóstico por imagem , Ultrassonografia/métodos , Adenoma/patologia , Adulto , Neoplasias da Mama/patologia , Calcinose/patologia , Diagnóstico Diferencial , Feminino , Doença da Mama Fibrocística/patologia , Humanos , Leiomioma/patologia , Masculino , Mastite , Pessoa de Meia-Idade , Mamilos/patologia , Doença de Paget Mamária/patologia , Dor/diagnóstico , Plasmócitos/patologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Ultrassonografia/tendências , Verrugas
15.
Breast Cancer Res Treat ; 180(2): 397-405, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32056054

RESUMO

PURPOSE: The three-dimensional (3D) structure of the human nipple has not been fully clarified. However, its importance has increased in recent years because it has become common practice to preoperatively explore the spread of breast cancer to the nipple with needle biopsy, ductoscopy, and/or ductal lavage for nipple-sparing mastectomy. Here, we demonstrated that X-ray dark-field computed tomography (XDFI-CT) is a powerful tool for reconstructing the 3D distribution pattern of human lactiferous ducts non-destructively, without contrast agent, and with high tissue contrast. METHODS: Nipples amputated from mastectomy specimens of 51 patients with breast cancer were visualized three-dimensionally by XDFI-CT. First, CT images and conventionally stained tissue sections were compared to demonstrate that XDFI-CT provides 3D anatomical information. Next, the number of ducts in the nipple and the number of ducts sharing an ostium near the tip of the nipple were measured from the volume set of XDFI-CT. Finally, the 3D distribution pattern of the ducts was determined. RESULTS: XDFI-CT can provide images almost equivalent to those of low-magnification light microscopy of conventional hematoxylin-eosin-stained histological sections. The mean number of ducts in all cases was 28.0. The total number of ducts sharing an ostium near the tip of the nipple was 525 of 1428. The 3D distribution patterns of the ducts were classified into three types that we defined as convergent (22%), straight (39%), or divergent (39%). CONCLUSIONS: XDFI-CT is useful for exploring the microanatomy of the human nipple and might be used for non-invasive nipple diagnosis in the future.


Assuntos
Neoplasias da Mama/patologia , Processamento de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Glândulas Mamárias Humanas/anatomia & histologia , Mamilos/anatomia & histologia , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/diagnóstico por imagem , Feminino , Humanos , Glândulas Mamárias Humanas/patologia , Pessoa de Meia-Idade , Mamilos/diagnóstico por imagem , Mamilos/patologia , Valor Preditivo dos Testes
16.
Surg Today ; 50(9): 1008-1015, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32052184

RESUMO

PURPOSE: Periareolar incisions for nipple-sparing mastectomy offer the advantages of smaller inconspicuous wounds and easier resection below the nipple-areolar complex. However, they provide a narrow surgical field, which complicates the procedure and carries a risk of nipple necrosis. This study evaluated the clinical outcomes and safety of periareolar incisions for breast reconstructive surgery in patients with breast cancer. METHODS: The study included 181 patients with primary operable breast cancer who underwent nipple-sparing mastectomy for reconstructive breast procedures without intraoperative nipple-areolar complex resection. The clinical outcomes and complications were retrospectively evaluated. The recurrence-free survival was compared using Kaplan-Meier curves. RESULTS: Nipple-sparing mastectomy was performed via inframammary fold and periareolar incisions in 31 and 150 patients, respectively. There were no significant differences in clinical outcomes related to surgery, frequency of complications, nipple necrosis (inframammary fold incision vs. periareolar incision: 0% vs. 3.3%, P = 0.590), or the recurrence-free survival (P = 0.860) between the 2 groups. CONCLUSION: Our results showed that the clinical outcomes and complication rates of periareolar incisions for breast reconstruction were equivalent to those of inframammary fold incisions, suggesting that the periareolar incision technique for breast reconstructive surgery may safely improve cosmetic outcomes if done with adequate care.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Mastectomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/mortalidade , Intervalo Livre de Doença , Feminino , Humanos , Pessoa de Meia-Idade , Necrose/epidemiologia , Mamilos/patologia , Mamilos/cirurgia , Tratamentos com Preservação do Órgão/métodos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Segurança , Resultado do Tratamento
19.
Breast Cancer Res Treat ; 179(3): 577-584, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31720992

RESUMO

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


Assuntos
Neoplasias da Mama/patologia , Glândulas Mamárias Animais/patologia , Mamilos/patologia , Doença de Paget Mamária/patologia , Receptor ErbB-2/metabolismo , Idoso , Animais , Carcinoma Ductal de Mama/patologia , Linhagem Celular Tumoral , Feminino , Humanos , Queratina-18/metabolismo , Queratina-7/metabolismo , Queratina-8/metabolismo , Camundongos , Camundongos Endogâmicos NOD , Camundongos SCID , Mucina-1/metabolismo , Transplante de Neoplasias , Fosfatidilinositol 3-Quinases/metabolismo , Receptores Androgênicos/metabolismo , Transplante Heterólogo
20.
Eur J Radiol ; 122: 108754, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31775081

RESUMO

PURPOSE: To evaluate magnetic resonance imaging (MRI) features including tumor-nipple enhancement for predicting nipple-areolar-complex (NAC) involvement in breast cancer. METHODS: A total of 249 breast cancer cases with available preoperative MRI data were studied. On MRI, tumor-nipple enhancement was evaluated 2 min (early) and 6 min (delayed) after contrast injection. Asymmetric nipple enhancement, mass size, tumor-nipple distance, presence of nipple discharge, and enhancement type (mass or non-mass enhancement) were evaluated. RESULTS: Of the 249 breast cancers, 24 (9.6%) showed NAC involvement. Early tumor-nipple enhancement was found in 37 (14.9%) cancers and delayed tumor-nipple enhancement in 12 (4.8%) cancers. On comparing early and delayed enhancement, 43.2% (16/37) of early tumor-nipple enhancements showed NAC involvement while 25.0% (3/12) of delayed tumor-nipple enhancements showed NAC involvement (P = 0.323). On multivariate analysis, tumor-nipple enhancement (P = 0.004) and tumor-nipple distance with 2 cm cut-off (P = 0.044) were significant. The area under the receiver-operating-characteristic curve (AUC) of early tumor-nipple enhancement was significantly higher (0.787) than that of delayed tumor-nipple enhancement (0.542, P = 0.001). The AUC was the highest when any kind of tumor-nipple enhancement was combined with a tumor-nipple distance of 1 cm (0.878). CONCLUSIONS: Tumor-nipple enhancement and tumor-nipple distance on MRI could predict NAC involvement in breast cancer. When enhancement was evaluated on both early and delayed phase images with a combined tumor-nipple distance of ≤1 cm, the prediction of NAC involvement showed the best performance.


Assuntos
Neoplasias da Mama/patologia , Mamilos/patologia , Adulto , Meios de Contraste , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Análise Multivariada , Curva ROC , Estudos Retrospectivos
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