A Clinical Analysis of 640 Inpatients With Pathologic Nipple Discharge

Objective To discuss the value of early confirmation of breast cancer in patients with pathologic nipple discharge based on double surgical indications under fiberoptic ductoscopy (FDS) followed by staining with methylene blue. Methods From October 2012 to October 2019, a total of 640 inpatients with pathologic nipple discharge from Wuhan University Zhongnan Hospital underwent fiberoptic ductoscopy, followed by injection of methylene blue into the lesional duct through the discharged hole that would be resected as a segment according to the range of the staining duct on the next day. Based on double surgical indications, different findings by fiberoptic ductoscopy were defined as surgical indications, both with space-occupying intraductal lesions scanned by FDS and without space-occupying intraductal lesions but with dark red bloody fluid or yellow serous fluid spillage at the opening of the terminal mammary duct or extensive erosive duct lesions. We retrospectively analyzed the relations between results from fiberoptic ductoscopy and pathologic diagnosis. Results Inpatients with pathological neoplasm accounted for 87.3%(452/518) of the 518 inpatients with space-occupying intraductal lesions scanned by FDS, but the 122 inpatients without space-occupying intraductal lesions only accounted for 28.7%(35/122) of the patients (P=0.00). However, patients pathologically diagnosed with breast cancer accounted for 11.8% (61/518) of the 518 inpatients with space-occupying lesions and 10.7%(13/122) of the 122 inpatients without space-occupying lesions (P=0.728). Conclusions According to the double standards of surgical indication with or without space-occupying intraductal lesions scanned by fiberoptic ductoscopy, the method of fiberoptic ductoscopy followed by staining of the mammary duct by methylene blue could not only avoid missed diagnosis of breast cancer caused by ductoscopy itself, but also reduce the rate of missed diagnosis on account of inoperative inaccurate resection range, which greatly improved the early diagnosis rate of breast cancer with nipple discharge as the only initial clinical manifestation.

The role of major duct excision and microdocectomy in the management of nipple discharge: Diagnostic and therapeutic approach

Mammary duct ectasia is considered as a benign condition of the mammary gland. Many theories analyses and summarized the disease regarding the pathogenesis. Firstly, the primary pathological process is due to be involutional and atrophy of the ducts. Other cause of dilation of the ducts, leading to the decrease or absent of secretion, inflammation and duct rupture. Secondly, the causative factor is inflammatory process with periductal inflammation followed by obliteration of ducts, sclerosis of duct and surrounding tissue and duct ectasia. Mostly mammary duct ectasia resolves without any treatment. Applying light warm compresses to nipple and wearing a supportive bra, can help to reduce discomfort of the patient. But If there is evidence of an infection, antibiotics will be prescribed without hesitation. It’s completely prohibited to squeeze the area to increase discharge, as there is increase chance to develop inflammation and infection. If symptoms still persisted than surgery may be done to disconnect the ducts and remove the ducts, Known as Hadfield’s operation. Recently sub-areolar major mammary duct excision – Hadfield’s procedure is very popular and has gained widespread acceptance in management of nipple-areola complex problems like suspicious or troublesome discharge, clinical or sono-mammographic central anomalies and chronic sinus-fistula. Here two cases with nipple discharge managed with two very common surgery with microdocectomy and total duct excision held in Z.H Sikder Women’s Medical College Hospital. Patients were very satisfied with the treatment as they got relief of symptoms and most importantly get rid of the fear of carcinoma.

An Organotypic Mammary Duct Model Capturing Distinct Events of DCIS Progression

ABSTRACTDuctal carcinoma in situ (DCIS) is a pre-cancerous stage breast cancer, where abnormal cells are contained within the duct, but have not invaded into the surrounding tissue. However, only 30-40% of DCIS cases are likely to progress into an invasive ductal carcinoma (IDC), while the remainder are innocuous. Since little is known about what contributes to the transition from DCIS to IDC, clinicians and patients tend to opt for treatment, leading to concerns of overdiagnosis and overtreatment. In vitro models are currently being used to probe how DCIS transitions into IDC, but many models do not take into consideration the macroscopic tissue architecture and the biomechanical properties of the microenvironment. Here, we developed an organotypic mammary duct model by molding a channel within a collagen matrix and lining it with a basement membrane. By adjusting the concentration of collagen, we effectively modulated the stiffness and morphological properties of the matrix and examined how an assortment of breast cells responded to changing density and stiffness of the matrix. We first validated the model using two established, phenotypically divergent breast cancer cell lines by demonstrating the ability of the cells to either invade (MDA-MB-231) or cluster (MCF7). We then examined how cells of the isogenic MCF10 series—spanning the range from healthy to aggressive—behaved within our model and observed distinct characteristics of breast cancer progression such as hyperplasia and invasion, in response to collagen concentration. Our results show that the model can recapitulate different stages of breast cancer progression and that the MCF10 series is adaptable to physiologically relevant in vitro studies, demonstrating the potential of both the model and cell lines to elucidate key factors that may contribute to understanding the transition from DCIS to IDC.IMPACT STATEMENTThe success of early preventative measures for breast cancer has left patients susceptible to overdiagnosis and overtreatment. Limited knowledge of factors driving an invasive transition has inspired the development of in vitro models that accurately capture this phenomenon. However, current models tend to neglect the macroscopic architecture and biomechanical properties of the mammary duct. Here, we introduce an organotypic model that recapitulates the cylindrical geometry of the tissue and the altered stroma seen in tumor microenvironments. Our model was able to capture distinct features associated with breast cancer progression, demonstrating its potential to uncover novel insights into disease progression.

Bloody Nipple Discharge in an Infant

: Bloody nipple discharge (BND) is an uncommon finding in infants and is a cause of anxiety for the parents since it can be associated with breast carcinoma in adults. Mammary duct ectasia is the most common cause. This report describes a 9-month old boy who presented with unilateral BND. Diagnosis of benign duct ectasia was made on ultrasound. The patient was followed and the condition resolved spontaneously over the next two months.