ABSTRACT
Introducción: La telorragia es un síntoma poco frecuente en pacientes pediátricos, la causa más frecuente en esta población es la ectasia ductal mamaria (EDM), que es una afección benigna y autolimitada, caracterizada por la dilatación del conducto mamario, fibrosis e inflamación periductal. Objetivo: Presentar un caso de EDM, para facilitar el rápido reconocimiento por parte de los médicos, y evitar estudios y tratamientos agresivos. Caso clínico: Lactante de sexo masculino de 6 meses de edad, sano, alimentado por lactancia materna exclusiva; consultó por un nódulo retroareolar derecho y telorragia unilateral. Se realizó una ecografía Doppler que mostró una lesión multiquística, sugerente de una EDM. Se planteó tratamiento expectante y acudió a control a los 6 meses con excelente evolución. Conclusiones: La EDM es la principal causa de telorragia en niños, corresponde a una afección benigna, y la resolución generalmente es espontánea, antes de los 9 meses. Por lo que su conocimiento es de gran relevancia para el adecuado diagnóstico y manejo de estos pacientes.
Introduction: Bloody nipple discharge is an infrequent symptom during childhood. The most common cause in this population is mammary duct ectasia (MDE), which is a benign and self-limiting condition, that is characterized by dilatation of the mammary ducts, fibrosis and periductal inflammation. Objective: Report of a case of MDE in order to improve physicians’ diagnosis accuracy and avoid aggressive studies and treatments. Case report: Six-months old male healthy infant, exclusively breastfeeded, that visited our clinic with a lump beneath his right nipple and bloody discharge from the same nipple. An ultrasound was performed which showed a multicystic lesion suggestive of MDE. Watchful waiting was decided as treatment, with good evolution after six months of follow up. Conclusions: The MDE is the leading cause of bloody discharge in pediatric population, being a benign condition that resolves spontaneously before nine months. The knowledge of this condition is essential so as to accurately diagnose and treat it.
Subject(s)
Humans , Cations/chemistry , Indicators and Reagents/chemistry , Lipids/chemistry , Polyenes/chemistry , RNA, Small Interfering/chemistry , Cell Line, Tumor , Chemistry, Pharmaceutical/methods , Gene Transfer Techniques , Genetic Vectors/genetics , HeLa Cells , Liposomes/chemistry , Luciferases/chemistry , Phospholipids/chemistry , RNA, Small Interfering/genetics , Transfection/methodsABSTRACT
La descarga de sangre a través del pezón (telorragia) es un síntoma muy infrecuente en pediatría. Si bien genera gran preocupación y alarma por su equivocada asociación con el carcinoma de pacientes adultos, en los niños se asocia, en la mayoría de los casos, con una ectasia ductal benigna. Hasta el momento, sólo existen informes o series de casos y, aunque se proponen diferentes teorías, la causa no se conoce con exactitud. Se presentan dos casos con características clínicas y evolución muy similar, en los que el sangrado se resolvió en forma espontánea, uno en cuatro y el otro en seis semanas. Se realiza una revisión del tema y, dado que se trata de un proceso benigno y autolimitado, se sugiere, en ausencia de otros hallazgos en el examen físico, realizar estudios mínimamente invasivos, adoptar una conducta expectante y tranquilizar a la familia en la espera de una resolución espontánea.
Bloody discharge from the nipple (thelorrhagia) is a rare symptom in childhood and is a cause of great concern due to the mistaken association with carcinoma in adults. However, in children thelorrhagia is due to benign mammary duct ectasia in the majority of cases. Up to date, only isolated case reports or case series have been published and, although different theories have been postulated, no definite etiology has been identified. We report two cases with similar clinical features and outcome, in whom bleeding resolved spontaneously 4 and 6 weeks after onset. We present a review of the literature. Based on the benign and self-limiting process and in the absence of other findings on physical examination, we suggest a watch-and-wait approach with minimally invasive studies and reassurance and support for the family as most cases resolve spontaneously.
Subject(s)
Humans , Infant , Male , Blood , Breast Diseases/complications , Nipples , Dilatation, PathologicABSTRACT
PURPOSE: Nipple discharge is a disturbing symptom due to the fear of breast cancer, although approximately 95% of incidents of nipple discharge arise from benign causes. This study was designed to determine a proper approach for referrals with nipple discharge. METHODS: One hundred and ten patients who underwent surgery due to nipple discharge were included in the study. Clinical parameters, including age, characteristics of nipple discharge, clinical breast examination findings, mammographic findings and ultrasonographic findings were analyzed in association with the pathologic diagnosis of malignancy. A chi-square test and logistic regression test were used to assess the statistical significance of the results. RESULTS: The mean age of the patients was 44.8 year-old (range: 19-84). The most common cause diagnosed was intraductal papilloma of 58 (52.7%), followed by 18 fibrocystic changes (16.4%), 17 infiltrating ducal carcinomas (15.5%), 14 intraductal carcinomas (12.7%) and 3 duct ectasias (2.7%). The number of incidences of malignancy was 31 (28.2%). Bloody nipple discharge, nipple discharge with accompanying mass, abnormal mammographic finding and abnormal ultrasound finding were associated with malignancy in 43.2%, 55.6%, 50% and 66.7%, respectively, as compared with 11.5% in serous discharge, 22.6% in discharge without accompanying mass, 21.9% in normal mammographic finding and 52.9% in normal ultrasonographic finding, respectively. In a multivariate analysis of factors predicting malignancy, nipple discharge with accompanying mass and bloody nipple discharge were the independent risk factors. CONCLUSION: Triple examinations including physical examination, mammogram and ultramammography would be necessary for the complete evaluation of nipple discharge and surgical excision is mandatory in cases with suspicion of cancer.