Papiloma intraductal metacrónico en un niño: Caso clínico / Intraductal metachronic papilloma: Clinical case

Introducción. La asociación de telorragia y ginecomastia nos orienta al diagnóstico de papiloma intraductal. Este tumor benigno es muy infrecuente en la edad pediátrica. Caso clínico. Niño de 2 años que presentó ginecomastia y telorragia en la mama izquierda. Se realizó mastectomia. A los 4 años, presentó el mismo cuadro en la mama derecha, que requirió también mastectomia derecha, con buena evolución posquirúrgica en ambas oportunidades. La anatomía patológica informó papiloma intraductal sin signos de malignidad ni atipia. Conclusión. El papiloma intraductal raramente afecta a niños; hay 15 casos reportados. La ecografía es el método de diagnóstico más empleado. En los pacientes masculinos, la mastectomia es recomendada para asegurar un diagnóstico y tratamiento definitivo.

Introduction. The association of gynecomastia and bloody nipple discharge (thelorragia) leads us to the diagnosis of intraductal papilloma. This is a very rare benign tumor in children. Clinical case. A 2 year old male child was referred due to gynecomastia and bloody nipple discharge of the left breast. A mastectomy was performed. At the age of 4 he returned with identical symptoms but in the right breast. A right mastectomy was also required. An excellent clinical outcome was present in the follow up. The pathology reported intraductal papilloma with no evidence of malignancy or atypia. Conclusion. The intraductal papilloma rarely affects children, there are 15 reported cases. Ultrasound is the most useful diagnostic method. In male patients, mastectomy is recommended to ensure definitive diagnosis and treatment.

Diagnostic Value of 3D Fast Low-Angle Shot Dynamic MRI of Breast Papillomas

PURPOSE: To evaluate the value of breast MRI in analysis of papillomas of the breast. MATERIALS AND METHODS: From 1996 to 2004, 94 patients underwent surgery due to papillomas of the breast. Among them, 21 patients underwent 3D fast low angle shot (FLASH) dynamic breast MRI. Eight masses were palpable and 11 of 21 patients had nipple discharge. Two radiologists indifferently analyzed the location, size of the lesions and shape, margin of the masses, multiplicity and ductal relation. The MRI findings were categorized according to breast imaging reporting and data system (BI-RADS) lexicon. The amount and pattern of enhancement and associated findings were also evaluated according to BI-RADS. We then compared the MRI findings with galactography, mammography and breast ultrasonography (US) and examined histopathologic correlation. RESULTS: On breast MRI, the lesion size was 0.4-1.59 cm, and 18 patients showed subareolar location. On 4.25 cm (mean 1.54) dynamic enhanced images, imaging findings showed mass (n = 10), intracystic mass (n = 3), focus (n = 5), ductal enhancement (n = 2), and segmental enhancement (n = 1). In cases of the masses, the shapes of the masses were round (n = 4), lobulated (n = 3), and irregular (n = 6), and margins were circumscribed (n = 6), microlobulated (n = 5), and indistinct (n = 2). The enhancement patterns were homogeneous enhancement (n = 7), heterogeneous (n = 3) or rim enhancement (n = 3). CONCLUSION: The contrast enhanced dynamic breast MRI was highly sensitive for diagnosis of breast papillomas. MRI could play a key role in the pre-operative work-up for multiple papillomas and papillomatosis.

Solitary intraductal papilloma of the breast--a diagnostic dilemma and the role of conferencing between surgeons and cytologist.

A 40 year female, presented with the complaints of spontaneous, sticky, blood stained discharge from the nipple of the left breast since 6 months. On examination there was no lump palpable in either breast. Cytology of the nipple discharge (ND) showed scanty cellularity consisting of tight papillary clusters of ductal cells in a hemorrhagic and inflammatory background. The nuclei were bland and showed degenerative atypia. Mammography showed no significant lesion. Our patient underwent microdochechtomy. Histopathology showed intraductal papilloma. Limitations of cytology must be kept in mind by both, the pathologist and the surgeon. The cytological diagnosis of a papillary tumor is provisional and the definitive diagnosis must await histological examination. In view of rarity of this lesion, combined with the overlapping of cytologic features in benign and malignant papillary lesions, conferencing and communication with the surgeon should be an integral part of patient evaluation and management. In our case this approach resulted in less radical excision of breast tissue.

Don't let me die Galactography the art is dying

The fancied and sophisticated investigations always catch the eye of the patient and the mind of clinicians. We are living in an era, which is certainly making headways in the field of medicine. The inventions like the state of art MRI, Computed Tomography and the newer modality of PET scanning certainly do help. For the sake of breast, the screening via mammography still remains the prime investigation but the frequently used method of investigating the ducts i.e; galactograhy or the commonly called Ductography is these days not the favorite of most clinicians these days. This article is a very limited study but it might be helpful in reviving the confidence of the clinicians in the art of Galactograhy

Investigación quirúrgica de las lesiones mamarias subclínicas / Surgical study of the subclinic breast lesions

Se analizan 146 biopsias radioquirúrgicas (BRQ) realizadas entre enero de 1989 y enero de 1994. Las imágenes mamográficas que motivaron las BRQ fueron: microcalcificaciones agrupadas (Mc), 68 casos (46,5 por ciento); imágenes nodulares (IN), 51 (34,9 por ciento); IN+Mc, 9 (6,1 por ciento); alteración estructural no nodular (AE), 8 (5,4 por ciento); y AE+Mc, 10 (6,8 por ciento). Las marcaciones se realizaron por estereotaxia y con carbón inactivo (130) o con arpón metálico y azul de toluidina (16), con eficiencia equivalente. Se hallaron: 108 lesiones benignas (73,9 por ciento), 5 premalignas (3,4 por ciento) y 33 carcinomas (22,6 por ciento). El diagnóstico final de cada grupo fue: displasias 63 (58,3 por ciento), fibroadenoams 34 (31,4 por ciento), galactoforitis crónica 8 (7,4 por ciento), papiloma intraductal 2 (1,8 por ciento), granuloma 1 (0,9 por ciento), lipoma 1 (0,9 por ciento). Las lesiones premalignas fueron 4 hiperplasias epiteliales atípicas y 1 carcinoma lobulillar no invasor. Entre los 33 carcinomas se reconocieron 19 invasores (57,6 por ciento) y 14 no invasores (42,4 por ciento). La media de tamaño tumoral entre las formas invasoras fue de 0,7 cm (rango 0,2 a 1,6). La axila fue negativa en todos los carcinomas in situ y en el 78,6 por ciento de los invasores; sólo hubo, por lo tanto, 3 casos (21,4 por ciento) de carcinomas invasores con axila positiva. Las Mc agrupadas y anárquicas fueron la causa más común para indicar BRQ, y asimismo tuvieron una alta correlación con cáncer (30,89 por ciento), superada sólo por la asociación IN+Mc (55,50 por ciento). Las AE sin Mc nunca resultaron carcinoma. En general, se diagnosticó una neoplasia cada 4,5 biopsias. Se convalidan por los hallazgos las indicaciones y procedimientos y se sugiere incrementar la experiencia en métodos de biopsia microinvasivos, para mejorar la razón entre malignopatías y biopsias quirúrgicas.