Evaluation of Different Modalities in Management of Erosive Diseases of the Nipple and Areola

Document Type : Original Article

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Department of General Surgery, Faculty of Medicine, Ain Shams University, Egypt

Abstract

Background: Erosive diseases of the nipple and areola are rare conditions that are not easily identified by many surgeons. These diseases include (Paget’s disease, nipple adenoma, eczema, melanoma, Bowen’s disease, retroareolar carcinoma and lymphoma). Clinically, they can present as ulcerations, erosions, nipple discharge, palpable masses, or as erythematous growths.
Patients and methods: this is a retrospective study reviewing of the clinical database of cases with erosive diseases of the nipple and/or areola treated in general surgery department, Ain Shams University in a period of three years. This study started with history and clinical examination of all patients. All patients underwent sonomammography and four patients needed MRI. Histological slides were reviewed by a pathological consultant to confirm diagnosis. Management was fashioned according to each patient.
Results: this study included 24 female patients with erosive disease of the nipple and areola with mean age at diagnosis 53.7 years, Bilateral breast sonomammograph was performed for all patients, 4 patients (16.6%) showed nipple inversion, 10 patients (41.66%) had microcalcifications while 7 patients (29.16%) had nipple mass and/or thickening, 10 patients (41.66%) had underlying breast mass and 7 patients (29.16%) showed axillary lymph nodes enlargement. Paget ‘s disease was diagnosed in 17 patients (70.83%), while Nine of these patients (37.5%) showed underlying invasive duct carcinoma, nipple adenoma was found in the other 7 patients (29.16%).
Conclusion: Erosive diseases of the nipple and areola represent a clinical dilemma. Biopsy and histopathology are the only way to exclude malignant lesion and should be done once suspected. There is no correlation between shape or size of the lesion and its neoplastic criteria.

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