International PhD School in Clinical and Experimental Medicine (CEM), University of Modena and Reggio Emilia, Modena, Italy.
Division of Breast Surgical Oncology, Department of Medical and Surgical, Maternal-Infantile and Adult Sciences, University Hospital of Modena, Modena, Italy.
Int Breastfeed J. 2023 Mar 21;18(1):19. doi: 10.1186/s13006-023-00554-4.
Nipple adenoma is a very uncommon, benign neoplasm that involves the nipple. A palpable mass of the nipple associated with nipple discharge and erosion or ulceration is the common clinical presentation. Generally, complete surgical excision of the nipple is the main treatment, alternative therapeutic methods such as Mohs micrographic surgery, nipple splitting enucleation, and cryotherapy can be considered. Disorders of the breast in young women are generally benign. Even if the management during pregnancy is usually conservative and surgical excision is reserved for very strong malignancy suspicion, benign lesions can cause the impossibility to breastfeed after giving birth when involving the nipple.
We present the case of a 28-year-old female, who was referred to the Breast Unit of the University Hospital of Modena (Italy) in May 2020 with a 12-months history of enlargement of the left nipple with associated erythema, serohemorrhagic discharge, and pain in the left nipple region. The diagnostic assessment came out in favor of a nipple adenoma. After surgical treatment was recommended, the patient got pregnant. Taking into account the major risks of surgery during pregnancy, a multidisciplinary discussion was conducted, to consider whether to proceed with surgery or postpone it after pregnancy. Because of the volume and the position of the adenoma, the indication for surgical excision was confirmed, to allow regular lactation and breastfeeding immediately after giving birth and to avoid potential obstructive complications. Surgical excision of nipple adenoma without complete resection of the nipple was performed after her first trimester of pregnancy under local anesthesia. A histopathological examination confirmed the diagnosis. No recurrence occurred after 12 months. The patient gave birth, had no deficit in lactation, and successfully breastfed.
Therefore, we consider that nipple adenoma enucleation might be a safe treatment even during pregnancy. Moreover, conservative local treatment of nipple adenomas can preserve the nipple aesthetically and functionally, thus allowing regular lactation and breastfeeding in young women.
乳头腺瘤是一种非常罕见的良性肿瘤，累及乳头。常见的临床表现是乳头可触及肿块，伴有乳头溢液、糜烂或溃疡。一般来说，完整切除乳头是主要的治疗方法，也可以考虑其他治疗方法，如 Mohs 显微外科手术、乳头分裂切除术和冷冻疗法。年轻女性的乳房疾病通常是良性的。即使在怀孕期间的处理通常是保守的，只有在强烈怀疑恶性的情况下才进行手术切除，但是当涉及到乳头时，良性病变可能会导致产后无法进行母乳喂养。
我们报告了一例 28 岁女性患者的病例，她于 2020 年 5 月因左乳头增大伴红斑、血性渗出物和左乳头区域疼痛 12 个月就诊于意大利摩德纳大学医院乳腺科。诊断评估支持乳头腺瘤。在建议进行手术治疗后，患者怀孕了。考虑到怀孕期间手术的主要风险，进行了多学科讨论，以确定是否进行手术或在怀孕后推迟手术。由于腺瘤的体积和位置，确认了手术切除的指征，以允许产后立即进行常规哺乳和母乳喂养，并避免潜在的阻塞性并发症。在她怀孕的第一个三个月，在局部麻醉下进行了乳头腺瘤的局部切除，未完全切除乳头。组织病理学检查证实了诊断。12 个月后无复发。患者分娩，哺乳无缺陷，成功母乳喂养。
因此，我们认为即使在怀孕期间，乳头腺瘤的剜除术也是一种安全的治疗方法。此外，乳头腺瘤的保守局部治疗可以在美学和功能上保留乳头，从而允许年轻女性进行常规哺乳和母乳喂养。
