背景:乳头腺瘤是一种非常罕见的,累及乳头的良性肿瘤。与乳头溢液和糜烂或溃疡相关的可触及的乳头肿块是常见的临床表现。一般来说,手术切除乳头是主要的治疗方法,替代治疗方法,如莫氏显微外科手术,乳头劈开摘除术,可以考虑冷冻疗法。年轻女性的乳房疾病通常是良性的。即使怀孕期间的管理通常是保守的,并且手术切除保留用于非常强烈的恶性肿瘤怀疑,良性病变可能导致在分娩后发生乳头时不可能进行母乳喂养。
方法:我们介绍了一名28岁的女性,他于2020年5月被转诊到摩德纳大学医院(意大利)的乳腺科,有12个月的左乳头增大并伴有红斑的病史,血清出血性放电,左侧乳头区疼痛.诊断评估结果有利于乳头腺瘤。建议手术治疗后,病人怀孕了.考虑到怀孕期间手术的主要风险,进行了多学科讨论,考虑是否在怀孕后进行手术或推迟手术。由于腺瘤的体积和位置,手术切除的指征得到证实,允许在分娩后立即定期哺乳和母乳喂养,并避免潜在的阻塞性并发症。在妊娠头三个月后,在局部麻醉下进行了乳头腺瘤的手术切除,但未完全切除乳头。组织病理学检查证实了诊断。12个月后无复发。病人生了孩子,没有泌乳缺陷,并成功母乳喂养。
结论:因此,我们认为即使在怀孕期间,乳头腺瘤摘除也可能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,从而允许年轻女性定期哺乳和母乳喂养。
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.