Nipple-areolar complex
Multimodality
approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Ductograms. a Normal ductogram, craniocaudal view. Note the normal “lobular blush” in (b) (arrows), caused by the contrast material filling the lobular portion of the terminal ductal lobular unit. Ninety-degree mediolateral ductogram (c) shows delayed extravasation from excess injection pressure (arrow)
Multimodality
approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Anatomy of the nipple-areolar complex
Multimodality
approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Radiation-associated angiosarcoma. A 76-year-old woman with a history of breast cancer treated with conservative surgery and whole-breast radiation therapy 6 years prior. a Photograph shows an ill-defined erythematous-violaceous infiltrated plaque with an eroded area occupying part of the areola. b Synthesized 2D mammogram shows skin thickening and interstitial edema in the retroareolar region of the left breast. c Ultrasound shows an ill-defined hypoechoic skin lesion with an internal Doppler signal. Punch biopsy diagnosed radiation-associated angiosarcoma, and the patient underwent mastectomy
Multimodality
approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Paget’s disease (II). An 81-year-old woman with an ulcerated lesion in her left nipple. a Synthesized 2D mammogram shows slight skin thickening in the left nipple-areolar complex (arrows). b MRI shows differential pathologic enhancement of the left nipple-areolar complex. c, d Hematoxylin-eosin-stained punch-biopsy specimen (× 0.3 and × 4, respectively) shows ductal carcinoma with extensive infiltration of the nipple and ulceration of the epidermis (Paget’s disease)
Multimodality
approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Paget’s disease (I). A 56-year-old woman with right nipple retraction. a 2D mammogram shows a spiculated retroareolar mass in the right breast with nipple retraction and skin thickening; b on ultrasound, it is seen as a solid lesion with ill-defined borders. c MRI shows the retroareolar lesion extending to the nipple-areolar complex. Histologic study revealed infiltrating ductal carcinoma extending to the epidermis
Multimodality
approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Retroareolar cyst in an adolescent. A 15-year-old girl presented with a palpable retroareolar mass in her left breast. Ultrasound shows a large thin-walled cystic lesion (a). Follow-up ultrasound 6 months later shows a marked decrease in the size of the lesion, which is oval and elongated (b)
Multimodality
approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Epidermal inclusion cyst. A 37-year-old woman with a palpable retroareolar nodule in her right breast, without inflammation. a Synthesized 2D mammogram (craniocaudal view) shows a well-defined isodense nodule measuring 25 mm (arrows) adjacent to the nipple. b Ultrasound shows a well-defined hypoechogenic nodule below the skin of the right areola (N nipple)
Multimodality
approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Syringomatous tumor of the nipple. A 47-year-old woman with retraction and hardening of the left nipple. a Mammogram shows retraction of the left nipple and asymmetric retroareolar density. b On ultrasound, the lesion is solid and hypoechogenic with ill-defined borders and increased peripheral color-Doppler signal. c Contrast-enhanced coronal T1-weighted MRI (subtracted image obtained 120 s after contrast injection) shows mass-type uptake with pronounced early enhancement in a lesion with hazy borders that retracts the nipple-areolar complex. d Hematoxylin-eosin stain (× 4) shows a proliferation of elongated glandular structures like strings of cells in the dermis, with the formation of keratin cysts (star)
Multimodality
approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Nipple adenoma. An 81-year-old woman with a several-week history of pain and swelling of the right breast. a Mammogram shows an isodense rounded retroareolar mass with slightly irregular margins (arrows); b on ultrasound, it is seen as a solid nodular lesion (N: nipple). c Immunohistochemistry stain with p63 (× 4) shows glandular and ductal proliferation consisting of epithelial and myoepithelial cells, which express p63
Multimodality
approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Zuska’s disease. a Photograph of a 47-year-old woman with a history of smoking who had a recurrent painful erythematous palpable subareolar mass with a small secreting ulcerous lesion. b Ultrasound shows skin thickening with a small hypoechogenic collection below the lesion (arrows), with increased peripheral color-Doppler signal (c)
Multimodality
approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Subareolar abscess. Photograph of a 42-year-old woman with a painful erythematous palpable areolar mass in her left breast with mild involvement of the adjacent skin (a). Synthesized 2D mammogram shows marked skin thickening of the nipple-areolar complex without other underlying findings (b). Ultrasound shows a heterogeneous hypoechogenic intradermal collection compatible with an abscess (c). Fine-needle aspiration was able to drain the collection completely (purulent material), and the patient was prescribed antibiotics and follow-up (d, e)
Multimodality
approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Periductal mastitis. Photograph of a 59-year-old smoker with a painful erythematous area in the upper outer quadrant of her right breast (a). Ultrasound shows skin thickening and retroareolar ductal ectasia with echogenic contents (b) and increased periductal Doppler signal (c). Fine-needle aspiration obtained purulent material (pus) (d, e)
Multimodality
approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Galactography technique. 30-gauge cannula (a); the nipple must be firmly stabilized between the thumb and forefinger (b); canalization of the discharging orifice and contrast injection (c). A magnified craniocaudal view is obtained with the cannula taped in place and the breast compressed
Multimodality
approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Morgagni tubercles. Photograph of a nipple-areolar complex. Note the small bumps in the skin (arrow)
Multimodality
approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Pathological enhancement in the nipple-areolar complex. A 71-year-old woman. Axial contrast-enhanced T1-weighted spoiled gradient-echo (subtracted) images show asymmetric irregular nodular early enhancement (a) that is maintained in late phases (b) secondary to involvement by invasive ductal carcinoma. Irregular-shaped masslike enhancement in the middle third of the junction of the outer quadrants in the right breast with linear uptake and segmental distribution to the nipple-areolar complex, compatible with an intraductal component (arrows)
Multimodality
approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Physiological enhancement in the nipple-areolar complex. Axial contrast-enhanced T1-weighted spoiled gradient-echo (subtracted) images show various degrees of enhancement in a normal nipple, including none (a), mild symmetric enhancement (b), intense symmetric enhancement (c), a thin symmetric ring of enhancement (d), and asymmetric early enhancement with symmetric late enhancement (e)
Multimodality
approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. US techniques. Stavros ultrasound techniques to best demonstrate the subareolar and intranipple ducts
Multimodality
approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Periareolar calcifications. A 47-year-old woman with a history of breast reduction surgery. a Synthesized craniocaudal 2D mammogram shows bilateral periareolar calcifications. b Photograph shows the periareolar scar
Multimodality
approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Nipple calcifications. Screening mammogram in a 54-year-old woman. a Craniocaudal view of the left breast shows a group of calcifications in the retroareolar region (note that the nipple is not tangential). b Magnified view with the nipple perfectly tangential, confirming that the calcifications have benign characteristics and are located in the nipple
Multimodality
approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Pitfall. a Synthesized craniocaudal 2D mammogram shows multiple dense punctiform images at the level of the nipple mimicking calcifications; these artifacts were caused by remnants of body cream. b Repeat image after cleansing the nipple shows the artifacts have disappeared
Multimodality
approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Inverted nipples. A 60-year-old woman with inverted nipples. a Craniocaudal 2D mammograms show bilateral inverted nipples that are perfectly tangential and symmetrical. b Photograph of the same patient
Multimodality
approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Projection centered in the anterior region. A 56-year-old woman with voluminous breasts. a Craniocaudal 2D mammogram: the nipple is not tangential and is hidden in the lower part of the breast, producing a false image of a nodule (arrow). b Repeat craniocaudal view with the nipple tangential
Multimodality
approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Mammography positioning. Craniocaudal and mediolateral oblique 2D mammograms show the nipples are perfectly tangential
Multimodality
approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Developmental abnormalities. a Photograph of polythelia in the right breast of a 45-year-old woman. b Craniocaudal and mediolateral oblique 2D mammograms show a nodule with well-defined margins in the posterior region of the junction between the lower quadrants. c Repeat craniocaudal mammogram with a cutaneous marker confirms that the nodule corresponds to the accessory nipple
Multimodality
approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Diagnostic imaging algorithm
During the 6 week of gestation, a pair of longitudinal thickening of the epidermis develop on the ventral surface of the embryo, extending from the axilla to the medial thigh, called "mammary ridges" (or "mammary line", “milk lines"). In large part these milk lines later atrophy, leaving only the part in the pectoral region, where the breasts will develop.
The nipple-areolar complex development begins about in the 14 week of gestation, with the differentiation of mesenchymal cells into smooth muscle components.
Sometimes may happens that other segments of the ridge, which do not correspond to the breast, remain giving rise to the development of supernumerary nipples most commonly in the axilla or inframammary fold, but they may occur anywhere along the milk line, from the axilla to the groin. This not uncommon condition is called polythelia (similarly may develops accessory mammary glands: this more rare condition is called polymastia).
The development of the nipple-areolar complex is followed by the development of special apocrine glands into the Montgomery glands, some large intermediate-stage sebaceous glands that are transitional between sweat glands and mammary glands, capable of secreting milk, that opens at the Morgagni tubercles, which are small papules on the areola. Pigmentation of the nipple-areolar complex develop between the 32 and the 40 week. In adult women the nipple contains the outlets for 15-20 lactiferous ducts arranged cylindrically around the tip.
The nipple-areolar complex consists of numerous vessels, intermixed with plain muscular fibers, which are principally arranged in a circular manner around the base, or even radiating from base to apex. The nipple-areolar complex also contains many sensory nerve endings, smooth muscle, and an abundant lymphatic system called subareolar plexus or Sappey's plexus. Nipple-areolar anatomy is remarkably variable in dimension, texture, and color across ethnic groups and among individuals.
The physiological purpose of nipple-areolar complex is to deliver milk produced by the mammary glands during lactation.
Siehe auch:
- Areolaveränderungen
- Glandulae areolares
- sappey's plexus
- subareolar plexus
- pathologische Kontrastmittelaufnahme des Mamillen-Areolen-Komplex
und weiter:
Assoziationen und Differentialdiagnosen zu Mamillen-Areolen-Komplex: pathologische
Kontrastmittelaufnahme des Mamillen-Areolen-Komplex