PLEASE HELP

[simsima]

In April 2007 I felt suddenly that my right nipple is sore and redish on the tip of it's head ONLY. I saw my doctor who refered me to a surgeon after feeling a lump in my breast, the second after breast examination told me this is fibroadenosis in both breasts due to hormonal fluctations as I have PCO and infertility problems. I saw another doctor who ordered an U/S and breast CA 15-3 plus mamogram. The U/S showed a fibroadenosis in the left breast and did not detect anything in the right breast which I was complaining of. The mamo did not detect anything in my right breast, but detected a suspicouse lump in my left breast which am not complaining about. I as well did hormonal tumor markers which was all normal.The blood test was normal and the Dr. told me this is fibroadenosis. I saw 4 other surgeons who ordered U/S and told me this is fibroadenosis in both breasts. One surgeon who was suspicouse about Paget's disease, ordered a FNAB who said ( mildly a typical cells, however the chromatine pattern does ot look malignant. Nipple with ulcer sign of subareolar papillomatosis). He asked me to redo the FNAB and it came out as ( cytology smear shows a few clsuters of uniform ductal epithelial cells. There are fragments of spndle cell stromal tissue. This is consistent with fibroadenosis). It is worth mentioning that the 1st FNAB was from inside the nipple suspecting an underneath lump, the 2nd was from the outer side of the nipple where the lump was felt. No nipple discharge up to date, not changes in breast shape or look, size or color. No lymph nodes involved. I check on my breast every two weeks with my Dr. I travelled abroad to meet a breast sepcialist, having saw all my exams and on breast examination he confirmed this is fibroadenosis in both breasts, and this is not Paget's disease as it does not have it's features. I took a local treatment for the nipple which was an infection based on doctors advise. He advised that I do not need to do a surgery to remove it since my body has a reciepe to make fibroadenosis and they will come again, a fact that 6 years ago I had one removed from my left breast. Recently I went to 2 skin specialists (Derm), one said this is bacterial infection localized around the milk opening and gave me tabs, Povison cream, and potasium menganite wash. The 2nd said this is eczema and gave me power cort cream and told me if not improved I have to do a skin biopsy!! I am really freaked out, I am only 33 years old married for 3 years, no family history of Breast CA. What shll I do, and whom shall I trust, and which derm shall I go with.

[Computer_Voice]

I was under the impression that it was already biopsied.  In rereading your post, if it was the breast that was actually biopsied and not the nipple itself, then I would strongly consider the nipple biopsy if the dermatologist thinks it is appropriate.

Here are some web pages with some photos:
http://www.cancer.gov/cancertopics/factsheet/Sites-Types/pagets-breast
http://www.breastcare.com/bcc/research/images_new/early_pagets_die.jpg
http://www.breastcare.com/bcc/research/pagets_disease.asp

Also, and probably better than the internet, go to the bookstore of your local medical school and browse through the dermatology and surgery textbooks for pictures of Paget's.

[simsima]

Thanks. Your advise is comforting. What if the derm insists that I do a biopsy, I am afraid and do not want to get in to this drama. He did not tell me what he is suspecting, but probably I think paget's disease. Is there any location where a person can see different photos for paget's disease at different stages? My nipple is not cracked, it is only redish at the tip of it's head?  Should I worry about paget's disease?

[Computer_Voice]

At this point after all that workup there's not much else it could be besides an infection or eczema.  Take both the antibiotics and use the cortizone at the same time and it will go away.  If it comes back after you stop using the medicines it was probably eczema and at that time try to get rid of it using only the cortizone.  If that doesn't work if/when it comes back, try using only the antibiotics.