Paget’s Disease of the Breast: A dangerous imitator of eczema

Abstract

A 46-year-old woman with no personal or family history of cancer presented to the Department of Dermatology at the Complejo Hospitalario Universitario de Granada, Granada, Spain, in 2017 with an eczematous plaque in the areola of the left breast. The plaque had developed over the course of the past four years and was associated with stinging, itching and occasional suppuration. She had been previously treated with topical corticosteroids and antibiotics without improvement. A mammogram performed the previous year showed a small benign nodule of 8 x 5 mm in diameter and a simple cyst of 5 mm in diameter in the right breast. There was no evidence of ductal ectasia or alterations at the left retroareolar level l. A physical examination revealed an erythematous-squamous plaque of 4 x 5 cm in diameter on the left breast without infiltration and with effacement of the areola-nipple complex [ Figure 1].No local lymph nodes were palpated. A cutaneous ultrasound showed hyperkeratosis of the epidermis with a hypoechoic area in the dermis with increased vascularisation. A large incisional biopsy confirmed a diagnosis of Paget's disease of the nipple with ductal carcinoma in situ. A quadrantectomy and selective sentinel node biopsy were performed, the latter of which was negative. The patient was subsequently monitored for the next three years without evidence of clinical recurrence. CommentPaget's disease of the breast is characterised by the intraepidermal infiltration of malignant glandular interesting medical image Sultan Qaboos University Med J, November 2017, Vol. 17, Iss. 4, pp. e487-488,

Cytopathological diagnosis of herpes simplex viral mastitis: Three rare cases and a review of the literature

“…[ 22 ] (4) Eczematous lesion of the nipple: it is an inflammatory lesion of unknown cause, which is characterized by erosion and itching of the nipple skin surface, often with serous exudate and thin scab. Microscopically, a background of inflammation is seen, with varying degrees of squamous hyperplasia,[ 23 ] no atypia of nuclei, and sometimes diffuse keratinized squamous cells, and scattered eosinophils.…”

Paget’s Breast Disease- A Diagnostic Dilemma: A Case Report with Review

“…An ultrasound exam, or mammogram, or magnetic resonance imaging scan is mandatory in cases with a palpable lump in the breast [12]. Mammogram is normal in patients with only nipple changes without a clinically palpable mass, as in our case [3,6,13].…”

“…PDB presents most commonly in postmenopausal women between 50 and 60 years old, with a median age of 56-57 [2,3]. PDB involving the nipple has been commonly associated with IDC and is thought to be because of epidermal extension of underlying ductal breast carcinoma [4][5][6]. Ultrasounds, mammography, and magnetic resonance imaging can search for underlying cancer and guide surgical management.…”

Cutaneous Disorders of the Breast

“…• Prognosis and treatment: Mild-to-moderate potency topical corticosteroids and topical tacrolimus are used for the treatment. • Differential diagnosis: Allergic contact dermatitis (Kim et al 2014), cracked nipple (Santos et al 2016), Paget's disease (Aguayo-Carreras et al 2017;Dubar et al 2017), erosive adenomatosis (Kumar and Thomas 2013), and clear cell acanthoma (Kuo et al 2019;Kim et al 1999). • Prognosis and treatment: Topical and systemic corticosteroids, topical calcineurin inhibitors, and punch skin graft are used for the treatment.…”

“…It is thought that malignant cells from intraductal carcinoma extend into the overlying epidermis through mammary duct epithelium and proliferate in the epidermis causing thickening of the nipple and areola (Ooi et al 2018). • Clinical feature: It usually manifests as a chronic eczematous change of the nipple and areola often associated with an underlying lump (Aguayo-Carreras et al 2017). Erythematous scaly plaque with well-defined, slightly elevated border may appear (Figs.…”