The Nipple-Areola Complex Epidermis: A Prospective Systematic Study in Adult Autopsies

Abstract

The prevalence of different types of clear cells and of the mite Demodex in the nipple-areola complex of adult autopsies of both sexes not suffering from breast cancer was studied in a total of 140 nipples. The epidermis of the nipple-areola complex shows squamous cells and 3 types of clear cells: Toker cells, pagetoid dyskeratosis cells, and signet ring-like cells. Toker cells were identified by standard light microscopy in 13 of 140 nipples (9.3%). Reactivity of these cells for CK7 was observed in 35 nipples (25%). They are derived from the lactiferous duct epithelium. Pagetoid dyskeratosis cells were identified in 56 of 140 nipples (40%). In 12 nipples, these cells were conspicuous (8.6%). It is suggested that the proliferation of these cells is induced by friction. Signet ring-like cells were identified in 71 nipples (50.7%). In 2 nipples, these cells were conspicuous (1.4%). They are a consequence of artefact related to formalin fixation. The prevalence of all these clear cells has no relationship with gender. Routine histopathological examination is usually enough to distinguish the characteristic features of the clear cells involving the nipple epidermis and permits differentiation of other entities with epidermal pale cells. Demodex mites were observed in 58 nipple-areola complexes (41.4%). They were more common in male nipple-areola complexes (P < 0.05). The prevalence of these mites was seen to remain steady along the years since the third decade. Demodex mites are common parasites of human nipple and are apparently of no pathologic significance.

Toker cells of the nipple are commonly associated with underlying sebaceous glands but not with lactiferous ducts

“…The 11% incidence of Toker cells noted in this study is similar to the incidence reported in most other studies1 2 8 This is in contrast to an unusually high incidence of 83% reported in 2009 in Canada by Nofech–Mozes and Hanna,3 with some of the detected Toker cells showing atypical features. It is possible that there might be regional and age variations in the incidence of Toker cells.…”

Clear cell acanthoma of the areola and nipple: clinical, histopathological, and immunohistochemical features of two Brazilian cases*

“…These latter three cell types are normal constituents or may be eventually present in the nipple/areola complex epidermis. 14 From a clinical standpoint, we consider that our case #2 met the classical morphological criteria for CCA, namely, net borders, 'stuck on' appearance, and humid, poorly scaly surface. Erosive areas were also seen both clinically and histopatologically (Figure 2C).…”

“…Taking into account the anatomical area under study, in which clear cells of at least three types may populate epithelial structures (Toker cells, pagetoid-dyskeratosis cells, and signetring cells), and according to a protocol recommended by Ko et al, an immunohistochemical study was performed. 14,15 Epitope retrieval was carried out by heating 0.01 M citrate buffer in a wet chamber (Pascal Dako,® Carpinteria, California, USA). The activity of endogenous peroxidase was blocked with a 5-minute treatment with 3% hydrogen peroxide.…”

Detection of Demodex folliculorum from nipple discharge

“…D. folliculorum is frequently observed in areas where many sebaceous glands exist such as the face, scalp, neck, eyelids, and upper chest, with many of these mites being detected by exfoliative cytodiagnosis . It has also been reported that D. folliculorum are common parasites of human nipples including the surrounding areola, and were found to be more common in male nipple‐areola complexes (30%) than women (10%) in adult autopsies . Fidler reported that D. folliculorum were found in a nipple imprint as well .…”

“…D. folliculorum mites, with a body length of approximately 0.3–0.4 mm, are often seen parasitizing the follicular openings of human skin in groups of 6–8 individuals . Because the mites are large, air bubbles may occur between the cover glass and slide‐glass.…”