Fig 2 - uploaded by Veronique Tan
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Photomicrographs of the skin lesion from Case 1 showing an acanthotic region (A) involved by intraepidermal malignant glands, focally extending into the rete pegs (B).
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Context 1
... 42-year-old Chinese woman underwent a right skin-sparing mastectomy 2 years prior to the current episode, for high grade DCIS diagnosed pre-operatively on core biopsy. At that time, she had pre- sented with a 6-month history of an enlarging 5 cm lump in the upper outer quadrant of her right breast, measured on ultrasound as 5.7 cm and subsequently assessed as 5.5 cm of high nuclear grade DCIS on pathological examination of the resected specimen. No invasive disease was seen. The DCIS was positive for HER2 and negative for hormone receptors (ER and PR). The nipple was free of malignancy and Paget's disease. Four sentinel lymph nodes that were biopsied were negative for metastasis. The superficial margin, however, was focally involved by tumour. Approximately 18 months after the skin-sparing mastectomy, the patient noticed a skin rash on the breast. Clinical examination found a 4-5 mm erythematous lesion at the 8 o'clock position of the right breast, resembling a hypertrophic scar that corresponded to the site of the original core biopsy scar, and hence no diagnostic skin biopsy was performed then. Upon review 6 months later, the appearance remained similar with no lesional enlargement. Two months later however, the patient underwent a punch biopsy of the persistent skin lesion (Fig. 1), followed by excision. nucleoli and several of the malignant cells extended into the deep rete pegs (Fig. 2B). This was associated with a mild to moderate chronic inflammatory infiltrate in the superficial dermis. There was no invasive disease present. A few sebaceous glands, eccrine glands and small hair follicles were seen in the dermis but otherwise no breast tissue was observed. Focal dermal scarring was ...
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... With only 9 cases reported in the English literature so far, and none of them is PBD on nipple-areola complex. [1] PBD, in which pagetoid cells are observed histologically, accounts for 5% of Bowen's disease. [2] The pagetoid growth pattern mimics mammary Paget's disease and superficial spreading melanoma. ...
... Sir, Myopericytoma was first described by Granter et al. in 1998 as benign tumor showing a myoid/pericytic line of differentiation. [1] It is most commonly found in subcutaneous and deep dermis of distal extremities, but in some cases, superficial dermis is also involved. "Cutaneous myopericytoma" usually occurs as a solitary lesion, although multiple lesions may be seen. ...
Because of the unique anatomic structure of the nipple, a few specific breast lesions occur only at this site. Large lactiferous sinuses may be involved by inflammatory conditions such as squamous metaplasia of lactiferous ducts and ductal ectasia or be the site of uncommon superficial epithelial neoplasms such as nipple adenoma or syringomatous tumor of the nipple. Paget disease of the nipple may be secondary to intraepidermal extension of ductal carcinoma in situ in the underlying lactiferous ducts or develop from malignant transformation of Toker cells. Invasive breast cancer may also arise primarily in the nipple. Most of these conditions present as a palpable mass and/or skin changes with or without nipple discharge. Due to the delicate location and often relatively small size of nipple lesions, biopsy specimens are often superficial and fragmented, and the interpretation is challenging. Knowledge of the morphologic and immunophenotypic features of nipple lesions is essential in making the correct diagnosis. Information on the molecular alterations underpinning nipple neoplasms is currently very limited.
Pagetoid Bowen disease is a subtype of Bowen disease that accounts for 5% of Bowen disease. It is extremely rare for Bowen disease to appear on the nipple-areola complex, with only seven cases described in the previous literature. Of those seven cases, only one was of the pagetoid subtype. We report two cases of pagetoid Bowen disease on this location, one of them being the first case of pagetoid Bowen disease affecting the nipple reported to date. On this location, it is crucial to perform a meticulous differential diagnosis to rule out Paget disease, due to its contrasting therapeutic and prognostic implications. In order to do this, clinical and histopathological aspects must be considered. From a clinical point of view, previous literature has stated that nipple involvement can be a clue that points to Paget disease. However, one of our cases shows that this is not always true. Regarding histopathological analysis, a complete excision of the tumor might be necessary to observe clear features of Bowen disease, such as full-thickness atypia of the epidermis and intercellular bridges. An immunohistochemical panel comprising CEA, GCDFP-15, EMA, p63, CK34betaE12, PAS, ER and PR can be decisive in complicated cases.
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