Paget's disease of the breast differential diagnosis: Difference between revisions

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{{CMG}};{{AE}} {{Preeti}}
{{CMG}};{{AE}} {{Preeti}}
==Overview==
==Overview==
Paget's disease of the breast must be differentiated from [[atopic dermatitis]], [[eczema]], [[psoriasis]], [[Melanoma|malignant melanoma]], [[Bowen's disease]], [[basal cell carcinoma]], and pagetoid dyskeratosis.<ref name="GaspariRicci2013">{{cite journal|last1=Gaspari|first1=Eleonora|last2=Ricci|first2=Aurora|last3=Liberto|first3=Valeria|last4=Scarano|first4=Angela Lia|last5=Fornari|first5=Maria|last6=Simonetti|first6=Giovanni|title=An Unusual Case of Mammary Paget’s Disease Diagnosed Using Dynamic Contrast-Enhanced MRI|journal=Case Reports in Radiology|volume=2013|year=2013|pages=1–5|issn=2090-6862|doi=10.1155/2013/206235}}</ref><ref name="Lopes FilhoLopes2015">{{cite journal|last1=Lopes Filho|first1=Lauro Lourival|last2=Lopes|first2=Ione Maria Ribeiro Soares|last3=Lopes|first3=Lauro Rodolpho Soares|last4=Enokihara|first4=Milvia M. S. S.|last5=Michalany|first5=Alexandre Osores|last6=Matsunaga|first6=Nobuo|title=Mammary and extramammary Paget's disease|journal=Anais Brasileiros de Dermatologia|volume=90|issue=2|year=2015|pages=225–231|issn=1806-4841|doi=10.1590/abd1806-4841.20153189}}</ref>
Due to close similarity with many skin lesions, the diagnosis of Mammary Paget’s diseas may be delayed or many cases can be misdiagnosed. [[Immunohistochemical]] staining for [[cytokeratin]], [[epithelial]] membrane [[antigen]] (EMA) and [[c-erb-B2]] oncoprotein is useful for the differential diagnosis. Toker cells found in the [[epidermis]] of the [[nipple]], close to the opening of [[Lactiferous duct|lactiferous ducts]], along the basal layer of the [[epidermis]], are [[Morphological computation|morphological]] and [[Immunohistochemistry|immunohistochemical]] similar to [[Mammary gland|mammary]] Paget's cells. In contrast to Paget's cells which are strongly associated with both [[Ki-67]] and Her-2/c-erbB-2 and these markers are mostly used to distinguish Paget's cells from Toker cells. In case of [[Atypical cells|atypical]] Toker cells a combination of [[CD138]] and [[p53]] is very helpful in distinguishing these atypical cells from Paget's cells. Paget's disease of the breast must be differentiated from [[atopic dermatitis]], [[eczema]], [[psoriasis]], [[Melanoma|malignant melanoma]], [[Bowen's disease]], [[basal cell carcinoma]], [[Intraductal papilloma|benign intraductal papilloma]], nevoid [[hyperkeratosis]] of the nipple and [[areola]]  (NHNA), [[squamous metaplasia]] of [[Lactiferous duct|lactiferous]] ducts (SMOLD)/ [[Zuska's disease]] and pagetoid dyskeratosis.


==Differential Diagnosis==
==Differential Diagnosis==
Paget’s disease of the breast must be differentiated from other benign and malignant processes of nipple-areola complex such as:


*[[Atopic dermatitis]]
*The Paget’s disease of the [[breast]] is associated with changes in the [[Nipple|nipple-areola complex]].
*Chronic contact dermatitis
*Any patient presenting with changes in the [[nipple]] or [[areola]] requires [[Biopsy|surgical biopsy]] of the [[Nipple|nipple-areola complex]] for definitive diagnosis.
*[[Immunohistochemical]] staining for [[cytokeratin]], [[epithelial]] membrane antigen (EMA) and [[c-erb-B2]] [[oncoprotein]] is useful for the differential diagnosis.
*Due to close similarity with many [[skin]] [[lesions]], the diagnosis of mammary Paget’s Diseas may be delayed or many cases can be misdiagnosed.
*Toker cells found in the [[epidermis]] of the [[nipple]], close to the opening of [[Lactiferous duct|lactiferous ducts]], along the basal layer of the [[epidermis]], are [[Morphological computation|morphological]] and [[Immunohistochemistry|immunohistochemical]] similar to [[Mammary gland|mammary]] Paget's cells
*They are observed in about 10% of standard [[histological]] preparations of normal [[nipples]] and can be confused with Paget's disease not associated with [[Breast carcinoma|invasive carcinoma]] or [[DICS]].
*Mainly in cases of Toker cell [[hyperplasia]] with cytologic [[atypia]], it may be difficult to distinguish them from Paget's cells.
*They are mainly distinguished from Paget's cells due to the latter having large, [[pleomorphic]] and [[Cytological|cytologically]] atypical nuclei.
*[[Cytokeratin|CK7]] and Her-2/c-erbB-2 have been proposed to be specific and sensitive markers for Paget cells.
*Toker cells are said to be consistently positive for [[Cytokine|CK7]] and estrogen receptors. [[Ki-67]] and Her-2/c-erbB-2 are rarely expressed in these cells.
*In contrast to Paget's cells which are strongly associated with both [[Ki-67]] and Her-2/c-erbB-2 and these markers are mostly used to distinguish Paget's cells from Toker cells.
*In case of [[Atypical cells|atypical]] Toker cells a combination of [[CD138]] and [[p53]] is very helpful in distinguishing these atypical cells from Paget's cells.<ref name="pmid8599455">{{cite journal| author=van der Putte SC, Toonstra J, Hennipman A| title=Mammary Paget's disease confined to the areola and associated with multifocal Toker cell hyperplasia. | journal=Am J Dermatopathol | year= 1995 | volume= 17 | issue= 5 | pages= 487-93 | pmid=8599455 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8599455  }} </ref><ref name="pmid9989849">{{cite journal| author=Lundquist K, Kohler S, Rouse RV| title=Intraepidermal cytokeratin 7 expression is not restricted to Paget cells but is also seen in Toker cells and Merkel cells. | journal=Am J Surg Pathol | year= 1999 | volume= 23 | issue= 2 | pages= 212-9 | pmid=9989849 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9989849  }} </ref><ref name="MitchellLachica2006">{{cite journal|last1=Mitchell|first1=Sonya|last2=Lachica|first2=Roberto|last3=Randall|first3=M. Barry|last4=Beech|first4=Derrick J.|title=Paget's Disease of the Breast Areola Mimicking Cutaneous Melanoma|journal=The Breast Journal|volume=12|issue=3|year=2006|pages=233–236|issn=1075-122X|doi=10.1111/j.1075-122X.2006.00247.x}}</ref><ref name="pmid1695889">{{cite journal| author=Reed W, Oppedal BR, Eeg Larsen T| title=Immunohistology is valuable in distinguishing between Paget's disease, Bowen's disease and superficial spreading malignant melanoma. | journal=Histopathology | year= 1990 | volume= 16 | issue= 6 | pages= 583-8 | pmid=1695889 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1695889  }} </ref><ref name="pmid4313654">{{cite journal| author=Toker C| title=Clear cells of the nipple epidermis. | journal=Cancer | year= 1970 | volume= 25 | issue= 3 | pages= 601-10 | pmid=4313654 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4313654  }} </ref><ref name="Di TommasoFranchi2008">{{cite journal|last1=Di Tommaso|first1=Luca|last2=Franchi|first2=Giada|last3=Destro|first3=Annarita|last4=Broglia|first4=Fabiana|last5=Minuti|first5=Francesco|last6=Rahal|first6=Daoud|last7=Roncalli|first7=Massimo|title=Toker cells of the breast. Morphological and immunohistochemical characterization of 40 cases|journal=Human Pathology|volume=39|issue=9|year=2008|pages=1295–1300|issn=00468177|doi=10.1016/j.humpath.2008.01.018}}</ref>
 
 
Paget's disease of the breast is often confused with
*[[Eczema]]
*[[Dermatitis]] of the [[nipple]]
*[[Duct ectasia of breast|Lactiferous duct ectasia]]
*[[Duct ectasia of breast|Lactiferous duct ectasia]]
*[[Eczema|Chronic eczema]]
*[[Eczema|Chronic eczema]]
*[[Psoriasis]]
*[[Psoriasis]]
*Nipple duct adenoma
*Nipple duct [[adenoma]]
*[[Melanoma|Malignant melanoma]]
*[[Melanoma|Malignant melanoma]](particularly the pigmented lesions)
*[[Bowen’s disease]]
*[[Bowen’s disease]]
*[[Basal cell carcinoma|Superficial basal cell carcinoma]]
*[[Basal cell carcinoma|Superficial basal cell carcinoma]]
*[[Squamous metaplasia]] of [[Lactiferous duct|lactiferous]] ducts (SMOLD)/  [[Zuska's disease]]
*[[Intraductal papilloma|Benign intraductal papilloma]]
*[[Intraductal papilloma|Benign intraductal papilloma]]
*Nevoid [[hyperkeratosis]] of the nipple and [[areola]]  (NHNA)
*Pagetoid dyskeratosis
*Pagetoid dyskeratosis
 
*[[Mastitis]]
Paget's disease of the breast is often misdiagnosed as nipple eczema 
*[[Breast abscess|Breast abcess]]


{|
{|
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|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Paget's disease of the breast<ref name="GaspariRicci2013">{{cite journal|last1=Gaspari|first1=Eleonora|last2=Ricci|first2=Aurora|last3=Liberto|first3=Valeria|last4=Scarano|first4=Angela Lia|last5=Fornari|first5=Maria|last6=Simonetti|first6=Giovanni|title=An Unusual Case of Mammary Paget’s Disease Diagnosed Using Dynamic Contrast-Enhanced MRI|journal=Case Reports in Radiology|volume=2013|year=2013|pages=1–5|issn=2090-6862|doi=10.1155/2013/206235}}</ref><ref name="Lopes FilhoLopes2015">{{cite journal|last1=Lopes Filho|first1=Lauro Lourival|last2=Lopes|first2=Ione Maria Ribeiro Soares|last3=Lopes|first3=Lauro Rodolpho Soares|last4=Enokihara|first4=Milvia M. S. S.|last5=Michalany|first5=Alexandre Osores|last6=Matsunaga|first6=Nobuo|title=Mammary and extramammary Paget's disease|journal=Anais Brasileiros de Dermatologia|volume=90|issue=2|year=2015|pages=225–231|issn=1806-4841|doi=10.1590/abd1806-4841.20153189}}</ref>
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Paget's disease of the breast<ref name="GaspariRicci2013">{{cite journal|last1=Gaspari|first1=Eleonora|last2=Ricci|first2=Aurora|last3=Liberto|first3=Valeria|last4=Scarano|first4=Angela Lia|last5=Fornari|first5=Maria|last6=Simonetti|first6=Giovanni|title=An Unusual Case of Mammary Paget’s Disease Diagnosed Using Dynamic Contrast-Enhanced MRI|journal=Case Reports in Radiology|volume=2013|year=2013|pages=1–5|issn=2090-6862|doi=10.1155/2013/206235}}</ref><ref name="Lopes FilhoLopes2015">{{cite journal|last1=Lopes Filho|first1=Lauro Lourival|last2=Lopes|first2=Ione Maria Ribeiro Soares|last3=Lopes|first3=Lauro Rodolpho Soares|last4=Enokihara|first4=Milvia M. S. S.|last5=Michalany|first5=Alexandre Osores|last6=Matsunaga|first6=Nobuo|title=Mammary and extramammary Paget's disease|journal=Anais Brasileiros de Dermatologia|volume=90|issue=2|year=2015|pages=225–231|issn=1806-4841|doi=10.1590/abd1806-4841.20153189}}</ref>
| align="center" style="background:#F5F5F5;" |
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*[[Malignant]]
*[[Malignant]]
| align="left" style="background:#F5F5F5;" |Most the patients have underlying [[Breast cancer|breast cancer.]]
| style="background:#F5F5F5;" align="left" |Most the patients have underlying [[Breast cancer|breast cancer.]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Ulcerated, crusted, or scaling lesion on the [[nipple]] that extends to the [[Areola|areolar region]].
* Ulcerated, crusted, or scaling lesion on the [[nipple]] that extends to the [[Areola|areolar region]].
| align="center" style="background:#F5F5F5;" | +
| style="background:#F5F5F5;" align="center" | +
| align="center" style="background:#F5F5F5;" | +
| style="background:#F5F5F5;" align="center" | +
| align="center" style="background:#F5F5F5;" |±
| style="background:#F5F5F5;" align="center" |±
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Well-demarcated [[erythematous]] and [[Desquamation|desquamative plaques]] with irregular borders seen.
* Well-demarcated [[erythematous]] and [[Desquamation|desquamative plaques]] with irregular borders seen.
* [[Breast lump]] palpated in >50% cases.
* [[Breast lump]] palpated in >50% cases.
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Usually unilateral [[nipple]] is effected
* Usually unilateral [[nipple]] is effected
| align="left" style="background:#F5F5F5;" |
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* The Paget cells are large round [[cells]] with abundant clear [[cytoplasm]] and [[Nuclei|atypical nuclei]].  
* The Paget cells are large round [[cells]] with abundant clear [[cytoplasm]] and [[Nuclei|atypical nuclei]].  
* The cytoplasm is often [[Periodic acid-Schiff|periodic-acid-Schiff (PAS)]] positive
* The cytoplasm is often [[Periodic acid-Schiff|periodic-acid-Schiff (PAS)]] positive
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* [[Biopsy]]
* [[Biopsy]]
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* 90% of the cases  will have an invasive [[Ductal carcinoma|intraductal carcinoma of the breast]].
* 90% of the cases  will have an invasive [[Ductal carcinoma|intraductal carcinoma of the breast]].
* May positive staining against [[CEA antigen]]  and the c erbB-2 / her-2 neu [[Oncogene|oncoprotein]].
* May positive staining against [[CEA antigen]]  and the c erbB-2 / her-2 neu [[Oncogene|oncoprotein]].
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! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Atopic dermatitis]]
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Atopic dermatitis]]
([[Eczema]])<ref name="pmid25079201">{{cite journal |vauthors=Song HS, Jung SE, Kim YC, Lee ES |title=Nipple eczema, an indicative manifestation of atopic dermatitis? A clinical, histological, and immunohistochemical study |journal=Am J Dermatopathol |volume=37 |issue=4 |pages=284–8 |date=April 2015 |pmid=25079201 |doi=10.1097/DAD.0000000000000195 |url=}}</ref><ref name="pmid15129318">{{cite journal |vauthors=Barankin B, Gross MS |title=Nipple and areolar eczema in the breastfeeding woman |journal=J Cutan Med Surg |volume=8 |issue=2 |pages=126–30 |date=2004 |pmid=15129318 |doi=10.1177/120347540400800209 |url=}}</ref>
([[Eczema]])<ref name="pmid25079201">{{cite journal |vauthors=Song HS, Jung SE, Kim YC, Lee ES |title=Nipple eczema, an indicative manifestation of atopic dermatitis? A clinical, histological, and immunohistochemical study |journal=Am J Dermatopathol |volume=37 |issue=4 |pages=284–8 |date=April 2015 |pmid=25079201 |doi=10.1097/DAD.0000000000000195 |url=}}</ref><ref name="pmid15129318">{{cite journal |vauthors=Barankin B, Gross MS |title=Nipple and areolar eczema in the breastfeeding woman |journal=J Cutan Med Surg |volume=8 |issue=2 |pages=126–30 |date=2004 |pmid=15129318 |doi=10.1177/120347540400800209 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
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* [[Benign]]
* [[Benign]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Epidermal]] barrier dysfunction
* [[Epidermal]] barrier dysfunction
* [[Immune]] dysregulation
* [[Immune]] dysregulation
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
*[[Erythema]], [[Exudate|exudates]], [[papules]],[[vesicles]], scales and crusts
*[[Erythema]], [[Exudate|exudates]], [[papules]],[[vesicles]], scales and crusts
* Infiltrated [[erythema]], [[prurigo]], scales and crusts
* Infiltrated [[erythema]], [[prurigo]], scales and crusts
| align="center" style="background:#F5F5F5;" | –
| style="background:#F5F5F5;" align="center" | –
| align="center" style="background:#F5F5F5;" | –
| style="background:#F5F5F5;" align="center" | –
| align="center" style="background:#F5F5F5;" |–
| style="background:#F5F5F5;" align="center" |–


| align="center" style="background:#F5F5F5;" | N/A
| style="background:#F5F5F5;" align="center" | N/A
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Usually bilateral [[nipple]] is effected with no accompanying [[induration]].
* Usually bilateral [[nipple]] is effected with no accompanying [[induration]].
* Centrofacial pallor
* Centrofacial pallor
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* [[Pityriasis alba]]
* [[Pityriasis alba]]
* [[Ichthyosis]]
* [[Ichthyosis]]
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* Epidermal psoriasiform [[hyperplasia]]
* Epidermal psoriasiform [[hyperplasia]]
* Marked intercellular [[edema]] with spongiotic vesiculation
* Marked intercellular [[edema]] with spongiotic vesiculation
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* Psoriasiform [[hyperplasia]]
* Psoriasiform [[hyperplasia]]
* [[Dyskeratosis congenita|Dyskeratosis]]
* [[Dyskeratosis congenita|Dyskeratosis]]
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* Clinical examination
* Clinical examination


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*  
*  
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Family history]] of  [[atopy]]
* [[Family history]] of  [[atopy]]
* History of [[Breast implants|silicon implants]] or [[Breast reconstruction|reconstruction]] of nipple areola complex or [[lactation]].
* History of [[Breast implants|silicon implants]] or [[Breast reconstruction|reconstruction]] of [[nipple]] [[areola]] complex or [[lactation]].
* Personal history of [[atopy]] or [[extramammary Paget's disease]] or hematological [[diseases]]
* Personal history of [[atopy]] or [[extramammary Paget's disease]] or hematological [[diseases]]
* Combined usage of [[interferon alfa-2b]] and [[ribavirin]].
* Combined usage of [[interferon alfa-2b]] and [[ribavirin]].
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Papillary adenoma of the nipple|Erosive adenomatosis of the nipple]]<ref name="pmid23984247">{{cite journal |vauthors=Kumar PK, Thomas J |title=Erosive adenomatosis of the nipple masquerading as Paget's disease |journal=Indian Dermatol Online J |volume=4 |issue=3 |pages=239–40 |date=July 2013 |pmid=23984247 |pmc=3752489 |doi=10.4103/2229-5178.115534 |url=}}</ref><ref name="pmid962337">{{cite journal |vauthors=Lewis HM, Ovitz ML, Golitz LE |title=Erosive adenomatosis of the nipple |journal=Arch Dermatol |volume=112 |issue=10 |pages=1427–8 |date=October 1976 |pmid=962337 |doi= |url=}}</ref>
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Papillary adenoma of the nipple|Erosive adenomatosis of the nipple]]<ref name="pmid23984247">{{cite journal |vauthors=Kumar PK, Thomas J |title=Erosive adenomatosis of the nipple masquerading as Paget's disease |journal=Indian Dermatol Online J |volume=4 |issue=3 |pages=239–40 |date=July 2013 |pmid=23984247 |pmc=3752489 |doi=10.4103/2229-5178.115534 |url=}}</ref><ref name="pmid962337">{{cite journal |vauthors=Lewis HM, Ovitz ML, Golitz LE |title=Erosive adenomatosis of the nipple |journal=Arch Dermatol |volume=112 |issue=10 |pages=1427–8 |date=October 1976 |pmid=962337 |doi= |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="center" |
* [[Benign]]
* [[Benign]]
* [[Neoplasm]] of [[breast]] [[Lactiferous duct|lactiferous ducts]].
* [[Neoplasm]] of [[breast]] [[Lactiferous duct|lactiferous ducts]].
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Proliferation]] of the inner  [[Epithelial|epithelial layer]] and outer, [[basal layer]] of [[myoepithelial cells]] of the [[Lactiferous duct|lactiferous ducts]]  the [[nipple]].
* [[Proliferation]] of the inner  [[Epithelial|epithelial layer]] and outer, [[basal layer]] of [[myoepithelial cells]] of the [[Lactiferous duct|lactiferous ducts]]  the [[nipple]].
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Eczema]], crusts or erosion of nipple
* [[Eczema]], crusts or erosion of [[nipple]]
| align="left" style="background:#F5F5F5;" | +
| style="background:#F5F5F5;" align="left" | +
| align="center" style="background:#F5F5F5;" | +
| style="background:#F5F5F5;" align="center" | +
| align="center" style="background:#F5F5F5;" |–
| style="background:#F5F5F5;" align="center" |–
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Nipple]] may have unencapsulated, firm  [[Granuloma|granulomatous lesion]] .
* [[Nipple]] may have unencapsulated, firm  [[Granuloma|granulomatous lesion]] .
* A non-tender [[nodule]] either within or under the [[nipple]] adherent to the [[skin]], but not the [[breast]] may be palpated.  
* A non-tender [[nodule]] either within or under the [[nipple]] adherent to the [[skin]], but not the [[breast]] may be palpated.  
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* Insidious onset.
* Insidious onset.
* [[Erythema]] may be seen prior to [[erosion]].
* [[Erythema]] may be seen prior to [[erosion]].
* No  [[lymphadenopathy]].
* No  [[lymphadenopathy]].
| align="left" style="background:#F5F5F5;" |
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* Overlying epidermis often shows [[acanthosis]] and [[hyperkeratosis]].  
* Overlying epidermis often shows [[acanthosis]] and [[hyperkeratosis]].  
* Papillomatous pattern: [[vascular]] papillae project into dilated [[lumina]] and are surrounded by [[Epithelial cells|proliferating epithelial cells]] .
* Papillomatous pattern: [[vascular]] papillae project into dilated [[lumina]] and are surrounded by [[Epithelial cells|proliferating epithelial cells]] .
* [[Papilla|Papillary]] pattern:  [[cells]] proliferate into large cords with deep fissures and clefts and dense [[stroma]].
* [[Papilla|Papillary]] pattern:  [[cells]] proliferate into large cords with deep fissures and clefts and dense [[stroma]].
| align="left" style="background:#F5F5F5;" |[[Biopsy]]: Shows absence of [[Atypia|cytological atypia]]
| style="background:#F5F5F5;" align="left" |[[Biopsy]]: Shows absence of [[Atypia|cytological atypia]]
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* [[Incidence]] is highest in the fifth decade in women.
* [[Incidence]] is highest in the fifth decade in women.
* No  [[lymphadenopathy]].
* No  [[lymphadenopathy]].
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Contact dermatitis|Allergic contact dermatitis]]<ref name="pmid19447733">{{cite journal |vauthors=Nosbaum A, Vocanson M, Rozieres A, Hennino A, Nicolas JF |title=Allergic and irritant contact dermatitis |journal=Eur J Dermatol |volume=19 |issue=4 |pages=325–32 |date=2009 |pmid=19447733 |doi=10.1684/ejd.2009.0686 |url=}}</ref>
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Contact dermatitis|Allergic contact dermatitis]]<ref name="pmid19447733">{{cite journal |vauthors=Nosbaum A, Vocanson M, Rozieres A, Hennino A, Nicolas JF |title=Allergic and irritant contact dermatitis |journal=Eur J Dermatol |volume=19 |issue=4 |pages=325–32 |date=2009 |pmid=19447733 |doi=10.1684/ejd.2009.0686 |url=}}</ref>
| align="left" style="background:#F5F5F5;" |
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* [[Benign]]
* [[Benign]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Delayed-type [[hypersensitivity]] response
* Delayed-type [[hypersensitivity]] response
* Skin [[inflammation]] mediated by [[Haptens|hapten]]-specific T cells
* [[Skin]] [[inflammation]] mediated by [[Haptens|hapten]]-specific T cells
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Erythematous well-demarcated [[papules]]
* [[Erythema|Erythematous]] well-demarcated [[papules]]
| align="center" style="background:#F5F5F5;" |–
| style="background:#F5F5F5;" align="center" |–
| align="center" style="background:#F5F5F5;" |–
| style="background:#F5F5F5;" align="center" |–
| align="center" style="background:#F5F5F5;" | +
| style="background:#F5F5F5;" align="center" | +
| align="center" style="background:#F5F5F5;" |N/A
| style="background:#F5F5F5;" align="center" |N/A
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Stinging and burning
* Stinging and burning
* Localized [[swelling]]
* Localized [[swelling]]
* [[Lichenification|Lichenified]] [[Itch|pruritic]] [[plaques]]
* [[Lichenification|Lichenified]] [[Itch|pruritic]] [[plaques]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Eosinophilic]] [[Spongiosum|spongiosis]] and [[microvesicles]]
* [[Eosinophilic]] [[Spongiosum|spongiosis]] and [[microvesicles]]
* [[Exocytosis]] of [[eosinophils]] and [[lymphocytes]]  
* [[Exocytosis]] of [[eosinophils]] and [[lymphocytes]]  
* Chronic - [[Hyperkeratosis]] and [[parakeratosis]]
* Chronic - [[Hyperkeratosis]] and [[parakeratosis]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Clinical examination
* Clinical examination
* [[Biopsy]]
* [[Biopsy]]
| align="center" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="center" |
* Contact with [[allergens]] in the past 1-2 days
* Contact with [[allergens]] in the past 1-2 days
* Positive [[family history]]
* Positive [[family history]]
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Psoriasis]]<ref name="pmid20107724">{{cite journal |vauthors=Ljosaa TM, Rustoen T, Mörk C, Stubhaug A, Miaskowski C, Paul SM, Wahl AK |title=Skin pain and discomfort in psoriasis: an exploratory study of symptom prevalence and characteristics |journal=Acta Derm. Venereol. |volume=90 |issue=1 |pages=39–45 |date=2010 |pmid=20107724 |doi=10.2340/00015555-0764 |url=}}</ref><ref name="pmid1390163">{{cite journal |vauthors=Naldi L, Parazzini F, Brevi A, Peserico A, Veller Fornasa C, Grosso G, Rossi E, Marinaro P, Polenghi MM, Finzi A |title=Family history, smoking habits, alcohol consumption and risk of psoriasis |journal=Br. J. Dermatol. |volume=127 |issue=3 |pages=212–7 |date=September 1992 |pmid=1390163 |doi= |url=}}</ref>
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Psoriasis]]<ref name="pmid20107724">{{cite journal |vauthors=Ljosaa TM, Rustoen T, Mörk C, Stubhaug A, Miaskowski C, Paul SM, Wahl AK |title=Skin pain and discomfort in psoriasis: an exploratory study of symptom prevalence and characteristics |journal=Acta Derm. Venereol. |volume=90 |issue=1 |pages=39–45 |date=2010 |pmid=20107724 |doi=10.2340/00015555-0764 |url=}}</ref><ref name="pmid1390163">{{cite journal |vauthors=Naldi L, Parazzini F, Brevi A, Peserico A, Veller Fornasa C, Grosso G, Rossi E, Marinaro P, Polenghi MM, Finzi A |title=Family history, smoking habits, alcohol consumption and risk of psoriasis |journal=Br. J. Dermatol. |volume=127 |issue=3 |pages=212–7 |date=September 1992 |pmid=1390163 |doi= |url=}}</ref>
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Benign]]
* [[Benign]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Keratinocyte]] hyperproliferation
* [[Keratinocyte]] hyperproliferation
* Dysregulation of the [[immune system]]
* Dysregulation of the [[immune system]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Well-circumscribed, pink [[papules]] and symmetrically distributed cutaneous [[plaques]] with silvery scales.
* Well-circumscribed, pink [[papules]] and symmetrically distributed cutaneous [[plaques]] with silvery scales.
| align="center" style="background:#F5F5F5;" |–
| style="background:#F5F5F5;" align="center" |–
| align="center" style="background:#F5F5F5;" | +
| style="background:#F5F5F5;" align="center" | +
| align="center" style="background:#F5F5F5;" | +
| style="background:#F5F5F5;" align="center" | +


| align="center" style="background:#F5F5F5;" | N/A
| style="background:#F5F5F5;" align="center" | N/A
| align="left" style="background:#F5F5F5;" |[[Auspitz's sign]]  (pinpoint bleeding)
| style="background:#F5F5F5;" align="left" |[[Auspitz's sign]]  (pinpoint bleeding)
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Epidermal]] [[hyperplasia]]
* [[Epidermal]] [[hyperplasia]]
* [[Parakeratosis]]
* [[Parakeratosis]]
* [[Neutrophils]] microabscesses (Munro microabscesses)
* [[Neutrophils]] microabscesses (Munro microabscesses)
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Clinical examination
* Clinical examination
* [[Biopsy]]
* [[Biopsy]]
Line 195: Line 211:
* [[Vitamin D deficiency]]  
* [[Vitamin D deficiency]]  
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Melanoma|Malignant melanoma]]
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Melanoma|Malignant melanoma]]<ref name="pmid1695889">{{cite journal| author=Reed W, Oppedal BR, Eeg Larsen T| title=Immunohistology is valuable in distinguishing between Paget's disease, Bowen's disease and superficial spreading malignant melanoma. | journal=Histopathology | year= 1990 | volume= 16 | issue= 6 | pages= 583-8 | pmid=1695889 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1695889  }} </ref>
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Malignant]]
* [[Malignant]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Neural crest cell]] derivative
* [[Neural crest cell]] derivative
* Development begins with disruption of [[nevus]] growth control
* Development begins with disruption of [[nevus]] growth control
* Progression involves [[MAPK/ERK pathway]]
* Progression involves [[MAPK/ERK pathway]]
* [[RAS|N-RAS]] or [[BRAF]] [[oncogene]]<nowiki/> also involved.
* [[RAS|N-RAS]] or [[BRAF]] [[oncogene]]<nowiki/> also involved.
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Macule]]
* [[Macule]]
* [[Plaque]] with irregular border
* [[Plaque]] with irregular border
Line 214: Line 230:
** Diameter changes
** Diameter changes
* [[Bleeding]] from the [[lesion]].
* [[Bleeding]] from the [[lesion]].
| align="center" style="background:#F5F5F5;"
| style="background:#F5F5F5;" align="center"
| align="center" style="background:#F5F5F5;" |–
| style="background:#F5F5F5;" align="center" |–
| align="center" style="background:#F5F5F5;" |–
| style="background:#F5F5F5;" align="center" |–
| align="center" style="background:#F5F5F5;" |N/A
| style="background:#F5F5F5;" align="center" |N/A
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Pigmented lesion with:  
* Pigmented lesion with:  
* Asymmetry
* Asymmetry
Line 224: Line 240:
* Variegated color
* Variegated color
* Diameter >6 mm
* Diameter >6 mm
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Nests of  atypical [[melanocytes]] with asymmetry, poor circumscription of varying sizes and shapes
* Nests of  atypical [[melanocytes]] with asymmetry, poor circumscription of varying sizes and shapes
* Present in the lower [[epidermis]] and [[dermis]]
* Present in the lower [[epidermis]] and [[dermis]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Complete full-thickness excisional [[biopsy]] of suspicious [[lesions]] with 1 to 3 mm margin of normal [[skin]].
* Complete full-thickness excisional [[biopsy]] of suspicious [[lesions]] with 1 to 3 mm margin of normal [[skin]].
* [[S-100]] is used to differentiate Paget's disease from [[melanoma]]. But, since 18-25% of Paget's are [[S-100]] positive, at least two [[melanoma]] markers, such as [[HMB-45]], [[S-100]], or Melan-A should be used.
* [[S-100]] is used to differentiate Paget's disease from [[melanoma]]. But, since 18-25% of Paget's are [[S-100]] positive, at least two [[melanoma]] markers, such as [[HMB-45]], [[S-100]], or Melan-A should be used.
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Ultraviolet|UV radiations]]
* [[Ultraviolet|UV radiations]]
* [[Genetic predisposition]]
* [[Genetic predisposition]]
Line 238: Line 254:
* Multiple benign or atypical [[Nevus|nevi]]
* Multiple benign or atypical [[Nevus|nevi]]
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Bowen’s disease]]
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Bowen’s disease]]<ref name="pmid1695889">{{cite journal| author=Reed W, Oppedal BR, Eeg Larsen T| title=Immunohistology is valuable in distinguishing between Paget's disease, Bowen's disease and superficial spreading malignant melanoma. | journal=Histopathology | year= 1990 | volume= 16 | issue= 6 | pages= 583-8 | pmid=1695889 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1695889  }} </ref>
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Benign]] can turn [[malignant]]
* [[Benign]] can turn [[malignant]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Solar damage
* Solar damage
* [[Arsenic]]  
* [[Arsenic]]  
Line 247: Line 263:
* [[Viral]] [[infection]] ([[human papillomavirus]] or [[HPV]])  
* [[Viral]] [[infection]] ([[human papillomavirus]] or [[HPV]])  
* [[Skin disease|Dermatoses]]
* [[Skin disease|Dermatoses]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Erythema|Erythematous]]
* [[Erythema|Erythematous]]
* Coloured [[skin]]  
* Coloured [[skin]]  
Line 254: Line 270:
* Scaly
* Scaly
* Varying size
* Varying size
| align="center" style="background:#F5F5F5;" |–
| style="background:#F5F5F5;" align="center" |–
| align="center" style="background:#F5F5F5;" | +
| style="background:#F5F5F5;" align="center" | +
| align="center" style="background:#F5F5F5;" |–
| style="background:#F5F5F5;" align="center" |–
| align="center" style="background:#F5F5F5;" |N/A
| style="background:#F5F5F5;" align="center" |N/A
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Presence of dotted and/or [[glomerular]] [[vessels]]
* Presence of dotted and/or [[glomerular]] [[vessels]]
* White to yellowish surface scales
* White to yellowish surface scales
* Red-yellowish background
* Red-yellowish background
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Keratinocyte|Keratinocytic]] [[dysplasia]]   
* [[Keratinocyte|Keratinocytic]] [[dysplasia]]   
*  
*  
Line 269: Line 285:
* [[Pleomorphic]] [[keratinocytes]]
* [[Pleomorphic]] [[keratinocytes]]
* [[Hyperchromatic]] [[nuclei]]
* [[Hyperchromatic]] [[nuclei]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Clinical examination
* Clinical examination


* [[Biopsy]]
* [[Biopsy]]
| align="left" style="background:#F5F5F5;" |
* [[Immunohistochemistry]]:  [[Bowen's disease]] can be differentiated from  Paget's disease as it  stains negative for [[CK7]] and positive for CK5, CK5/6, and [[p63]].
| style="background:#F5F5F5;" align="left" |
* Slow growth over the years
* Slow growth over the years
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Basal cell carcinoma|Superficial basal cell carcinoma]]<ref name="pmid11668245">{{cite journal |vauthors=Yamamoto H, Ito Y, Hayashi T, Urano N, Kato T, Kimura Y, Tanigawa T, Endo W, Kurokawa E, Kikkawa N, Taniguchi H |title=A case of basal cell carcinoma of the nipple and areola with intraductal spread |journal=Breast Cancer |volume=8 |issue=3 |pages=229–33 |date=2001 |pmid=11668245 |doi= |url=}}</ref><ref name="pmid30057838">{{cite journal |vauthors=Ulanja MB, Taha ME, Al-Mashhadani AA, Al-Tekreeti MM, Elliot C, Ambika S |title=Basal Cell Carcinoma of the Female Breast Masquerading as Invasive Primary Breast Carcinoma: An Uncommon Presentation Site |journal=Case Rep Oncol Med |volume=2018 |issue= |pages=5302185 |date=2018 |pmid=30057838 |pmc=6051126 |doi=10.1155/2018/5302185 |url=}}</ref>
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Basal cell carcinoma|Superficial basal cell carcinoma]]<ref name="pmid11668245">{{cite journal |vauthors=Yamamoto H, Ito Y, Hayashi T, Urano N, Kato T, Kimura Y, Tanigawa T, Endo W, Kurokawa E, Kikkawa N, Taniguchi H |title=A case of basal cell carcinoma of the nipple and areola with intraductal spread |journal=Breast Cancer |volume=8 |issue=3 |pages=229–33 |date=2001 |pmid=11668245 |doi= |url=}}</ref><ref name="pmid30057838">{{cite journal |vauthors=Ulanja MB, Taha ME, Al-Mashhadani AA, Al-Tekreeti MM, Elliot C, Ambika S |title=Basal Cell Carcinoma of the Female Breast Masquerading as Invasive Primary Breast Carcinoma: An Uncommon Presentation Site |journal=Case Rep Oncol Med |volume=2018 |issue= |pages=5302185 |date=2018 |pmid=30057838 |pmc=6051126 |doi=10.1155/2018/5302185 |url=}}</ref>
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Malignant]]
* [[Malignant]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Ultraviolet|UV]] light induces [[inflammation]] of the [[skin]].
* [[Ultraviolet|UV]] light induces [[inflammation]] of the [[skin]].
* Patched 1 (PTCH1) [[tumor suppressor gene]] on [[chromosome 9]]  
* Patched 1 (PTCH1) [[tumor suppressor gene]] on [[chromosome 9]]  
* [[P53]] mutations.
* [[P53]] mutations.
| align="center" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="center" |
* [[Erythematous]]
* [[Erythematous]]
* Superficial scaly patch
* Superficial scaly patch
| align="center" style="background:#F5F5F5;" |–
| style="background:#F5F5F5;" align="center" |–
| align="center" style="background:#F5F5F5;" | +
| style="background:#F5F5F5;" align="center" | +
| align="center" style="background:#F5F5F5;" |–
| style="background:#F5F5F5;" align="center" |–
| align="center" style="background:#F5F5F5;" |N/A
| style="background:#F5F5F5;" align="center" |N/A
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Superficial fine [[telangiectasia]]
* Superficial fine [[telangiectasia]]
* Shiny white to red, translucent or opaque structureless areas
* Shiny white to red, translucent or opaque structureless areas
* Multiple small [[erosions]].
* Multiple small [[Erosion|erosions]].
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Large, hyperchromatic, oval [[nuclei]]
* Large, hyperchromatic, oval [[nuclei]]
* Minimal [[cytoplasm]]
* Minimal [[cytoplasm]]
* Small basaloid [[nodules]].
* Small basaloid [[nodules]].
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Biopsy]]
* [[Biopsy]]
| align="center" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="center" |
* Higher [[incidence]] in men
* Higher [[incidence]] in men
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Squamous metaplasia of lactiferous ducts (SMOLD)/  [[Zuska's disease]]<ref name="pmid20610247">{{cite journal |vauthors=Gollapalli V, Liao J, Dudakovic A, Sugg SL, Scott-Conner CE, Weigel RJ |title=Risk factors for development and recurrence of primary breast abscesses |journal=J. Am. Coll. Surg. |volume=211 |issue=1 |pages=41–8 |date=July 2010 |pmid=20610247 |doi=10.1016/j.jamcollsurg.2010.04.007 |url=}}</ref><ref name="pmid7570336">{{cite journal |vauthors=Meguid MM, Oler A, Numann PJ, Khan S |title=Pathogenesis-based treatment of recurring subareolar breast abscesses |journal=Surgery |volume=118 |issue=4 |pages=775–82 |date=October 1995 |pmid=7570336 |doi= |url=}}</ref>
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Squamous metaplasia of lactiferous ducts (SMOLD)/  [[Zuska's disease]]<ref name="pmid20610247">{{cite journal |vauthors=Gollapalli V, Liao J, Dudakovic A, Sugg SL, Scott-Conner CE, Weigel RJ |title=Risk factors for development and recurrence of primary breast abscesses |journal=J. Am. Coll. Surg. |volume=211 |issue=1 |pages=41–8 |date=July 2010 |pmid=20610247 |doi=10.1016/j.jamcollsurg.2010.04.007 |url=}}</ref><ref name="pmid7570336">{{cite journal |vauthors=Meguid MM, Oler A, Numann PJ, Khan S |title=Pathogenesis-based treatment of recurring subareolar breast abscesses |journal=Surgery |volume=118 |issue=4 |pages=775–82 |date=October 1995 |pmid=7570336 |doi= |url=}}</ref>
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Benign]]
* [[Benign]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Keratin]] plug blocking [[lactiferous duct]] leads to [[duct]] rupture and spillage of [[keratin]] debris in [[stroma]]  
* [[Keratin]] plug blocking [[lactiferous duct]] leads to [[duct]] rupture and spillage of [[keratin]] debris in [[stroma]]  
* Leading to [[chronic inflammation]] with [[giant cells]] surrounding ducts and  [[squamous metaplasia]]
* Leading to [[chronic inflammation]] with [[giant cells]] surrounding ducts and  [[squamous metaplasia]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Painful [[erythematous]] [[Subareolar abscess|subareolar mass]]  
* Painful [[erythematous]] [[Subareolar abscess|subareolar mass]]  
* Single [[Fistula|fistula tract]] at the [[Areolar tissue|areolar]] edge.
* Single [[Fistula|fistula tract]] at the [[Areolar tissue|areolar]] edge.
* Inverted [[nipple]] may be seen.
* Inverted [[nipple]] may be seen.
| align="center" style="background:#F5F5F5;" |–
| style="background:#F5F5F5;" align="center" |–
| align="center" style="background:#F5F5F5;" | +
| style="background:#F5F5F5;" align="center" | +
| align="center" style="background:#F5F5F5;" | +
| style="background:#F5F5F5;" align="center" | +
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Tenderness (medicine)|Tender]] [[Erythema|erythematous]], [[Subareolar abscess|subareolar]] [[mass]].
* [[Tenderness (medicine)|Tender]] [[Erythema|erythematous]], [[Subareolar abscess|subareolar]] [[mass]].
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Appears as an ill-defined firm area.
* Appears as an ill-defined firm area.
* No associated [[lymphadenopathy]].
* No associated [[lymphadenopathy]].
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Squamous epithelium]] extending beyond the normal transition point within the [[Duct carcinoma|duct]] orifice into ductal [[epithelium]].
* [[Squamous epithelium]] extending beyond the normal transition point within the [[Duct carcinoma|duct]] orifice into ductal [[epithelium]].
* [[Keratin]] debris can extend into [[duct]] spaces.  
* [[Keratin]] debris can extend into [[duct]] spaces.  
* [[Squamous metaplasia]] of the deep [[ducts]] filled with [[keratin]] debris can be seen along with areas of rupture and spillage of [[keratin]] into the surrounding [[stroma]].
* [[Squamous metaplasia]] of the deep [[ducts]] filled with [[keratin]] debris can be seen along with areas of rupture and spillage of [[keratin]] into the surrounding [[stroma]].
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Biopsy]]
* [[Biopsy]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Strong association with [[smoking]].
* Strong association with [[smoking]].
* [[Tobacco]] exposure or decreased level of [[vitamin A]] secondary to [[smoking]] may cause [[squamous metaplasia]].
* [[Tobacco]] exposure or decreased level of [[vitamin A]] secondary to [[smoking]] may cause [[squamous metaplasia]].
Line 333: Line 350:
* Multiple [[surgical]] [[Intervention (counseling)|interventions]] may lead to [[Microbial|polymicrobial]], [[anaerobic]] [[bacterial]] [[superinfection]].
* Multiple [[surgical]] [[Intervention (counseling)|interventions]] may lead to [[Microbial|polymicrobial]], [[anaerobic]] [[bacterial]] [[superinfection]].
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Duct ectasia of breast|Lactiferous duct ectasia]] / Plasma cell mastitis / Comedomastitis
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Duct ectasia of breast|Lactiferous duct ectasia]] / Plasma cell mastitis / Comedomastitis<ref name="pmid6286199">{{cite journal| author=Schwartz GF| title=Benign neoplasms and "inflammations" of the breast. | journal=Clin Obstet Gynecol | year= 1982 | volume= 25 | issue= 2 | pages= 373-85 | pmid=6286199 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6286199  }} </ref>
| align="center" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="center" |
*[[Benign]]
*[[Benign]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Lactiferous duct|Lactiferous sinuses]] lose their supporting [[Elastic fiber|elastic fibers]] causing accumulation of [[Secretion|secretions]].
* [[Lactiferous duct|Lactiferous sinuses]] lose their supporting [[Elastic fiber|elastic fibers]] causing accumulation of [[Secretion|secretions]].
* Rupture of [[sinuses]]  can incite a [[Chronic inflammation|chronic inflammatory]] response leading to [[fibrosis]].
* Rupture of [[sinuses]]  can incite a [[Chronic inflammation|chronic inflammatory]] response leading to [[fibrosis]].


| align="left" style="background:#F5F5F5;" |[[Nipple]] retraction  
| style="background:#F5F5F5;" align="left" |[[Nipple]] retraction  
| align="center" style="background:#F5F5F5;" | +
| style="background:#F5F5F5;" align="center" | +
| align="center" style="background:#F5F5F5;" |–
| style="background:#F5F5F5;" align="center" |–
| align="center" style="background:#F5F5F5;" |–
| style="background:#F5F5F5;" align="center" |–
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Palpable irregular [[mass]] that can closely resemble [[Breast carcinoma|invasive carcinoma]]
* Palpable irregular [[mass]] that can closely resemble [[Breast carcinoma|invasive carcinoma]]
| align="left" style="background:#F5F5F5;" |Thick [[nipple]] discharge.
| style="background:#F5F5F5;" align="left" |Thick [[nipple]] discharge.
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Multiple large ectatic [[Duct (anatomy)|ducts]] surrounded by a [[chronic inflammatory]] [[cells]]
* Multiple large ectatic [[Duct (anatomy)|ducts]] surrounded by a [[chronic inflammatory]] [[cells]]
* [[Giant cells]], [[Foam cells|foamy histiocytes]], [[lymphocytes]], [[plasma cells]], and pigment-laden [[macrophages]] may be seen in the surrounding [[stroma]] .
* [[Giant cells]], [[Foam cells|foamy histiocytes]], [[lymphocytes]], [[plasma cells]], and pigment-laden [[macrophages]] may be seen in the surrounding [[stroma]] .
| align="left" style="background:#F5F5F5;" |[[Ultrasound]]:
| style="background:#F5F5F5;" align="left" |[[Ultrasound]]:
* Dilated [[Lactiferous duct|lactiferous ducts]]
* Dilated [[Lactiferous duct|lactiferous ducts]]
* Fluid-filled ducts
* Fluid-filled ducts
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Most common in older women.
* Most common in older [[women]].
* [[Squamous metaplasia]] is not genrally seenof [[Duct ectasia of breast|duct ectasia]].
* [[Squamous metaplasia]] is not genrally seen of [[Duct ectasia of breast|duct ectasia]].
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Nipple Adenoma / Papillary adenoma of the nipple
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Nipple Adenoma / Papillary adenoma of the nipple<ref name="SpohnTrotter2016">{{cite journal|last1=Spohn|first1=Gina P.|last2=Trotter|first2=Shannon C.|last3=Tozbikian|first3=Gary|last4=Povoski|first4=Stephen P.|title=Nipple adenoma in a female patient presenting with persistent erythema of the right nipple skin: case report, review of the literature, clinical implications, and relevancy to health care providers who evaluate and treat patients with dermatologic conditions of the breast skin|journal=BMC Dermatology|volume=16|issue=1|year=2016|issn=1471-5945|doi=10.1186/s12895-016-0041-6}}</ref>
| align="center" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="center" |
*[[Benign]]
*[[Benign]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Circumcised [[Adenoma|adenomas]] arising in the large [[Lactiferous duct|lactiferous ducts]] of the [[nipple]].
* Circumcised [[Adenoma|adenomas]] arising in the large [[Lactiferous duct|lactiferous ducts]] of the [[nipple]].
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Erosion|Erosive]] or [[Ulcer|ulcerative]] [[lesion]].
* [[Erosion|Erosive]] or [[Ulcer|ulcerative]] [[lesion]].


* [[Erythema]] and crusting of the [[nipple]].
* [[Erythema]] and crusting of the [[nipple]].
| align="center" style="background:#F5F5F5;"
| style="background:#F5F5F5;" align="center"
| align="center" style="background:#F5F5F5;" | +
| style="background:#F5F5F5;" align="center" | +
| align="center" style="background:#F5F5F5;" |–
| style="background:#F5F5F5;" align="center" |–
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Multiple small palpable masses below
* Multiple small palpable [[Mass|masses]] below
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Usually unilateral [[nipple]] is effected
* Usually unilateral [[nipple]] is effected
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Fibrosis]] with distortion of the [[ducts]] that resembles  pseudo [[Invasive (medical)|invasion]].
* [[Fibrosis]] with distortion of the [[ducts]] that resembles  pseudo [[Invasive (medical)|invasion]].
* [[Epithelial hyperplasia]] with a partial or total obliteration of the [[lumen]] or with [[Intraductal papillary mucinous neoplasm|intraductal papillary]] projections
* [[Epithelial hyperplasia]] with a partial or total obliteration of the [[lumen]] or with [[Intraductal papillary mucinous neoplasm|intraductal papillary]] projections
* Presence of [[intraducta]]<nowiki/>l [[necrosis]] and cellular [[monomorphism]] and/or [[polymorphism]].
* Presence of [[intraducta]]<nowiki/>l [[necrosis]] and cellular [[monomorphism]] and/or [[polymorphism]].
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Biopsy]] with [[Immunophenotyping|Immunophenotyping.]]
* [[Biopsy]] with [[Immunophenotyping|Immunophenotyping.]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Mostly occur in the fifth decade of life.
* Mostly occur in the fifth decade of life.
* [[Immunophenotyping|Immunophenotypic]] analysis is essential for differentiating by documenting the presence of [[myoepithelial cells]] in [[adenomas]] (eg, [[p63]], [[Actin|smooth muscle actin]], or smooth muscle [[Heavy chains|myosin heavy chain]]).
* [[Immunophenotyping|Immunophenotypic]] analysis is essential for differentiating by documenting the presence of [[myoepithelial cells]] in [[adenomas]] (eg, [[p63]], [[Actin|smooth muscle actin]], or smooth muscle [[Heavy chains|myosin heavy chain]]).
Line 386: Line 403:
|-
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! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Nevoid hyperkeratosis|Nevoid hyperkeratosis of the nipple and areola]]  (NHNA) <ref name="pmid28004028">{{cite journal |vauthors=Mazzella C, Costa C, Fabbrocini G, Marangi GF, Russo D, Merolla F, Scalvenzi M |title=Nevoid hyperkeratosis of the nipple mimicking a pigmented basal cell carcinoma |journal=JAAD Case Rep |volume=2 |issue=6 |pages=500–501 |date=November 2016 |pmid=28004028 |pmc=5161776 |doi=10.1016/j.jdcr.2016.09.007 |url=}}</ref><ref name="pmid24082214">{{cite journal |vauthors=Ghanadan A, Balighi K, Khezri S, Kamyabhesari K |title=Nevoid Hyperkeratosis of the Nipple and/or Areola: Treatment with Topical Steroid |journal=Indian J Dermatol |volume=58 |issue=5 |pages=408 |date=September 2013 |pmid=24082214 |pmc=3778809 |doi=10.4103/0019-5154.117347 |url=}}</ref>
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Nevoid hyperkeratosis|Nevoid hyperkeratosis of the nipple and areola]]  (NHNA) <ref name="pmid28004028">{{cite journal |vauthors=Mazzella C, Costa C, Fabbrocini G, Marangi GF, Russo D, Merolla F, Scalvenzi M |title=Nevoid hyperkeratosis of the nipple mimicking a pigmented basal cell carcinoma |journal=JAAD Case Rep |volume=2 |issue=6 |pages=500–501 |date=November 2016 |pmid=28004028 |pmc=5161776 |doi=10.1016/j.jdcr.2016.09.007 |url=}}</ref><ref name="pmid24082214">{{cite journal |vauthors=Ghanadan A, Balighi K, Khezri S, Kamyabhesari K |title=Nevoid Hyperkeratosis of the Nipple and/or Areola: Treatment with Topical Steroid |journal=Indian J Dermatol |volume=58 |issue=5 |pages=408 |date=September 2013 |pmid=24082214 |pmc=3778809 |doi=10.4103/0019-5154.117347 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="center" |
*[[Benign]]
*[[Benign]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Common among [[premenopausal]] women
* Common among [[premenopausal]] [[women]]


| align="left" style="background:#F5F5F5;" |Slow growing bluish-brown  verrucous thickening of the nipple or areola.
| style="background:#F5F5F5;" align="left" |Slow growing bluish-brown  verrucous thickening of the [[nipple]] or [[areola]].
| align="center" style="background:#F5F5F5;" |–
| style="background:#F5F5F5;" align="center" |–
| align="center" style="background:#F5F5F5;" |–
| style="background:#F5F5F5;" align="center" |–
| align="center" style="background:#F5F5F5;" |–
| style="background:#F5F5F5;" align="center" |–
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* The skin of the [[nipple]] and [[areola]] is thickened and [[hyperpigmented]] developing an isolated [[Nevus|nevoid]] defect .
* The skin of the [[nipple]] and [[areola]] is thickened and [[hyperpigmented]] developing an isolated [[Nevus|nevoid]] defect .
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Usually bilateral nipple is effected
* Usually bilateral nipple is effected
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Acanthosis]], [[hyperkeratosis]], and [[papillomatosis]] of [[Epidermis|the epidermis]]
* [[Acanthosis]], [[hyperkeratosis]], and [[papillomatosis]] of [[Epidermis|the epidermis]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Biopsy]]
* [[Biopsy]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* NHNA might be hormonal [[hyperkeratosis]] as it is shown to worsen in [[pregnancy]].
* NHNA might be hormonal [[hyperkeratosis]] as it is shown to worsen in [[pregnancy]].
* Might seperately effect the [[nipple]] or only the [[areola]]
* Might seperately effect the [[nipple]] or only the [[areola]]
* Associated with [[Darier’s disease]], chronic [[acanthosis nigricans]], [[Cutaneous T cell lymphoma|cutaneous Tcell lymphoma]], [[Mycosis fungoides cost-effectiveness of therapy|mycosis fungoides]], and [[follicular mucinosis]].
* Associated with [[Darier’s disease]], chronic [[acanthosis nigricans]], [[Cutaneous T cell lymphoma|cutaneous Tcell lymphoma]], [[Mycosis fungoides cost-effectiveness of therapy|mycosis fungoides]], and [[follicular mucinosis]].
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Benign Toker cell  hyperplasia
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Benign Toker cell  hyperplasia<ref name="Di TommasoFranchi2008">{{cite journal|last1=Di Tommaso|first1=Luca|last2=Franchi|first2=Giada|last3=Destro|first3=Annarita|last4=Broglia|first4=Fabiana|last5=Minuti|first5=Francesco|last6=Rahal|first6=Daoud|last7=Roncalli|first7=Massimo|title=Toker cells of the breast. Morphological and immunohistochemical characterization of 40 cases|journal=Human Pathology|volume=39|issue=9|year=2008|pages=1295–1300|issn=00468177|doi=10.1016/j.humpath.2008.01.018}}</ref><ref name="pmid8599455">{{cite journal| author=van der Putte SC, Toonstra J, Hennipman A| title=Mammary Paget's disease confined to the areola and associated with multifocal Toker cell hyperplasia. | journal=Am J Dermatopathol | year= 1995 | volume= 17 | issue= 5 | pages= 487-93 | pmid=8599455 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8599455  }} </ref><ref name="ParkSuh2009">{{cite journal|last1=Park|first1=Sanghui|last2=Suh|first2=Yeon-Lim|title=Useful immunohistochemical markers for distinguishing Paget cells from Toker cells|journal=Pathology|volume=41|issue=7|year=2009|pages=640–644|issn=00313025|doi=10.3109/00313020903273092}}</ref>
| align="center" style="background:#F5F5F5;" |
 
| style="background:#F5F5F5;" align="center" |
*[[Benign]]
*[[Benign]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Normal components of the [[nipple]] skin
* Normal components of the [[nipple]] skin
* Appears similar to paget cells.
* Appears similar to paget cells.
| align="center" style="background:#F5F5F5;" |Normal nipple- areolar complex
| style="background:#F5F5F5;" align="center" |Normal nipple- areolar complex
| align="center" style="background:#F5F5F5;" |–
| style="background:#F5F5F5;" align="center" |–
| align="center" style="background:#F5F5F5;" |–
| style="background:#F5F5F5;" align="center" |–
| align="center" style="background:#F5F5F5;" |–
| style="background:#F5F5F5;" align="center" |–
| align="center" style="background:#F5F5F5;" |Normal breast examination.
| style="background:#F5F5F5;" align="center" |Normal breast examination.
| align="center" style="background:#F5F5F5;" |N/A
| style="background:#F5F5F5;" align="center" |N/A
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Toker cells have bland nuclei and abundant eosinophilic or clear cytoplasm. Occasional clusters or glands may be present.
* [[Toker cells]] have bland [[nuclei]] and abundant [[eosinophilic]] or clear [[cytoplasm]].
* Do not generally have cellular atypia and have minimal nuclear pleomorphism.
* Occasional clusters or [[glands]] may be present.
| align="left" style="background:#F5F5F5;" |
* Do not generally have [[cellular]] [[atypia]] and have minimal [[nuclear]] [[pleomorphism]].
| style="background:#F5F5F5;" align="left" |
* [[Biopsy]] with [[Immunophenotyping|Immunophenotyping.]]
* [[Biopsy]] with [[Immunophenotyping|Immunophenotyping.]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Toker cells are immunoreactive for cytokeratin 7 and CAM5.2 but are not positive for HER2- neu.
* Toker cells are immunoreactive for cytokeratin 7 and CAM5.2 but are not positive for HER2- neu.
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Breast abscess]]
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Breast abscess]]<ref name="pmid26095437">{{cite journal| author=D'Alfonso TM, Ginter PS, Shin SJ| title=A Review of Inflammatory Processes of the Breast with a Focus on Diagnosis in Core Biopsy Samples. | journal=J Pathol Transl Med | year= 2015 | volume= 49 | issue= 4 | pages= 279-87 | pmid=26095437 | doi=10.4132/jptm.2015.06.11 | pmc=4508565 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26095437  }}</ref><ref name="pmid17639835">{{cite journal| author=Dixon JM| title=Breast abscess. | journal=Br J Hosp Med (Lond) | year= 2007 | volume= 68 | issue= 6 | pages= 315-20 | pmid=17639835 | doi=10.12968/hmed.2007.68.6.23574 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17639835  }}</ref>
| align="center" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="center" |
*[[Benign]]
*[[Benign]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Complication of lactational [[mastitis]] in 14% of cases
* Complication of lactational [[mastitis]] in 14% of cases
* Common among African-American women, heavy smokers and [[obese]] patients.
* Common among African-American women, heavy smokers and [[obese]] patients.
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Inflammation]] of [[nipple]] [[Areolar tissue|areolar]] complex
* [[Inflammation]] of [[nipple]] [[Areolar tissue|areolar]] complex
* Dimpling of [[nipple]] or inversion.
* Dimpling of [[nipple]] or inversion.
| align="center" style="background:#F5F5F5;"
| style="background:#F5F5F5;" align="center"
| align="center" style="background:#F5F5F5;" | +
| style="background:#F5F5F5;" align="center" | +
| align="center" style="background:#F5F5F5;" | +
| style="background:#F5F5F5;" align="center" | +
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Localized breast [[edema]] leading to [[breast]] [[tenderness]]
* Localized breast [[edema]] leading to [[breast]] [[tenderness]]
* Swollen warm [[breast]] [[tissue]].
* Swollen warm [[breast]] [[tissue]].
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Associated symptoms of fever, nausea, vomiting.
* Associated symptoms of fever, nausea, vomiting.
* Resolve after drainage/[[antibiotic therapy]].
* Resolve after drainage/[[antibiotic therapy]].
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Mixed [[inflammatory]]<nowiki/>feature by [[neutrophils]].
* Mixed [[inflammatory]]<nowiki/>feature by [[neutrophils]].
* [[Granulation tissue]]<nowiki/>and [[chronic]][[inflammation]] feature caused by [[Gram-positive cocci]].
* [[Granulation tissue]]<nowiki/>and [[chronic]][[inflammation]] feature caused by [[Gram-positive cocci]].
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
[[Ultrasound]]:
[[Ultrasound]]:
* Fluid collection
* Fluid collection
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Smoking]] history
* [[Smoking]] history
* If not lactating, patient may be [[Diabetes mellitus|diabetic]].  
* If not lactating, patient may be [[Diabetes mellitus|diabetic]].  
* History of privious breast infection
* History of previous [[breast]] [[infection]]
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mondor's disease|Mondors disease]]<ref name="pmid20890261">{{cite journal |vauthors=Hokama A, Fujita J |title=Mondor disease: an unusual cause of chest pain |journal=South. Med. J. |volume=103 |issue=11 |pages=1189 |date=November 2010 |pmid=20890261 |doi=10.1097/SMJ.0b013e3181ecfcf3 |url=}}</ref><ref name="pmid11566698">{{cite journal |vauthors=Shetty MK, Watson AB |title=Mondor's disease of the breast: sonographic and mammographic findings |journal=AJR Am J Roentgenol |volume=177 |issue=4 |pages=893–6 |date=October 2001 |pmid=11566698 |doi=10.2214/ajr.177.4.1770893 |url=}}</ref>
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mondor's disease|Mondors disease]]<ref name="pmid20890261">{{cite journal |vauthors=Hokama A, Fujita J |title=Mondor disease: an unusual cause of chest pain |journal=South. Med. J. |volume=103 |issue=11 |pages=1189 |date=November 2010 |pmid=20890261 |doi=10.1097/SMJ.0b013e3181ecfcf3 |url=}}</ref><ref name="pmid11566698">{{cite journal |vauthors=Shetty MK, Watson AB |title=Mondor's disease of the breast: sonographic and mammographic findings |journal=AJR Am J Roentgenol |volume=177 |issue=4 |pages=893–6 |date=October 2001 |pmid=11566698 |doi=10.2214/ajr.177.4.1770893 |url=}}</ref><ref name="pmid11436415">{{cite journal| author=Becker L, McCurdy LI, Taves DH| title=Superficial thrombophlebitis of the breast (Mondor's disease). | journal=Can Assoc Radiol J | year= 2001 | volume= 52 | issue= 3 | pages= 193-5 | pmid=11436415 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11436415  }}</ref><ref name="pmid1562972">{{cite journal| author=Catania S, Zurrida S, Veronesi P, Galimberti V, Bono A, Pluchinotta A| title=Mondor's disease and breast cancer. | journal=Cancer | year= 1992 | volume= 69 | issue= 9 | pages= 2267-70 | pmid=1562972 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1562972  }}</ref>
| align="center" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="center" |
*[[Benign]]
*[[Benign]]
| align="left" style="background:#F5F5F5;" |Superficial [[phlebitis]] and [[periphlebitis]] of the superficial vein.
| style="background:#F5F5F5;" align="left" |Superficial [[phlebitis]] and [[periphlebitis]] of the superficial vein.
| align="left" style="background:#F5F5F5;" |Red linear cord running from the lateral margin of the [[breast]] attached to the overlying skin.
| style="background:#F5F5F5;" align="left" |Red linear cord running from the lateral margin of the [[breast]] attached to the overlying [[skin]].
| align="center" style="background:#F5F5F5;" |–
| style="background:#F5F5F5;" align="center" |–
| align="center" style="background:#F5F5F5;" | +
| style="background:#F5F5F5;" align="center" | +
| align="center" style="background:#F5F5F5;" | +
| style="background:#F5F5F5;" align="center" | +
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Red tender cord which may last up to 4-8 weeks before spontaneously [[remitting]] leaving a puckered groove along the [[breast]].
* Red tender cord which may last up to 4-8 weeks before spontaneously [[remitting]] leaving a puckered groove along the [[breast]].
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Usually unilateral [[nipple]] is effected
* Usually unilateral [[nipple]] is effected
* No associated [[lymphadenopathy]].
* No associated [[lymphadenopathy]].
| align="center" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="center" |
* N/A–
* N/A–
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Mammography]]: shows [[tubular]] density.
* [[Mammography]]: shows [[tubular]] density.
* [[Ultrasound]]: [[Tubular]] anechoic structure and multiple narrowing areas.
* [[Ultrasound]]: [[Tubular]] anechoic structure and multiple narrowing areas.
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Predominantly seen in middle-aged women but is also seen in men.
* Predominantly seen in middle-aged women but is also seen in men.
* May indicate breast cancer.  
* May indicate [[breast cancer]].  
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mastitis]]<ref name="pmid18394188">{{cite journal |vauthors=Kvist LJ, Larsson BW, Hall-Lord ML, Steen A, Schalén C |title=The role of bacteria in lactational mastitis and some considerations of the use of antibiotic treatment |journal=Int Breastfeed J |volume=3 |issue= |pages=6 |date=April 2008 |pmid=18394188 |pmc=2322959 |doi=10.1186/1746-4358-3-6 |url=}}</ref><ref name="pmid11790672">{{cite journal |vauthors=Foxman B, D'Arcy H, Gillespie B, Bobo JK, Schwartz K |title=Lactation mastitis: occurrence and medical management among 946 breastfeeding women in the United States |journal=Am. J. Epidemiol. |volume=155 |issue=2 |pages=103–14 |date=January 2002 |pmid=11790672 |doi= |url=}}</ref>
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mastitis]]<ref name="pmid18394188">{{cite journal |vauthors=Kvist LJ, Larsson BW, Hall-Lord ML, Steen A, Schalén C |title=The role of bacteria in lactational mastitis and some considerations of the use of antibiotic treatment |journal=Int Breastfeed J |volume=3 |issue= |pages=6 |date=April 2008 |pmid=18394188 |pmc=2322959 |doi=10.1186/1746-4358-3-6 |url=}}</ref><ref name="pmid11790672">{{cite journal |vauthors=Foxman B, D'Arcy H, Gillespie B, Bobo JK, Schwartz K |title=Lactation mastitis: occurrence and medical management among 946 breastfeeding women in the United States |journal=Am. J. Epidemiol. |volume=155 |issue=2 |pages=103–14 |date=January 2002 |pmid=11790672 |doi= |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="center" |
* [[Benign]]
* [[Benign]]
* No increased risk of [[malignancy]]
* No increased risk of [[malignancy]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Common among [[lactating]] women (first three months of [[breast-feeding]])
* Common among [[lactating]] women (first three months of [[breast-feeding]])
* Periductal [[mastitis]] among [[smokers]] associated with [[squamous]] [[metaplasia]].
* Periductal [[mastitis]] among [[smokers]] associated with [[squamous]] [[metaplasia]].
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Localized [[erythema]], warmth, swelling, and pain.
* Localized [[erythema]], warmth, swelling, and pain.
| align="center" style="background:#F5F5F5;"
| style="background:#F5F5F5;" align="center"
| align="center" style="background:#F5F5F5;" | +
| style="background:#F5F5F5;" align="center" | +
| align="center" style="background:#F5F5F5;" |±
| style="background:#F5F5F5;" align="center" |±
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Swollen warm [[breast]]  [[tissue]].
* Swollen warm [[breast]]  [[tissue]].
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Associated symptoms of  fever, chills, or rigor may be present.
* Associated symptoms of  fever, chills, or rigor may be present.
* Resolve after drainage/[[antibiotic therapy]]
* Resolve after drainage/[[antibiotic therapy]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
[[Breast]] [[parenchyma]][[inflammation]]:
[[Breast]] [[parenchyma]][[inflammation]]:
* [[Acute]] [[mastitis]]: [[Staphylococcus]] [[infection]]
* [[Acute]] [[mastitis]]: [[Staphylococcus]] [[infection]]
* [[Granulomatous]] [[mastitis]]: [[Tuberculosis]] or [[sarcoidosis]][[infection]]
* [[Granulomatous]] [[mastitis]]: [[Tuberculosis]] or [[sarcoidosis]][[infection]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
[[Ultrasound]]:
[[Ultrasound]]:
* Ill-defined area with hyperechogenicity with inflamed fat lobules
* Ill-defined area with hyperechogenicity with inflamed fat lobules
* [[Skin]] thickening.
* [[Skin]] thickening.
| align="left" style="background:#F5F5F5;" |History of [[lactation]] including difficulty in [[breastfeeding]], [[breast engorgement]], or [[erosion]] of  [[nipples]].
| style="background:#F5F5F5;" align="left" |History of [[lactation]] including difficulty in [[breastfeeding]], [[breast engorgement]], or [[erosion]] of  [[nipples]].
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Inflammatory Breast Cancer]]<ref name="pmid25034439">{{cite journal |vauthors=Matro JM, Li T, Cristofanilli M, Hughes ME, Ottesen RA, Weeks JC, Wong YN |title=Inflammatory breast cancer management in the national comprehensive cancer network: the disease, recurrence pattern, and outcome |journal=Clin. Breast Cancer |volume=15 |issue=1 |pages=1–7 |date=February 2015 |pmid=25034439 |pmc=4422394 |doi=10.1016/j.clbc.2014.05.005 |url=}}</ref><ref name="pmid20603440">{{cite journal |vauthors=Dawood S, Merajver SD, Viens P, Vermeulen PB, Swain SM, Buchholz TA, Dirix LY, Levine PH, Lucci A, Krishnamurthy S, Robertson FM, Woodward WA, Yang WT, Ueno NT, Cristofanilli M |title=International expert panel on inflammatory breast cancer: consensus statement for standardized diagnosis and treatment |journal=Ann. Oncol. |volume=22 |issue=3 |pages=515–23 |date=March 2011 |pmid=20603440 |pmc=3105293 |doi=10.1093/annonc/mdq345 |url=}}</ref>
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Inflammatory Breast Cancer]]<ref name="pmid25034439">{{cite journal |vauthors=Matro JM, Li T, Cristofanilli M, Hughes ME, Ottesen RA, Weeks JC, Wong YN |title=Inflammatory breast cancer management in the national comprehensive cancer network: the disease, recurrence pattern, and outcome |journal=Clin. Breast Cancer |volume=15 |issue=1 |pages=1–7 |date=February 2015 |pmid=25034439 |pmc=4422394 |doi=10.1016/j.clbc.2014.05.005 |url=}}</ref><ref name="pmid20603440">{{cite journal |vauthors=Dawood S, Merajver SD, Viens P, Vermeulen PB, Swain SM, Buchholz TA, Dirix LY, Levine PH, Lucci A, Krishnamurthy S, Robertson FM, Woodward WA, Yang WT, Ueno NT, Cristofanilli M |title=International expert panel on inflammatory breast cancer: consensus statement for standardized diagnosis and treatment |journal=Ann. Oncol. |volume=22 |issue=3 |pages=515–23 |date=March 2011 |pmid=20603440 |pmc=3105293 |doi=10.1093/annonc/mdq345 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="center" |
* [[Malignant]]
* [[Malignant]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Cancer]] [[cells]] block the [[Lymphatic|lymphatic vessels]] in [[skin]] covering the [[breast]].
* [[Cancer]] [[cells]] block the [[Lymphatic|lymphatic vessels]] in [[skin]] covering the [[breast]].
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Localized [[erythema]], warmth, swelling, and pain.
* Localized [[erythema]], warmth, swelling, and pain.
| align="center" style="background:#F5F5F5;" |–
| style="background:#F5F5F5;" align="center" |–
| align="center" style="background:#F5F5F5;" | +
| style="background:#F5F5F5;" align="center" | +
| align="center" style="background:#F5F5F5;" | +
| style="background:#F5F5F5;" align="center" | +
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Usually unilateral
* Usually unilateral


* Swollen warm tender [[erythematous]]  [[breast]] [[tissue]].
* Swollen warm tender [[erythematous]]  [[breast]] [[tissue]].
* Peau d’orange: Dimpling on the [[skin]] of the affected [[breast]].
* Peau d’orange: Dimpling on the [[skin]] of the affected [[breast]].
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Generally associated with [[Lymphadenopathy|lymphadenopathy.]]
* Generally associated with [[Lymphadenopathy|lymphadenopathy.]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* [[Dermal]] [[lymphatic]] invasion by [[Tumor cell|tumor cells]].
* [[Dermal]] [[lymphatic]] invasion by [[Tumor cell|tumor cells]].
| align="center" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="center" |
* Core needle [[Biopsy]]
* Core needle [[Biopsy]]
| align="left" style="background:#F5F5F5;" |
| style="background:#F5F5F5;" align="left" |
* Rare [[Disease|disease,]] accounts for 0.5–2 % of invasive [[breast cancers]] .
* Rare [[Disease|disease,]] accounts for 0.5–2 % of invasive [[breast cancers]] .
* Considered locally [[Cancer|advanced cancer]].
* Considered locally [[Cancer|advanced cancer]].

Latest revision as of 15:30, 27 March 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Preeti Singh, M.B.B.S.[2]

Overview

Due to close similarity with many skin lesions, the diagnosis of Mammary Paget’s diseas may be delayed or many cases can be misdiagnosed. Immunohistochemical staining for cytokeratin, epithelial membrane antigen (EMA) and c-erb-B2 oncoprotein is useful for the differential diagnosis. Toker cells found in the epidermis of the nipple, close to the opening of lactiferous ducts, along the basal layer of the epidermis, are morphological and immunohistochemical similar to mammary Paget's cells. In contrast to Paget's cells which are strongly associated with both Ki-67 and Her-2/c-erbB-2 and these markers are mostly used to distinguish Paget's cells from Toker cells. In case of atypical Toker cells a combination of CD138 and p53 is very helpful in distinguishing these atypical cells from Paget's cells. Paget's disease of the breast must be differentiated from atopic dermatitis, eczema, psoriasis, malignant melanoma, Bowen's disease, basal cell carcinoma, benign intraductal papilloma, nevoid hyperkeratosis of the nipple and areola (NHNA), squamous metaplasia of lactiferous ducts (SMOLD)/ Zuska's disease and pagetoid dyskeratosis.

Differential Diagnosis


Paget's disease of the breast is often confused with

Diseases Benign or Malignant Etiology Clinical manifestations Histopathology Gold Standard Associated factors
Symptoms Physical examination
Rash Nipple Discharge Erythema Mastalgia Breast Exam Other
Paget's disease of the breast[7][8] Most the patients have underlying breast cancer. + + ±
  • Usually unilateral nipple is effected
Atopic dermatitis

(Eczema)[9][10]

N/A
  • Clinical examination
Erosive adenomatosis of the nipple[11][12] + + Biopsy: Shows absence of cytological atypia
Allergic contact dermatitis[13] + N/A
Psoriasis[14][15]
  • Well-circumscribed, pink papules and symmetrically distributed cutaneous plaques with silvery scales.
+ + N/A Auspitz's sign (pinpoint bleeding) Risk factors include
Malignant melanoma[4]
  • A lesion with ABCD
    • Asymmetry
    • Border irregularity
    • Color variation
    • Diameter changes
  • Bleeding from the lesion.
± N/A
  • Pigmented lesion with:
  • Asymmetry
  • Irregular borders
  • Variegated color
  • Diameter >6 mm
  • Nests of atypical melanocytes with asymmetry, poor circumscription of varying sizes and shapes
  • Present in the lower epidermis and dermis
  • Complete full-thickness excisional biopsy of suspicious lesions with 1 to 3 mm margin of normal skin.
  • S-100 is used to differentiate Paget's disease from melanoma. But, since 18-25% of Paget's are S-100 positive, at least two melanoma markers, such as HMB-45, S-100, or Melan-A should be used.
Bowen’s disease[4] + N/A
  • Presence of dotted and/or glomerular vessels
  • White to yellowish surface scales
  • Red-yellowish background
  • Clinical examination
  • Slow growth over the years
Superficial basal cell carcinoma[16][17] + N/A
  • Superficial fine telangiectasia
  • Shiny white to red, translucent or opaque structureless areas
  • Multiple small erosions.
Squamous metaplasia of lactiferous ducts (SMOLD)/ Zuska's disease[18][19] + +
Lactiferous duct ectasia / Plasma cell mastitis / Comedomastitis[20] Nipple retraction + Thick nipple discharge. Ultrasound:
Nipple Adenoma / Papillary adenoma of the nipple[21] ± +
  • Multiple small palpable masses below
  • Usually unilateral nipple is effected
Nevoid hyperkeratosis of the nipple and areola (NHNA) [22][23] Slow growing bluish-brown verrucous thickening of the nipple or areola.
  • Usually bilateral nipple is effected
Benign Toker cell hyperplasia[6][1][24]
  • Normal components of the nipple skin
  • Appears similar to paget cells.
Normal nipple- areolar complex Normal breast examination. N/A
  • Toker cells are immunoreactive for cytokeratin 7 and CAM5.2 but are not positive for HER2- neu.
Breast abscess[25][26]
  • Complication of lactational mastitis in 14% of cases
  • Common among African-American women, heavy smokers and obese patients.
± + +
  • Associated symptoms of fever, nausea, vomiting.
  • Resolve after drainage/antibiotic therapy.

Ultrasound:

  • Fluid collection
Mondors disease[27][28][29][30] Superficial phlebitis and periphlebitis of the superficial vein. Red linear cord running from the lateral margin of the breast attached to the overlying skin. + +
  • Red tender cord which may last up to 4-8 weeks before spontaneously remitting leaving a puckered groove along the breast.
  • N/A–
  • Predominantly seen in middle-aged women but is also seen in men.
  • May indicate breast cancer.
Mastitis[31][32]
  • Localized erythema, warmth, swelling, and pain.
± + ±
  • Associated symptoms of fever, chills, or rigor may be present.
  • Resolve after drainage/antibiotic therapy

Breast parenchymainflammation:

Ultrasound:

  • Ill-defined area with hyperechogenicity with inflamed fat lobules
  • Skin thickening.
History of lactation including difficulty in breastfeeding, breast engorgement, or erosion of nipples.
Inflammatory Breast Cancer[33][34]
  • Localized erythema, warmth, swelling, and pain.
+ +
  • Usually unilateral

References

  1. 1.0 1.1 van der Putte SC, Toonstra J, Hennipman A (1995). "Mammary Paget's disease confined to the areola and associated with multifocal Toker cell hyperplasia". Am J Dermatopathol. 17 (5): 487–93. PMID 8599455.
  2. Lundquist K, Kohler S, Rouse RV (1999). "Intraepidermal cytokeratin 7 expression is not restricted to Paget cells but is also seen in Toker cells and Merkel cells". Am J Surg Pathol. 23 (2): 212–9. PMID 9989849.
  3. Mitchell, Sonya; Lachica, Roberto; Randall, M. Barry; Beech, Derrick J. (2006). "Paget's Disease of the Breast Areola Mimicking Cutaneous Melanoma". The Breast Journal. 12 (3): 233–236. doi:10.1111/j.1075-122X.2006.00247.x. ISSN 1075-122X.
  4. 4.0 4.1 4.2 Reed W, Oppedal BR, Eeg Larsen T (1990). "Immunohistology is valuable in distinguishing between Paget's disease, Bowen's disease and superficial spreading malignant melanoma". Histopathology. 16 (6): 583–8. PMID 1695889.
  5. Toker C (1970). "Clear cells of the nipple epidermis". Cancer. 25 (3): 601–10. PMID 4313654.
  6. 6.0 6.1 Di Tommaso, Luca; Franchi, Giada; Destro, Annarita; Broglia, Fabiana; Minuti, Francesco; Rahal, Daoud; Roncalli, Massimo (2008). "Toker cells of the breast. Morphological and immunohistochemical characterization of 40 cases". Human Pathology. 39 (9): 1295–1300. doi:10.1016/j.humpath.2008.01.018. ISSN 0046-8177.
  7. Gaspari, Eleonora; Ricci, Aurora; Liberto, Valeria; Scarano, Angela Lia; Fornari, Maria; Simonetti, Giovanni (2013). "An Unusual Case of Mammary Paget's Disease Diagnosed Using Dynamic Contrast-Enhanced MRI". Case Reports in Radiology. 2013: 1–5. doi:10.1155/2013/206235. ISSN 2090-6862.
  8. Lopes Filho, Lauro Lourival; Lopes, Ione Maria Ribeiro Soares; Lopes, Lauro Rodolpho Soares; Enokihara, Milvia M. S. S.; Michalany, Alexandre Osores; Matsunaga, Nobuo (2015). "Mammary and extramammary Paget's disease". Anais Brasileiros de Dermatologia. 90 (2): 225–231. doi:10.1590/abd1806-4841.20153189. ISSN 1806-4841.
  9. Song HS, Jung SE, Kim YC, Lee ES (April 2015). "Nipple eczema, an indicative manifestation of atopic dermatitis? A clinical, histological, and immunohistochemical study". Am J Dermatopathol. 37 (4): 284–8. doi:10.1097/DAD.0000000000000195. PMID 25079201.
  10. Barankin B, Gross MS (2004). "Nipple and areolar eczema in the breastfeeding woman". J Cutan Med Surg. 8 (2): 126–30. doi:10.1177/120347540400800209. PMID 15129318.
  11. Kumar PK, Thomas J (July 2013). "Erosive adenomatosis of the nipple masquerading as Paget's disease". Indian Dermatol Online J. 4 (3): 239–40. doi:10.4103/2229-5178.115534. PMC 3752489. PMID 23984247.
  12. Lewis HM, Ovitz ML, Golitz LE (October 1976). "Erosive adenomatosis of the nipple". Arch Dermatol. 112 (10): 1427–8. PMID 962337.
  13. Nosbaum A, Vocanson M, Rozieres A, Hennino A, Nicolas JF (2009). "Allergic and irritant contact dermatitis". Eur J Dermatol. 19 (4): 325–32. doi:10.1684/ejd.2009.0686. PMID 19447733.
  14. Ljosaa TM, Rustoen T, Mörk C, Stubhaug A, Miaskowski C, Paul SM, Wahl AK (2010). "Skin pain and discomfort in psoriasis: an exploratory study of symptom prevalence and characteristics". Acta Derm. Venereol. 90 (1): 39–45. doi:10.2340/00015555-0764. PMID 20107724.
  15. Naldi L, Parazzini F, Brevi A, Peserico A, Veller Fornasa C, Grosso G, Rossi E, Marinaro P, Polenghi MM, Finzi A (September 1992). "Family history, smoking habits, alcohol consumption and risk of psoriasis". Br. J. Dermatol. 127 (3): 212–7. PMID 1390163.
  16. Yamamoto H, Ito Y, Hayashi T, Urano N, Kato T, Kimura Y, Tanigawa T, Endo W, Kurokawa E, Kikkawa N, Taniguchi H (2001). "A case of basal cell carcinoma of the nipple and areola with intraductal spread". Breast Cancer. 8 (3): 229–33. PMID 11668245.
  17. Ulanja MB, Taha ME, Al-Mashhadani AA, Al-Tekreeti MM, Elliot C, Ambika S (2018). "Basal Cell Carcinoma of the Female Breast Masquerading as Invasive Primary Breast Carcinoma: An Uncommon Presentation Site". Case Rep Oncol Med. 2018: 5302185. doi:10.1155/2018/5302185. PMC 6051126. PMID 30057838.
  18. Gollapalli V, Liao J, Dudakovic A, Sugg SL, Scott-Conner CE, Weigel RJ (July 2010). "Risk factors for development and recurrence of primary breast abscesses". J. Am. Coll. Surg. 211 (1): 41–8. doi:10.1016/j.jamcollsurg.2010.04.007. PMID 20610247.
  19. Meguid MM, Oler A, Numann PJ, Khan S (October 1995). "Pathogenesis-based treatment of recurring subareolar breast abscesses". Surgery. 118 (4): 775–82. PMID 7570336.
  20. Schwartz GF (1982). "Benign neoplasms and "inflammations" of the breast". Clin Obstet Gynecol. 25 (2): 373–85. PMID 6286199.
  21. Spohn, Gina P.; Trotter, Shannon C.; Tozbikian, Gary; Povoski, Stephen P. (2016). "Nipple adenoma in a female patient presenting with persistent erythema of the right nipple skin: case report, review of the literature, clinical implications, and relevancy to health care providers who evaluate and treat patients with dermatologic conditions of the breast skin". BMC Dermatology. 16 (1). doi:10.1186/s12895-016-0041-6. ISSN 1471-5945.
  22. Mazzella C, Costa C, Fabbrocini G, Marangi GF, Russo D, Merolla F, Scalvenzi M (November 2016). "Nevoid hyperkeratosis of the nipple mimicking a pigmented basal cell carcinoma". JAAD Case Rep. 2 (6): 500–501. doi:10.1016/j.jdcr.2016.09.007. PMC 5161776. PMID 28004028.
  23. Ghanadan A, Balighi K, Khezri S, Kamyabhesari K (September 2013). "Nevoid Hyperkeratosis of the Nipple and/or Areola: Treatment with Topical Steroid". Indian J Dermatol. 58 (5): 408. doi:10.4103/0019-5154.117347. PMC 3778809. PMID 24082214.
  24. Park, Sanghui; Suh, Yeon-Lim (2009). "Useful immunohistochemical markers for distinguishing Paget cells from Toker cells". Pathology. 41 (7): 640–644. doi:10.3109/00313020903273092. ISSN 0031-3025.
  25. D'Alfonso TM, Ginter PS, Shin SJ (2015). "A Review of Inflammatory Processes of the Breast with a Focus on Diagnosis in Core Biopsy Samples". J Pathol Transl Med. 49 (4): 279–87. doi:10.4132/jptm.2015.06.11. PMC 4508565. PMID 26095437.
  26. Dixon JM (2007). "Breast abscess". Br J Hosp Med (Lond). 68 (6): 315–20. doi:10.12968/hmed.2007.68.6.23574. PMID 17639835.
  27. Hokama A, Fujita J (November 2010). "Mondor disease: an unusual cause of chest pain". South. Med. J. 103 (11): 1189. doi:10.1097/SMJ.0b013e3181ecfcf3. PMID 20890261.
  28. Shetty MK, Watson AB (October 2001). "Mondor's disease of the breast: sonographic and mammographic findings". AJR Am J Roentgenol. 177 (4): 893–6. doi:10.2214/ajr.177.4.1770893. PMID 11566698.
  29. Becker L, McCurdy LI, Taves DH (2001). "Superficial thrombophlebitis of the breast (Mondor's disease)". Can Assoc Radiol J. 52 (3): 193–5. PMID 11436415.
  30. Catania S, Zurrida S, Veronesi P, Galimberti V, Bono A, Pluchinotta A (1992). "Mondor's disease and breast cancer". Cancer. 69 (9): 2267–70. PMID 1562972.
  31. Kvist LJ, Larsson BW, Hall-Lord ML, Steen A, Schalén C (April 2008). "The role of bacteria in lactational mastitis and some considerations of the use of antibiotic treatment". Int Breastfeed J. 3: 6. doi:10.1186/1746-4358-3-6. PMC 2322959. PMID 18394188.
  32. Foxman B, D'Arcy H, Gillespie B, Bobo JK, Schwartz K (January 2002). "Lactation mastitis: occurrence and medical management among 946 breastfeeding women in the United States". Am. J. Epidemiol. 155 (2): 103–14. PMID 11790672.
  33. Matro JM, Li T, Cristofanilli M, Hughes ME, Ottesen RA, Weeks JC, Wong YN (February 2015). "Inflammatory breast cancer management in the national comprehensive cancer network: the disease, recurrence pattern, and outcome". Clin. Breast Cancer. 15 (1): 1–7. doi:10.1016/j.clbc.2014.05.005. PMC 4422394. PMID 25034439.
  34. Dawood S, Merajver SD, Viens P, Vermeulen PB, Swain SM, Buchholz TA, Dirix LY, Levine PH, Lucci A, Krishnamurthy S, Robertson FM, Woodward WA, Yang WT, Ueno NT, Cristofanilli M (March 2011). "International expert panel on inflammatory breast cancer: consensus statement for standardized diagnosis and treatment". Ann. Oncol. 22 (3): 515–23. doi:10.1093/annonc/mdq345. PMC 3105293. PMID 20603440.