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

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! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Etiology
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Etiology
! colspan="6" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Clinical manifestations
! colspan="6" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Clinical manifestations
! rowspan="3" |Histopathology
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;"|Histopathology
| rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold Standard
| rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold Standard
| rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Associated factors'''
| rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Associated factors'''

Revision as of 03:38, 1 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

Paget's disease of the breast must be differentiated from atopic dermatitis, eczema, psoriasis, malignant melanoma, Bowen's disease, basal cell carcinoma, and pagetoid dyskeratosis.[1][2]

Differential Diagnosis

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

Paget's disease of the breast is often misdiagnosed as nipple eczema

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[1][2] Most the patients have underlying breast cancer. + + ±
  • Usually unilateral nipple is effected
Atopic dermatitis

(Eczema)[3][4]

N/A
  • Clinical examination
Erosive adenomatosis of the nipple[5][6]
  • Eczema, crusts or erosion of nipple
+ + Biopsy: Shows absence of cytological atypia
Allergic contact dermatitis[7]
  • Erythematous well-demarcated papules
+ N/A
Psoriasis[8][9]
  • Well-circumscribed, pink papules and symmetrically distributed cutaneous plaques with silvery scales.
+ + N/A Auspitz's sign (pinpoint bleeding) Risk factors include
Malignant melanoma
  • 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.
Bowen’s disease + 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[10][11] + N/A
  • Superficial fine telangiectasia
  • Shiny white to red, translucent or opaque structureless areas
  • Multiple small erosions.
  • Higher incidence in men
Squamous metaplasia of lactiferous ducts (SMOLD)/ Zuska's disease[12][13] + +
Lactiferous duct ectasia / Plasma cell mastitis / Comedomastitis Nipple retraction + Thick nipple discharge. Ultrasound:
Nipple Adenoma / Papillary adenoma of the nipple ± +
  • Multiple small palpable masses below
  • Usually unilateral nipple is effected
Nevoid hyperkeratosis of the nipple and areola (NHNA) [14][15] Slow growing bluish-brown verrucous thickening of the nipple or areola.
  • Usually bilateral nipple is effected
Benign Toker cell hyperplasia
  • Normal components of the nipple skin
  • Appears similar to paget cells.
Normal nipple- areolar complex Normal breast examination. N/A
  • Toker cells have bland nuclei and abundant eosinophilic or clear cytoplasm. Occasional clusters or glands may be present.
  • Do not generally have cellular atypia and have minimal nuclear pleomorphism.
  • Toker cells are immunoreactive for cytokeratin 7 and CAM5.2 but are not positive for HER2- neu.
Breast abscess
  • 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
  • Smoking history
  • If not lactating, patient may be diabetic.
  • History of privious breast infection
Mondors disease[16][17] 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[18][19]
  • 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[20][21]
  • Localized erythema, warmth, swelling, and pain.
+ +
  • Usually unilateral

References

  1. 1.0 1.1 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.
  2. 2.0 2.1 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.
  3. 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.
  4. 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.
  5. 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.
  6. Lewis HM, Ovitz ML, Golitz LE (October 1976). "Erosive adenomatosis of the nipple". Arch Dermatol. 112 (10): 1427–8. PMID 962337.
  7. 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.
  8. 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.
  9. 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.
  10. 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.
  11. 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.
  12. 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.
  13. 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.
  14. 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.
  15. 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.
  16. 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.
  17. 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.
  18. 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.
  19. 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.
  20. 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.
  21. 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.