Paget's disease of the breast differential diagnosis: Difference between revisions
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Paget's disease of the breast is often misdiagnosed as nipple eczema | Paget's disease of the breast is often misdiagnosed as nipple eczema | ||
{| | {| | ||
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category | ! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category | ||
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! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Benign or Malignant | ! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Benign or Malignant | ||
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Etiology | ! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Etiology | ||
! colspan=" | ! colspan="6" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Clinical manifestations | ||
! rowspan="2" |Para-clinical findings | ! rowspan="2" |Para-clinical findings | ||
| rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold Standard | | rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold Standard | ||
| rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Associated factors''' | | rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Associated factors''' | ||
|- | |- | ||
! colspan=" | ! colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptoms | ||
! colspan="2" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination | ! colspan="2" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination | ||
|- | |- | ||
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Nipple Discharge | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Nipple Discharge | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Erythema | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Erythema | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Mastalgia | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Mastalgia | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Breast Exam | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Breast Exam | ||
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| align="center" style="background:#F5F5F5;" |Serous or bloody [[nipple discharge]] may be present. | | align="center" style="background:#F5F5F5;" |Serous or bloody [[nipple discharge]] may be present. | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
* Well-demarcated [[erythematous]] and [[Desquamation|desquamative plaques]] with irregular borders seen. | |||
* [[Breast lump]] palpated in >50% cases. | |||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
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! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Extramammary Paget's disease]] | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Extramammary Paget's disease]] | ||
| align="center" style="background:#F5F5F5;" |[[Malignant]] | | align="center" style="background:#F5F5F5;" |[[Malignant]] | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
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| align="center" style="background:#F5F5F5;" | – | | align="center" style="background:#F5F5F5;" | – | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
| align="center" style="background:#F5F5F5;" | – | | align="center" style="background:#F5F5F5;" | – | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
* Usually bilateral, no accompanying induration | * Usually bilateral, nipple with no accompanying induration. | ||
* Centrofacial pallor | * Centrofacial pallor | ||
* Delayed blanch response | * Delayed blanch response | ||
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* [[Pityriasis alba]] | * [[Pityriasis alba]] | ||
* [[Ichthyosis]] | * [[Ichthyosis]] | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
* Epidermal psoriasiform [[hyperplasia]] | * Epidermal psoriasiform [[hyperplasia]] | ||
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* [[Dyskeratosis congenita|Dyskeratosis]] | * [[Dyskeratosis congenita|Dyskeratosis]] | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
* | |||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
* [[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]]. | ||
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| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
| | * [[Nipple]] may have [[Granuloma|granulomatous lesion]] . | ||
* A [[nodule]] either within or under the [[nipple]] adherent to the [[skin]], but not the [[breast]] may be palpated. | |||
* | |||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
* Insidious onset. | * Insidious onset. | ||
* No [[lymphadenopathy]]. | |||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
* 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]]. | |||
| align="center" style="background:#F5F5F5;" |[[Biopsy]] | | align="center" style="background:#F5F5F5;" |[[Biopsy]] | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
* [[Incidence]] is highest in the fifth decade in women. | * [[Incidence]] is highest in the fifth decade in women. | ||
* 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> | ||
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| align="center" style="background:#F5F5F5;" |– | | align="center" style="background:#F5F5F5;" |– | ||
| align="center" style="background:#F5F5F5;" |– | | align="center" style="background:#F5F5F5;" |– | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
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* [[Eosinophilic]] spongiosis and [[microvesicles]] | * [[Eosinophilic]] spongiosis and [[microvesicles]] | ||
* [[Exocytosis]] of [[eosinophils]] and [[lymphocytes]] | * [[Exocytosis]] of [[eosinophils]] and [[lymphocytes]] | ||
* Chronic - [[Hyperkeratosis]] and parakeratosis | * Chronic - [[Hyperkeratosis]] and [[parakeratosis]] | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
* | |||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
* Contact with [[allergens]] in the past 1-2 days | * Contact with [[allergens]] in the past 1-2 days | ||
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| align="center" style="background:#F5F5F5;" |– | | align="center" style="background:#F5F5F5;" |– | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="center" style="background:#F5F5F5;" |+ | |||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
| align="center" style="background:#F5F5F5;" |[[Auspitz's sign]] (pinpoint bleeding) | |||
| align="center" style="background:#F5F5F5;" | | |||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
* [[Epidermal]] [[hyperplasia]] | |||
* [[ | * Parakeratosis | ||
* [[Neutrophils]] microabscesses (Munro microabscesses) | |||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
* [[Epidermal]] [[hyperplasia]] | * [[Epidermal]] [[hyperplasia]] | ||
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* [[Neutrophils]] microabscesses (Munro microabscesses) | * [[Neutrophils]] microabscesses (Munro microabscesses) | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
Risk factors include | |||
* [[Smoking]] | * [[Smoking]] | ||
* Skin trauma | * Skin trauma | ||
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[[Bleeding]] from the lesion may be present | [[Bleeding]] from the lesion may be present | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
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| align="center" style="background:#F5F5F5;" |– | | align="center" style="background:#F5F5F5;" |– | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
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| align="center" style="background:#F5F5F5;" |– | | align="center" style="background:#F5F5F5;" |– | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
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|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Intraductal papilloma|Benign intraductal papilloma]] | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Intraductal papilloma|Benign intraductal papilloma]] | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
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|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Pagetoid dyskeratosis | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |Pagetoid dyskeratosis | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
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| align="center" style="background:#F5F5F5;" |* Common among [[perimenopausal]]<nowiki/> women | | align="center" style="background:#F5F5F5;" |* Common among [[perimenopausal]]<nowiki/> women | ||
* Usually resolve spontaneously | * Usually resolve spontaneously | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
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|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Nipple duct adenoma | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |Nipple duct adenoma | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
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|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Benign Toker cell hyperplasia | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |Benign Toker cell hyperplasia | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
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! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Breast abscess]] | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Breast abscess]] | ||
| align="center" style="background:#F5F5F5;" |[[Benign]] | | align="center" style="background:#F5F5F5;" |[[Benign]] | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
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|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mondors disease]] | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mondors disease]] | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
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* [[Benign]] | * [[Benign]] | ||
* No increased risk of [[malignancy]] | * No increased risk of [[malignancy]] | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
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! style="background: #DCDCDC; padding: 5px; text-align: center;" |Inflammatory Breast Cancer | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |Inflammatory Breast Cancer | ||
| align="center" style="background:#F5F5F5;" |[[Malignant]] | | align="center" style="background:#F5F5F5;" |[[Malignant]] | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | |
Revision as of 00:24, 25 February 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:[1][2]
- Atopic dermatitis
- Chronic contact dermatitis
- Lactiferous duct ectasia
- Chronic eczema
- Psoriasis
- Nipple duct adenoma
- Malignant melanoma
- Bowen’s disease
- Superficial basal cell carcinoma
- Benign intraductal papilloma
- Pagetoid dyskeratosis
Paget's disease of the breast is often misdiagnosed as nipple eczema
Category | Diseases | Benign or Malignant | Etiology | Clinical manifestations | Para-clinical findings | Gold Standard | Associated factors | |||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Symptoms | Physical examination | |||||||||||
Histopathology | ||||||||||||
Rash | Nipple Discharge | Erythema | Mastalgia | Breast Exam | Other | |||||||
Skin disorders | Paget's disease of the breast | Malignant | Ulcerated, crusted, or scaling lesion on the nipple that extends to the areolar region | Serous or bloody nipple discharge may be present. | + |
|
||||||
Extramammary Paget's disease | Malignant | Biopsy | ||||||||||
Atopic dermatitis
(Eczema) |
|
– | – | – |
|
|
|
| ||||
Erosive adenomatosis of the nipple |
|
|
Eczema, crusts or erosion of nipple | Serous or bloody nipple discharge. |
|
|
Biopsy |
| ||||
Allergic contact dermatitis[3] | Benign |
|
Erythematous well-demarcated papules | – | – | + |
|
|
|
| ||
Psoriasis | Benign |
|
Well-circumscribed, pink papules and symmetrically distributed cutaneous plaques with silvery scales | – | + | + | Auspitz's sign (pinpoint bleeding) |
|
|
Risk factors include
| ||
Malignant melanoma | Malignant |
|
|
–
Bleeding from the lesion may be present |
| |||||||
Bowen’s disease | Benign can turn malignant |
|
– |
|
|
| ||||||
Superficial basal cell carcinoma | Malignant |
|
– |
|
|
| ||||||
Benign intraductal papilloma | ||||||||||||
Pagetoid dyskeratosis | ||||||||||||
Lactiferous duct ectasia | Benign | * Common among perimenopausal women
|
Ultrasound:
|
|||||||||
Nipple duct adenoma | ||||||||||||
Benign Toker cell hyperplasia | ||||||||||||
Breast abscess | Benign | + |
|
|
||||||||
Mondors disease | ||||||||||||
Mastitis |
|
± |
|
|
||||||||
Inflammatory Breast Cancer | Malignant | Biopsy |
References
- ↑ 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.
- ↑ 2.0 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.
- ↑ 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.