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Rolim I, Rafael M, Robson A, Costa Rosa J. Pigmented Epidermotropic Breast Carcinoma: A Diagnostic Pitfall Mimicking Melanoma A Case Report and Literature Review. Int J Surg Pathol 2024; 32:386-393. [PMID: 37291852 DOI: 10.1177/10668969231177702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We report the clinical and pathologic features of a patient with breast carcinoma, who developed clinically visible pigmented skin lesions during the course of the disease. The combination of clinical pigmentation, histological pagetoid epidermal spread, and considerable melanin pigment within tumour cells lead to a misdiagnosis of melanoma. This case provides a striking example of the ability of epidermotropic breast carcinoma to mimic melanoma. A literature review is also reported.
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Affiliation(s)
- Ines Rolim
- Anatomic Pathology, Fundação Champalimaud, Lisboa, Portugal
- Pathology Department, Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
| | - Margarida Rafael
- Dermatology Department, Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
| | - Alistair Robson
- Pathology Department, Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
- Source LDPath, London, UK
| | - Joaninha Costa Rosa
- Pathology Department, Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
- Pathology, Nova Medical School/Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal
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2
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Dehner CA, Johnson EF, Peters MS, Guo RR. Primary melanoma of the nipple: Report of 10 cases including coexistence with Paget's disease. Pathol Res Pract 2024; 253:155058. [PMID: 38181578 DOI: 10.1016/j.prp.2023.155058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/17/2023] [Accepted: 12/20/2023] [Indexed: 01/07/2024]
Abstract
Primary melanoma of the nipple (PMN) is exceedingly rare, with only single cases reported to date. We identified 10 patients with PMN: 5 females, 5 males, median age 55.5 years (range 29-66) at diagnosis of melanoma in situ (4 cases) or invasive melanoma (6 cases, Breslow depth 0.2 mm to 3.5 mm). Follow-up was available for all 10 patients (median 19 months, range 1-183). Nine patients had no evidence of disease; one patient died of disease (13.5 months) after presenting with a nodal metastasis. One case was exceptional, because the patient presented with a pigmented lesion that histopathologically exhibited co-existence of melanoma in situ and Paget disease, a challenging differential diagnosis due to immunohistochemical pitfalls in distinction between melanoma in situ and the pigmented variant of mammary Paget disease. Here we report the second largest series of PMN including a case of PMN colliding with mammary Paget disease, to raise awareness of these rare malignancies.
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Affiliation(s)
- Carina A Dehner
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA; Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Emma F Johnson
- Department of Dermatology, Mayo Clinic, Rochester, MN 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Margot S Peters
- Department of Dermatology, Mayo Clinic, Rochester, MN 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Ruifeng Ray Guo
- Department of Dermatology, Mayo Clinic, Rochester, MN 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA.
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3
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Hartzell C, Hernandez E, Arriola AGP. A Rare Collison of Vulvar Melanoma and Extramammary Paget Disease: Case Report and Review of the Literature. Am J Dermatopathol 2023; 45:133-136. [PMID: 36669079 DOI: 10.1097/dad.0000000000002371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Connor Hartzell
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Enrique Hernandez
- Department of Obstetrics and Gynecology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA; and
- Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Aileen Grace P Arriola
- Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
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Chen L, Yang N, Jiang F, Shao J, Ye Y, Zhu J, Li Z, Liu J. Clinical and dermoscopic features of extramammary Paget's disease: A retrospective analysis of 49 cases. Photodiagnosis Photodyn Ther 2022; 40:103105. [PMID: 36075520 DOI: 10.1016/j.pdpdt.2022.103105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/20/2022] [Accepted: 08/31/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Extramammary Paget's disease (EMPD) is a rare cutaneous malignancy that can be easily confused with other diseases due to its diverse clinical manifestations, delaying the timing of treatment. Therefore, early diagnosis is extremely important. It has been reported that dermoscopy can be used to evaluate superficial skin tumors. OBJECTIVE To investigate the dermoscopic characteristics of EMPD diagnosed by histopathology and to develop a decision tree model that can provide clinicians with a reference to facilitate early diagnosis. METHODS All patients were evaluated by dermoscopic and histopathologic examinations. Dermoscopic images were assessed, and a decision tree model was constructed using SPSS (version 25.0). RESULTS A total of 49 patients were included in this study. We found that EMPD was most likely to be misdiagnosed when the disease duration was less than 2.5 years. Porcelain-white patches were the only key clinical feature other varying dermoscopic features could not be differentiated from those of EMPD-mimicking diseases. Polymorphic vessels were considered to be significant when the duration of the disease ranged from 0.1 year to 2.5 years. However, when the duration was >2.5 years, present (or absent) glomerular vessels were all considered EMPD. CONCLUSIONS Dermoscopy can be used as an auxiliary diagnostic tool for the diagnosis and management of EMPD. The decision tree can guide clinical diagnosis further validation studies are necessary due to the limited number of cases.
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Affiliation(s)
- Lele Chen
- Department of Dermatology and Venereology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Nali Yang
- Department of Dermatology and Venereology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Fan Jiang
- Department of Dermatology and Venereology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Junyi Shao
- Department of Dermatology and Venereology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Yahui Ye
- Department of Dermatology and Venereology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Jiling Zhu
- Department of Dermatology and Venereology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Zhiming Li
- Department of Dermatology and Venereology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China.
| | - Jingjing Liu
- Department of Dermatology and Venereology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China.
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5
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Rao S, Wang A, Liu W, Yin H, Li J, Tsang LSL, Wu Y, Shi W. Mammary Paget Disease With Melanocytic Proliferation Mimicking Malignant Melanoma in situ: A Case Report. Front Med (Lausanne) 2022; 9:839954. [PMID: 35386919 PMCID: PMC8978827 DOI: 10.3389/fmed.2022.839954] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/17/2022] [Indexed: 11/14/2022] Open
Abstract
Several cases of pigmented mammary Paget’s disease (PMPD) mimicking cutaneous malignant melanoma have been reported. In these cases, the tumor cells are colonized by melanocytes, particularly with the presence of a population of melanocytes staining for HMB-45 and S100. Here, we report a case of mammary Paget disease (MPD) which was misdiagnosed as melanoma in situ due to the interpretation of the staining of melanocytic markers S-100, Melan-A, and HMB-45. The tumor cells strongly expressed CK7 and GATA3, and a dual-labeling showed negative PHH3 labeling for the melanocytes. Pathologists need to be aware of the caveat of colonization of melanocytes in Paget disease.
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Affiliation(s)
- Shijia Rao
- Department of Dermatology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Alun Wang
- Department of Pathology, Tulane University School of Medicine, New Orleans, LA, United States
| | - Wei Liu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Hongling Yin
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Ji Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - Lemuel Shui-Lun Tsang
- College of Medicine, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Yuhui Wu
- Department of Breast Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Wei Shi
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
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Torre-Castro J, Moya-Martínez C, Haya-Martínez L, Mendoza-Cembranos MD, Eraña-Tomás I, Requena L. Pigmented epidermotropic breast cancer metastases: A rare variant with a particularly unusual feature. J Cutan Pathol 2022; 49:99-102. [PMID: 34519091 DOI: 10.1111/cup.14132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 11/26/2022]
Abstract
Pigmented epidermotropic breast cancer metastases are a rarity, often clinically misdiagnosed as melanocytic lesions. Histopathologically, they show a dermal proliferation of neoplastic metastatic cells that extend to the overlying epidermis in a pattern identical to that seen in primary Paget disease (PD). Differential diagnosis should be established with entities with a similar presentation, such as pigmented mammary PD and malignant melanoma. Immunohistochemistry may be useful for this purpose. We present a new case of pigmented epidermotropic breast cancer metastases with a particularly unusual feature: the absence of dermal infiltration by neoplastic cells, thus considered as pure epidermotropic metastatic involvement.
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Affiliation(s)
- Juan Torre-Castro
- Dermatology Department, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Cristina Moya-Martínez
- Dermatology Department, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Lara Haya-Martínez
- Dermatology Department, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | | | - Itziar Eraña-Tomás
- Pathology Department, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Luis Requena
- Dermatology Department, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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7
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Ishizuki S, Nakamura Y. Extramammary Paget's Disease: Diagnosis, Pathogenesis, and Treatment with Focus on Recent Developments. ACTA ACUST UNITED AC 2021; 28:2969-2986. [PMID: 34436026 PMCID: PMC8395499 DOI: 10.3390/curroncol28040260] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/01/2021] [Accepted: 08/03/2021] [Indexed: 12/31/2022]
Abstract
Extramammary Paget’s disease (EMPD) is a rare neoplasm that usually develops in apocrine gland-bearing areas, such as the vulva, scrotum, and penis. EMPD may present with a focal, multifocal, or an ectopic lesion. Clinically, EMPD lesions often exhibit infiltrative erythema, which is sometimes similar to other skin disorders such as eczema. While primary EMPD arises as intraepithelial neoplasm of the epidermis, EMPD-like lesions may occur from epidermotropic spread of malignant cells or direct extension from an underlying internal neoplasm, known as secondary EMPD. Because treatment strategies differ for primary EMPD and secondary EMPD, accurate diagnosis based on detailed histopathological evaluation is required. In the early stages, EMPD usually shows indolent growth, and most cases are diagnosed as carcinoma in situ. However, invasive lesions may result in metastases, and deep invasion is associated with high incidence of metastases. Conventional chemotherapies have been used for EMPD treatment in patients with distant metastases, but the efficacy is not satisfactory, and the prognosis for such patients remains poor. Recent studies have provided various insights into the molecular pathogenesis of the development and advancement of EMPD, which may lead to novel treatment approaches for metastatic EMPD. This review addresses the diagnosis, pathogenesis, and treatment of EMPD with focus on recent progress in understanding this disease.
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8
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Zhang L, Gao XH, Li JH. Pigmented Plaque in the Axilla. JAMA Dermatol 2021; 156:1255-1256. [PMID: 32936236 DOI: 10.1001/jamadermatol.2020.3250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Lan Zhang
- Department of Dermatology and Key Laboratory of Immunodermatology, the First Hospital of China Medical University, Shenyang, China
| | - Xing-Hua Gao
- Department of Dermatology and Key Laboratory of Immunodermatology, the First Hospital of China Medical University, Shenyang, China
| | - Jiu-Hong Li
- Department of Dermatology and Key Laboratory of Immunodermatology, the First Hospital of China Medical University, Shenyang, China
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9
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Konstantinova AM, Kazakov DV. Extramammary Paget disease of the vulva. Semin Diagn Pathol 2020; 38:50687. [PMID: 32921571 DOI: 10.1053/j.semdp.2020.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 02/03/2023]
Abstract
Extramammary Paget disease (EMPD) is a rare neoplasm with uncertain histogenesis, usually presenting in the anogenital area, most commonly in the vulva. The disease is characterized by slow grow and high recurrence rates. This article reviews the epidemiological, clinical, morphological, genetic and treatment features of EMPD of the vulva reported in recent years.
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Affiliation(s)
- Anastasia M Konstantinova
- Department of Pathology, Clinical Research and Practical Center for Specialized Oncological care, Saint-Petersburg, Russian Federation; Department of Pathology, Medical Faculty, Saint-Petersburg State University, Russian Federation; Department of Pathology, Saint-Petersburg Medico-Social Institute, St.-Petersburg, Russian Federation
| | - Dmitry V Kazakov
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic; Bioptical Laboratory, Pilsen, Czech Republic.
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10
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Chuchvara N, Reilly C, Haroon A, Wassef C, Maghari A, Rao B. Atypical cells on reflectance confocal microscopy may not represent melanoma: A case of axillary pigmented extramammary Paget disease. J Cutan Pathol 2020; 47:1170-1174. [DOI: 10.1111/cup.13804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/12/2020] [Accepted: 07/05/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Nadiya Chuchvara
- Center for Dermatology Rutgers Robert Wood Johnson Medical School Somerset NJ USA
| | - Catherine Reilly
- Center for Dermatology Rutgers Robert Wood Johnson Medical School Somerset NJ USA
| | - Attiya Haroon
- Center for Dermatology Rutgers Robert Wood Johnson Medical School Somerset NJ USA
| | - Cindy Wassef
- Center for Dermatology Rutgers Robert Wood Johnson Medical School Somerset NJ USA
| | - Amin Maghari
- Department of Pathology and Laboratory Medicine Rutgers Robert Wood Johnson Medical School New Brunswick NJ USA
| | - Babar Rao
- Center for Dermatology Rutgers Robert Wood Johnson Medical School Somerset NJ USA
- Department of Dermatology Weill Cornell Medicine New York NY USA
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11
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Caputo V, Caselli E, Ribotta M, Bonoldi E. A challenging case of pigmented Bowen's disease and differential diagnosis of pagetoid pigmented skin lesions. Pathologica 2019; 111:98-104. [PMID: 31748756 PMCID: PMC8138492 DOI: 10.32074/1591-951x-21-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 08/30/2019] [Indexed: 11/30/2022] Open
Abstract
Differentiation of pagetoid cutaneous neoplasms can be very challenging on hematoxylin and eosin-stained sections. We report a singular case of pigmented pagetoid Bowen’s disease showing transitional features between extramammary Paget’s disease and in situ squamous cell carcinoma.
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Affiliation(s)
- V Caputo
- UOC Anatomia Patologica, ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - E Caselli
- UOC Anatomia Patologica, ASST Fatebenefratelli-Sacco, Milano
| | - M Ribotta
- UOC Anatomia Patologica, ASO OIRM Sant'Anna, Torino
| | - E Bonoldi
- UOC Anatomia Patologica, ASST Grande Ospedale Metropolitano Niguarda, Milano
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