Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Quiz
2019:85:3;307-309
doi: 10.4103/ijdvl.IJDVL_446_17
PMID: 30058561

Erythematous eroded plaque on the left nipple in a 75-year-old woman

Sergio Alvarez-Veliz1 , Paula Majluf-Caceres1 , Sergio González-Bombardiére2
1 Department of Dermatology, Faculty of Medicine, Pontificia Universidad Católica De Chile, Santiago, Chile
2 Department of Pathology, Faculty of Medicine, Pontificia Universidad Católica De Chile, Santiago, Chile

Correspondence Address:
Sergio González-Bombardiére
Vicuña Mackenna 4686, Macul, Santiago
Chile
How to cite this article:
Alvarez-Veliz S, Majluf-Caceres P, González-Bombardiére S. Erythematous eroded plaque on the left nipple in a 75-year-old woman. Indian J Dermatol Venereol Leprol 2019;85:307-309
Copyright: (C)2019 Indian Journal of Dermatology, Venereology, and Leprology

A 75-year-old woman presented with a 2-year history of a painful, ulcerated lesion on the left nipple, with intermittent bloody discharge. Physical examination revealed an erythematous eroded plaque on the left areola and nipple [Figure - 1]. Dermoscopy showed a pink structureless zone, ulceration with sticky-fiber sign (hair fibers trapped in the crust of the ulcer) and cherry red spots [Figure - 2]. Mammographic echography and mammography had no signs of malignancy.

Figure 1: Erythematous eroded plaque on the left areola and nipple
Figure 2: Dermoscopy showed a pink structureless zone, ulceration (green arrow) with fiber sign (black arrow) and cherry red spots (blue arrow)

A biopsy was performed from the plaque for histological examination. Hematoxylin and eosin (H and E) staining of the biopsy revealed an ulcerated, well-circumscribed proliferation of tubular glands [Figure - 3]a, with some luminal papillary projections [Figure - 3]b. Two rows of normotypic epithelial cells and discrete stromal lymphoplasmocellular inflammation were also seen; decapitation of luminal cells was evident and basal myoepithelial cells were also visible [Figure - 3]c. No necrosis, atypical mitoses or cellular pleomorphism were observed.

Figure 3:

Question

What is your diagnosis?

Answer

Erosive adenomatosis of the nipple.

Review

Erosive adenomatosis of the nipple or florid papillomatosis of nipple, is an uncommon and under-recognized pathology of the breast. It is a benign proliferative neoplasm of lactiferous ducts of the nipple, seen predominantly in middle-aged women, but also reported in men and children.[1] It is clinically polymorphic and presents as erythema, nodule or erosion, usually unilateral. The serous or sanguineous discharge from the surface of the nipple is commonly reported as an initial presenting symptomatology. In contrast to mammary Paget's disease in which it is a genuine nipple discharge, in erosive adenomatosis of the nipple it is secondary to the presence of an erosive lesion on the nipple. It has been reported that patients consult years after the onset of the first symptoms.[1]

Dermoscopy may be useful to differentiate erosive adenomatosis of the nipple from clinically similar diseases as mammary Paget's disease. Takashima et al. revealed dermoscopic features present in erosive adenomatosis of the nipple as linear cherry-red structures that might represent luminal openings amidst a light-reddish area, with collar-like orange veils at the periphery of the lesion. Instead, mammary Paget's disease usually shows light brown diffuse pigmentation, irregular black dots, peppering and irregular linear vessels, which are not present in erosive adenomatosis of the nipple.[2],[3]

Histopathologic examination can present various histologic features but usually shows ductal proliferation of gland-like structures within the stroma with well-circumscribed borders and no encapsulation.[1]

Mammography and/or breast ultrasound should always be done to rule out breast neoplasms; however, it is not useful to diagnose erosive adenomatosis of the nipple because of the similarity in the tissue density of the nipple, the surrounding skin and the underlying breast tissue.[1],[4]

The differential diagnosis is broad and includes mammary Paget's disease, squamous cell carcinoma of the nipple, eczema, psoriasis or skin infections.[1]

Treatment is often curative when a complete surgical excision is possible, minimizing local recurrence and is indicated as the first-line therapy. Unfortunately, it usually results in nipple amputation. Other alternatives include cryotherapy or Moh's micrographic surgery, especially indicated in young females to allow breastfeeding.[1],[5] Surgical excision was performed in our patient with no recurrences at a follow-up after 6 months.

Regular clinical breast follow-up after treatment is crucial, and includes annual screening mammography and/or breast ultrasonography. Incidental breast cancer (upto 17.6%) had been detected at the time of excision or at the site of biopsy. Nevertheless, it is still unknown if erosive adenomatosis of the nipple is a risk factor for the development of breast cancer. The incidence of erosive adenomatosis of the nipple in patients with breast cancer versus patients without breast cancer has not been studied, but the transformation of an erosive adenomatosis of the nipple into a breast cancer later cannot be completely excluded. Hence it is reasonable to encourage patients to maintain regular follow-up.[1]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given the consent for the images and other clinical information to be reported in the journal. The patient understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References
1.
Spohn G, Trotter S, Tozbikian G, Povoski S. 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 Dermatol 2016;16:4.
[Google Scholar]
2.
Takashima S, Fujita Y, Miyauchi T, Nomura T, Nishie W, Hamaoka H, et al. Dermoscopic observation in adenoma of the nipple. J Dermatol 2015;42:341-2.
[Google Scholar]
3.
Crignis GS, Abreu Ld, Buçard AM, Barcaui CB. Polarized dermoscopy of mammary Paget disease. An Bras Dermatol 2013;88:290-2.
[Google Scholar]
4.
Wang C, Wang X, Ma R. Diagnosis and surgical treatment of nipple adenoma. ANZ J Surg 2015;85:444-7.
[Google Scholar]
5.
Pasquali P, Freites-Martinez A, Fortuño A. Nipple adenoma: New images and cryosurgery treatment. Breast J 2016;22:584-5.
[Google Scholar]

Fulltext Views
552

PDF downloads
136
Show Sections