Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
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 Issue
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
Images in Dermatology
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
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
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
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
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 Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
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 Issue
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
Images in Dermatology
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
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
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
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
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 Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Case Letter
88 (
5
); 653-655
doi:
10.25259/IJDVL_491_2021
pmid:
35841365

Primary localized cutaneous nodular amyloidosis on areola

Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan

Corresponding author: Dr. Wei-Ming Wang, Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan. ades0431@ms38.hinet.net

Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Liu S, Hung C, Gao H, Chiang C, Chen C, Chen Y. Primary localized cutaneous nodular amyloidosis on areola. Indian J Dermatol Venereol Leprol 2022;88:653-5.

Sir,

Primary localized cutaneous nodular amyloidosis is a rare disorder in which amyloid light-chain deposits within the skin without any systemic involvement. Primary localized cutaneous nodular amyloidosis most commonly affects the acral region, followed by the face and trunk. We herein report a unique case of primary localized cutaneous nodular amyloidosis, located on the nipple-areolar complex.

A 57-year-old female presented with an asymptomatic enlarging skin lesion on her left breast which was noticed two months back. She also gave history of fibrocystic change of bilateral breasts for 10 years. On physical examination, the skin lesion appeared as a well-demarcated, reddish-orange, polygonal, waxy plaque on her left areola with a similar but smaller plaque at the centre of the left nipple [Figure 1a]. Polarized contact dermoscopy showed several yellowish-orange globules on a milky-red background, with some arborizing vessels at the periphery [Figure 1b]. An incisional biopsy was performed. Histopathology revealed abundant deposition of pale eosinophilic amorphous material separated by clefts and accompanied by a sparse lymphoplasmacytic infiltrate in the upper dermis [Figure 2a]. The deposited material showed positive staining with Congo-red stain and showed apple-green birefringence on polarized microscopy [Figure 2b]. It was also stained with Thioflavin S and showed immunoreactivity to kappa and lambda light chains.

Well-demarcated, reddish orange, polygonal, flat and waxy plaques on left areola and the center of nipple
Figure 1a:
Well-demarcated, reddish orange, polygonal, flat and waxy plaques on left areola and the center of nipple
Dermatoscopy showed several yellowish-orange globules (asterisks) on a milky-red background with some arborizing vessels (arrows) at the periphery (Non-polarized Heine Delta 20 dermatoscope; original magnification: x 10)
Figure 1b:
Dermatoscopy showed several yellowish-orange globules (asterisks) on a milky-red background with some arborizing vessels (arrows) at the periphery (Non-polarized Heine Delta 20 dermatoscope; original magnification: x 10)
Abundant deposition of pale eosinophilic amorphous material separated by clefts in the upper dermis (H&E; original magnification: x 100)
Figure 2a:
Abundant deposition of pale eosinophilic amorphous material separated by clefts in the upper dermis (H&E; original magnification: x 100)
The deposited material stained positively with Congo-red (Congo-red stain; original magnification: x 40)
Figure 2b:
The deposited material stained positively with Congo-red (Congo-red stain; original magnification: x 40)

A series of examinations to survey systemic involvement of amyloid light-chain amyloidosis was conducted, including a complete blood cell count with differential count, serum and urine protein electrophoresis, serum immunoglobulins and free light chains levels, which were all within normal limits. Serum creatinine was 0.5 mg/dL and alanine transaminase was 16 U/L. Electrocardiography showed sinus rhythm without abnormal findings.

Based on the histopathologic findings and laboratory studies, the diagnosis of primary localized cutaneous nodular amyloidosis was confirmed. Surgical removal of the tumour was done and no recurrence was noticed during 1-year follow-up.

Primary localized cutaneous nodular amyloidosis, the rarest subtype of cutaneous amyloidosis, is characterised clinically by solitary or multiple waxy yellowish nodules or plaques. Most of the cases of primary localized cutaneous nodular amyloidosis were found over extremities. We found only two previous reports of breast amyloidosis in the literature.1,2 However, the lesions in those cases were located in the subcutaneous tissue of the breast and were detected by the patient or imaging studies. In contrast, our case is a visible skin lesion on the nipple and areola. Dermoscopy which reveals orange-yellowish areas in cutaneous nodular amyloidosis,3 may aid dermatologists in the initial differential diagnosis.

Primary localized cutaneous nodular amyloidosis is caused by dermal deposition of amyloid fibrils derived from immunoglobulin light-chain, which is produced by local monoclonally-expanded plasma cells in the skin. Primary localized cutaneous nodular amyloidosis is clinically and histologically indistinguishable from cutaneous lesions of primary systemic amyloidosis, which is also composed of light-chain amyloid protein. The risk of progression of primary localized cutaneous nodular amyloidosis to systemic amyloidosis could hardly be estimated due to the rarity of primary localized cutaneous nodular amyloidosis, but was reported within the range of 7–50% in some case series.4 Therefore, it is crucial to perform systemic evaluation and long-term follow-up for patients with primary localized cutaneous nodular amyloidosis.

Various treatment modalities have been proposed, including surgical excision, dermabrasion, laser therapy, electrodesiccation and curettage, intralesional steroid injection and cryosurgery.

In conclusion, we report a case of primary localized cutaneous amyloidosis with a unique location and also highlight the importance of using dermoscopy in guiding clinical suspicion of amyloidosis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

  1. , , , , , , et al. Amyloidosis of the breast: Predominantly AL type and over half have concurrent breast hematologic disorders. Mod Pathol. 2013;26:232-8.
    [CrossRef] [PubMed] [Google Scholar]
  2. , , , . Localized primary breast amyloidosis and 1-year changes in imaging: A case report. Radiol Case Rep. 2020;15:2637-2640.
    [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
  3. , , , , , . A unique dermoscopy pattern of primary cutaneous nodular amyloidosis mimicking a granulomatous disease. J Am Acad Dermatol. 2016;74:e9-e10.
    [CrossRef] [PubMed] [Google Scholar]
  4. , . Nodular localized primary cutaneous amyloidosis: A long-term follow-up study. Br J Dermatol. 2001;145:105-9.
    [CrossRef] [PubMed] [Google Scholar]

Fulltext Views
5,463

PDF downloads
3,574
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections