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

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Revision as of 21:16, 20 February 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Suveenkrishna Pothuru, 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]

						Symptoms					Physical examination			Para-clinical findings
Category	Diseases	Begnin	Etiology	Inherited	Acquired	Clinical manifestations								Para-clinical findings			Associated factors
						Symptoms					Physical examination			Lab Findings		Histopathology
						Appearance				Itching	Fever	Tenderness	Other	Eosinophils	Serum IgE
						Single/ Multiple	Rash	Involved areas	Pustule	Itching	Fever	Tenderness	Other	Eosinophils	Serum IgE
Skin disorders	Atopic dermatitis		Epidermal barrier dysfunction Immune dysregulation	+	+	Multiple	Erythema, exudates, papules,vesicles, scales and crusts Infiltrated erythema, prurigo, scales and crusts	Young children -Scalp, cheeks amd extensor surface Adolescents -flexural areas and buttock-thigh creases Adults - facial involvement and skin flexures	–	+	–	–	Centrofacial pallor Delayed blanch response Keratosis pilaris Palmar hyperlinearity Pityriasis alba Ichthyosis Infra-auricular and retro-auricular fissuring Nipple eczema White dermographism Perifollicular accentuation	Nl to ↑ (Eosinophilia)	↑	Epidermal psoriasiform hyperplasia Marked intercellular edema with spongiotic vesiculation Hyperkeratosis Psoriasiform hyperplasia Dyskeratosis	Family history of atopic dermatitis or other atopy Personal history of atopy (asthma, allergic rhinitis, food allergy) Active and passive exposure to tobacco
	Allergic contact dermatitis^[3]		Delayed-type hypersensitivity response Skin inflammation mediated by hapten-specific T cells	–	+	May be multiple after 1-2 days of exposure	Erythematous well-demarcated papules	Surrounding the area in contact with the offending agent	–	+	–	+	Stinging and burning Localized swelling Lichenified pruritic plaques	Nl to ↑ (Eosinophilia)	Nl	Eosinophilic spongiosis and microvesicles Exocytosis of eosinophils and lymphocytes Chronic - Hyperkeratosis and parakeratosis	Contact with allergens in the past 1-2 days Positive family history
	Irritant contact dermatitis^[4]		Activation of the innate immune system by the pro-inflammatory properties of chemicals	–	+	Usually single immediately after the exposure	Well-demarcated red patch with a glazed surface	Any area in contact with the irritant	–	+	–	+	Swelling, blistering and scaling of the damaged area Dryness Thicker skin	Nl	Nl	Spongiosis Intraepidermal vesicles or bullae Necrosis of keratinocytes	Cumulative exposure to irritants Negative hypersensitivity tests
	Psoriasis		Keratinocyte hyperproliferation Dysregulation of the immune system	+	+	Multiple	Well-circumscribed, pink papules and symmetrically distributed cutaneous plaques with silvery scales	Scalp Trunk Gluteal cleft Extensor surface of elbows and knees	+	+	_	+	Auspitz's sign (pinpoint bleeding)	Nl	Nl	Epidermal hyperplasia Parakeratosis Neutrophils microabscesses (Munro microabscesses)	Risk factors include Smoking Skin trauma Alcohol abuse Stress Cold weather Vitamin D deficiency
	Chronic eczema			–	+	Multiple	Scalp, face, trunk, postauricular, diaper area and axilla	+	+	–	–		Nl	Nl	Focal parakeratosis and spongiosis in epidermis Psoriasiform hyperplasia Neutrophils at the margins	Risk factors include Stress Cold, dry weather can cause flare ups Superinfection with bacteria and candida Generalized seborrheic erythroderma in immunodeficient patients
	Malignant melanoma
	Bowen’s disease
	Superficial basal cell carcinoma
	Pagetoid basal cell carcinoma
	Benign intraductal papilloma
	Pagetoid dyskeratosis
	Lactiferous duct ectasia
	Nipple duct adenoma

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.
↑ Bains SN, Nash P, Fonacier L (October 2018). "Irritant Contact Dermatitis". Clin Rev Allergy Immunol. doi:10.1007/s12016-018-8713-0. PMID 30293200.

[GaspariRicci2013-1] 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.

[Lopes_FilhoLopes2015-2] 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.

[pmid19447733-3] 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.

[pmid30293200-4] Bains SN, Nash P, Fonacier L (October 2018). "Irritant Contact Dermatitis". Clin Rev Allergy Immunol. doi:10.1007/s12016-018-8713-0. PMID 30293200.

[1]

[2]

[3]

[4]

@@ Line 16: / Line 16: @@
 *[[Melanoma|Malignant melanoma]]
 *[[Bowen’s disease]]
-*Cutaneous extension of a mammary carcinoma
 *[[Basal cell carcinoma|Superficial basal cell carcinoma]]
 *[[Basal cell carcinoma|Pagetoid basal cell carcinoma]]
@@ Line 25: / Line 24: @@
 ! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
 ! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
+! rowspan="5" |Begnin
 ! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Etiology
 ! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Inherited
@@ Line 52: / Line 52: @@
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pustule
 |-
-! rowspan="10" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Skin disorders
+! rowspan="18" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Skin disorders
 ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Atopic dermatitis]]
+|
 | align="center" style="background:#F5F5F5;" |
 * Epidermal barrier dysfunction
@@ Line 101: / Line 102: @@
 |-
 ! 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>
+|
 | align="center" style="background:#F5F5F5;" |
 * Delayed-type [[hypersensitivity]] response
@@ Line 129: / Line 131: @@
 |-
 ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Contact dermatitis|Irritant contact dermatitis]]<ref name="pmid30293200">{{cite journal |vauthors=Bains SN, Nash P, Fonacier L |title=Irritant Contact Dermatitis |journal=Clin Rev Allergy Immunol |volume= |issue= |pages= |date=October 2018 |pmid=30293200 |doi=10.1007/s12016-018-8713-0 |url=}}</ref>
+|
 | align="center" style="background:#F5F5F5;" |
 * Activation of the [[innate immune system]] by the pro-[[inflammatory]] properties of chemicals
@@ Line 155: / Line 158: @@
 |-
 ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Psoriasis]]
+|
 | align="center" style="background:#F5F5F5;" |
 * [[Keratinocyte]] hyperproliferation
@@ Line 188: / Line 192: @@
 |-
 ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Eczema|Chronic eczema]]
+|
 | align="center" style="background:#F5F5F5;" |
 *
@@ Line 213: / Line 218: @@
 Generalized seborrheic [[erythroderma]] in immunodeficient patients
 |-
+![[Melanoma|Malignant melanoma]]
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+|-
+![[Bowen’s disease]]
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+|-
+![[Basal cell carcinoma|Superficial basal cell carcinoma]]
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+|-
+![[Basal cell carcinoma|Pagetoid basal cell carcinoma]]
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+|-
+![[Intraductal papilloma|Benign intraductal papilloma]]
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+|-
+!Pagetoid dyskeratosis
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+|-
+![[Duct ectasia of breast|Lactiferous duct ectasia]]
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+|-
+!Nipple duct adenoma
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+|-
 |}

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

Revision as of 21:16, 20 February 2019

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