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Presented by Pedram Argani, M.D. and prepared by Mohammed Lilo, M.D.
Case 2: This is a 59 year old female with an ulcer involving the nipple of the breast.
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Question 1 of 1
1. Question
Week 585: Case 2
This is a 59 year old female with an ulcer involving the nipple of the breastimages/lilo/Arg-2-A.jpg
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images/lilo/Arg-2-E.jpgCorrect
Answer: Paget’s disease
Histology: The nipple epidermis contains a proliferation of atypical epithelioid cells with focal gland formation. The atypical cells spare the basal layer of the squamous epithelium. The lesion cells label for low molecular weight cytokeratin and HER2, supporting the diagnosis of mammary Paget’s disease.
Discussion: Paget’s disease may occasionally acquire melanin pigment due to phagocytosis of melanin from the associated disrupted keratinocytes, and therefore mimic melanoma. However, melanoma would not label for cytokeratin and would label for Melan A. Squamous cell carcinoma in situ is excluded by the areas of glandular differentiation within the lesion, and immunoreactivity for low molecular cytokeratin. Actinic keratosis features basal atypia and alternating atypical parakeratosis and orthokeratosis. It would lack the glandular features of the current lesion.
Incorrect
Answer: Paget’s disease
Histology: The nipple epidermis contains a proliferation of atypical epithelioid cells with focal gland formation. The atypical cells spare the basal layer of the squamous epithelium. The lesion cells label for low molecular weight cytokeratin and HER2, supporting the diagnosis of mammary Paget’s disease.
Discussion: Paget’s disease may occasionally acquire melanin pigment due to phagocytosis of melanin from the associated disrupted keratinocytes, and therefore mimic melanoma. However, melanoma would not label for cytokeratin and would label for Melan A. Squamous cell carcinoma in situ is excluded by the areas of glandular differentiation within the lesion, and immunoreactivity for low molecular cytokeratin. Actinic keratosis features basal atypia and alternating atypical parakeratosis and orthokeratosis. It would lack the glandular features of the current lesion.
