What is your diagnosis?
Case for diagnosis. Phagedenic ulcer on the thorax
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Úlcera fagedênica no tórax" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "tieneResumen" => "pt" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "751" "paginaFinal" => "753" ] ] "contieneResumen" => array:1 [ "pt" => true ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 676 "Ancho" => 905 "Tamanyo" => 122699 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Tórax e dorso à direita: úlcera extensa com bordas eritêmato‐violáceas, infiltradas e irregulares. Face lateral do tórax: tumoração de aspecto vegetante, eritematosa e ulcerada.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Isabella Lemos Baltazar, Flávia Regina Ferreira, Mariana Galhardo Tressino, Fernanda da Rocha Gonçalves" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Isabella Lemos" "apellidos" => "Baltazar" ] 1 => array:2 [ "nombre" => "Flávia Regina" "apellidos" => "Ferreira" ] 2 => array:2 [ "nombre" => "Mariana Galhardo" "apellidos" => "Tressino" ] 3 => array:2 [ "nombre" => "Fernanda da Rocha" "apellidos" => "Gonçalves" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0365059620302129" "doi" => "10.1016/j.abd.2020.03.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620302129?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275220302903?idApp=UINPBA00008Z" "url" => "/26662752/0000009500000006/v1_202012150903/S2666275220302903/v1_202012150903/pt/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S0365059620302130" "issn" => "03650596" "doi" => "10.1016/j.abd.2019.11.016" "estado" => "S300" "fechaPublicacion" => "2020-11-01" "aid" => "250" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "crp" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">What is your diagnosis?</span>" "titulo" => "Case for diagnosis. Eyelid edema and erythematous papules disseminated on the face" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "754" "paginaFinal" => "756" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1041 "Ancho" => 905 "Tamanyo" => 178733 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Erythematous papules on the malar areas, forehead and chin. Plaques formed by coalescence of papules on both eyelids.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ana Cristina M. Garcia, Ângela Marques Barbosa, Marilda Aparecida Milanez Morgado de Abreu, Carlos Zelandi Filho" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Ana Cristina M." "apellidos" => "Garcia" ] 1 => array:2 [ "nombre" => "Ângela Marques" "apellidos" => "Barbosa" ] 2 => array:2 [ "nombre" => "Marilda Aparecida Milanez Morgado de" "apellidos" => "Abreu" ] 3 => array:2 [ "nombre" => "Carlos Zelandi" "apellidos" => "Filho" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275220302915" "doi" => "10.1016/j.abdp.2020.09.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275220302915?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620302130?idApp=UINPBA00008Z" "url" => "/03650596/0000009500000006/v2_202011230629/S0365059620302130/v2_202011230629/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0365059620302208" "issn" => "03650596" "doi" => "10.1016/j.abd.2020.04.010" "estado" => "S300" "fechaPublicacion" => "2020-11-01" "aid" => "257" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Dermatology</span>" "titulo" => "Cauliflower-like exophytic mass on the skin: polypoid melanoma. Clinical, dermoscopic, and histologic features" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "748" "paginaFinal" => "750" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 668 "Ancho" => 905 "Tamanyo" => 223249 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">(A) Histopathology shows fibroepithelial branches subdividing the tumor into lobules. Pigment distribution is irregular, both in terms of quantity and depth. Pleomorphic vessels and ulceration are visible throughout the lesions. (B) Histological findings include ulceration, atypical polymorphic vessels with scattered depositions of pigment, and absence of rete ridges. Inflammatory infiltrate is scarce.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ambra Di Altobrando, Annalisa Patrizi, Emi Dika, Francesco Savoia" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Ambra" "apellidos" => "Di Altobrando" ] 1 => array:2 [ "nombre" => "Annalisa" "apellidos" => "Patrizi" ] 2 => array:2 [ "nombre" => "Emi" "apellidos" => "Dika" ] 3 => array:2 [ "nombre" => "Francesco" "apellidos" => "Savoia" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275220302988" "doi" => "10.1016/j.abdp.2020.09.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275220302988?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620302208?idApp=UINPBA00008Z" "url" => "/03650596/0000009500000006/v2_202011230629/S0365059620302208/v2_202011230629/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">What is your diagnosis?</span>" "titulo" => "Case for diagnosis. Phagedenic ulcer on the thorax" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "751" "paginaFinal" => "753" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Isabella Lemos Baltazar, Flávia Regina Ferreira, Mariana Galhardo Tressino, Fernanda da Rocha Gonçalves" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Isabella Lemos" "apellidos" => "Baltazar" "email" => array:1 [ 0 => "isabellalb@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Flávia Regina" "apellidos" => "Ferreira" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Mariana Galhardo" "apellidos" => "Tressino" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Fernanda da Rocha" "apellidos" => "Gonçalves" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Dermatology Service, Hospital Municipal Universitário de Taubaté, Taubaté, SP, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Medicine, Universidade de Taubaté, Taubaté, SP, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Hospital do Servidor Público Estadual, São Paulo, SP, Brazil" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1128 "Ancho" => 905 "Tamanyo" => 156128 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">CK7-positive epithelial cells (Immunohistochemistry, x100).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Case report</span><p id="par0005" class="elsevierStylePara elsevierViewall">A female patient, 64 years old, mixed race, complained of a lesion in the right nipple for eight years. On examination, she presented a phagedenic ulcer, of approximately 45<span class="elsevierStyleHsp" style=""></span>cm in the largest diameter, with infiltrated and irregular erythematous-violaceous borders, extending from the left breast, across the right hemithorax, where tumoral lesion and extension of the ulcer to the right dorsum were observed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). She denied personal and family history of breast cancer. Incisional biopsies at the border of the ulceration and in the tumor showed evidence of malignant neoplasia restricted to the epidermis, exulcerated, and characterized by the presence of numerous individualized atypical epidermal cells, with large nuclei and clear cytoplasm (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The immunohistochemical panel was negative for estrogen and progesterone receptors and revealed a 3+/3 positive (score 3+) membrane pattern for c-erbB-2 and CK7 (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">What is your diagnosis?</span><p id="par0010" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">a)</span><p id="par0015" class="elsevierStylePara elsevierViewall">Squamous cell carcinoma</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">b)</span><p id="par0020" class="elsevierStylePara elsevierViewall">Skin metastasis from breast cancer</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">c)</span><p id="par0025" class="elsevierStylePara elsevierViewall">Paget's disease</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">d)</span><p id="par0030" class="elsevierStylePara elsevierViewall">Pyoderma gangrenosum</p></li></ul></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">Paget's disease (PD) of the breast is an uncommon disease, accounting for 0.5–5% of all breast carcinomas.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> It is usually observed in postmenopausal women.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Clinically, it presents as an erythematous or eczematoid lesion, with irregular borders, usually limited to the nipple or spreading to the areola; in advanced cases, it can also involve the surrounding skin. Pain or itching are frequent.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">It is associated with underlying breast cancer in 92–100% of the cases.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a> Approximately 50% present a palpable mass in the breast, usually an associated carcinoma.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,6</span></a> Patients who do not have a palpable mass are likely to have ductal carcinoma <span class="elsevierStyleItalic">in situ.</span><a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Biopsy for histopathological and immunohistochemical examination is the gold standard for diagnosing this condition.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Histologically, the classic pattern comprises large oval or round intraepidermal cells with clear and broad cytoplasm, and pleomorphic and hyperchromatic nuclei. Paget cells are most often located in the lower layers of the epidermis, as single cells or as clusters of cells that form structures similar to glands or nests.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The immunohistochemical profile corroborates the diagnosis and assists in the differentiation from other entities; furthermore, it defines the cell of origin in PD. Paget cells are positive for CK7 in almost all cases, and are not reactive with CK20. They are often negative for estrogen and progesterone receptors, because the underlying carcinomas tend to be poorly differentiated.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,8,9</span></a> The c-erbB-2 oncoprotein is overexpressed in the majority (>90%) of cases of mammary PD, a finding also observed in the present case. In many patients, a correlation is observed between the positivity of c-erbB-2 oncoprotein in the Paget cells and in the underlying intraductal <span class="elsevierStyleItalic">in situ</span> or invasive breast carcinoma.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Due to the clinical similarity of PD with other dermatoses, the differential diagnosis must include atopic or contact dermatitis, Bowen's disease, superficial basal cell carcinoma or superficial spreading melanoma, and psoriasis, diagnostic hypotheses that were not applicable to the present case.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">As a general rule, in any chronic dermatosis of the nipple or areola, the skin should be examined histologically for a conclusive diagnosis.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> The dermatologist and the gynecologist play a fundamental role in the early diagnosis of PD; by paying due attention to the patient complaints and performing a complete physical examination, they can impact the prognosis of these patients.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The present case was referred for specialized oncologic follow-up.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Financial support</span><p id="par0080" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Authors’ contributions</span><p id="par0085" class="elsevierStylePara elsevierViewall">Isabella Lemos Baltazar: Approval of the final version of the manuscript; elaboration and writing of the manuscript; intellectual participation in propaedeutic and/or therapeutic conduct of studied cases; critical review of the literature; critical review of the manuscript.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Flávia Regina Ferreira: Approval of the final version of the manuscript; elaboration and writing of the manuscript; intellectual participation in propaedeutic and/or therapeutic conduct of studied cases; critical review of the literature; critical review of the manuscript.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Mariana Galhardo Tressino: Approval of the final version of the manuscript; elaboration and writing of the manuscript.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Fernanda da Rocha Gonçalves: Approval of the final version of the manuscript; intellectual participation in propaedeutic and/or therapeutic conduct of studied cases; critical review of the manuscript.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1418424" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1297633" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Case report" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "What is your diagnosis?" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Financial support" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Authors’ contributions" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-11-14" "fechaAceptado" => "2020-03-05" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1297633" "palabras" => array:3 [ 0 => "Breast" 1 => "Neoplasms" 2 => "Paget's disease, mammary" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Paget's disease is a rare disorder of the nipple and/or the areola that is characterized by an erythematosquamous lesion and is often associated with <span class="elsevierStyleItalic">in situ</span> or invasive breast carcinoma. The authors present an atypical, exuberant case that had evolved over eight years, emphasizing the importance of early diagnosis.</p></span>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "⋆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Baltazar IL, Ferreira FR, Tressino MG, Gonçalves FR. Case for diagnosis. Phagedenic ulcer on the thorax. An Bras Dermatol. 2020. <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.abd.2020.03.012">https://doi.org/10.1016/j.abd.2020.03.012</span></p>" ] 1 => array:2 [ "etiqueta" => "⋆⋆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Hospital Municipal Universitário de Taubaté, Taubaté, SP, Brazil.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 676 "Ancho" => 905 "Tamanyo" => 122699 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Chest and abdomen on the right side: extensive ulcer with infiltrated, irregular, erythematous-violaceous borders. Lateral of the trunk: vegetative erythemato-ulcerated tumor.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1207 "Ancho" => 905 "Tamanyo" => 282004 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Epidermis showing infiltration by atypical epithelial cells with broad and clear cytoplasm (Hematoxylin & eosin, x100).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1128 "Ancho" => 905 "Tamanyo" => 156128 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">CK7-positive epithelial cells (Immunohistochemistry, x100).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Paget's disease of the breast" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C. 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| Year/Month | Html | Total | |
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