What is your diagnosis?
Case for diagnosis. An exophytic plaque on the chest. Carcinoma of the mammary crease
Sonsoles Yáñez-Díaz, Marcos A. González-López
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Dermatology Service, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Cantabria, Spain
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An exophytic plaque on the chest. Carcinoma of the mammary crease" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "771" "paginaFinal" => "773" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Sonsoles Yáñez-Díaz, Marcos A. González-López" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Sonsoles" "apellidos" => "Yáñez-Díaz" ] 1 => array:4 [ "nombre" => "Marcos A." "apellidos" => "González-López" "email" => array:1 [ 0 => "marcosg@aedv.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Dermatology Service, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Cantabria, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 551 "Ancho" => 1500 "Tamanyo" => 150837 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Immunohistochemical staining of the lesion. (a), Positive immunostaining for estrogen receptors (×20). (b), Positive immunostaining for progesterone receptors (×20).</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">An 88-year-old woman was referred to our Department for evaluation of a cutaneous lesion on the chest. The lesion first appeared approximately 10 years ago and had gradually grown over time. She reported that the lesion was asymptomatic, although it bled several times in the last months. Dermatological examination revealed an exophytic, firm, infiltrated, erythematous-purple plaque measuring 6 × 4 cm in the median mammary crease, spreading to both inframammary creases and upper abdomen (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The lesion had well-demarcated borders with a scar-like appearance. There were no adenopathies and breast nodules were not palpable.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">A biopsy specimen revealed a dermal infiltrate of atypical cells which formed small solid nests within a myxoid stroma. The tumor cells exhibited large nuclei, prominent nucleoli and abundant eosinophilic cytoplasm (<a class="elsevierStyleCrossRef" href="#fig0010">Fig.2</a>). Immunohistochemically, the neoplastic cells were positive for epithelial membrane antigen (EMA), estrogen receptors (ER) and progesterone receptors (PR) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), and Bcl-2, but were negative for c-erbB-2.</p><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="par0015" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">a)</span><p id="par0020" class="elsevierStylePara elsevierViewall">Basal cell carcinoma</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">b)</span><p id="par0025" class="elsevierStylePara elsevierViewall">Dermatofibrosarcoma protuberans</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">c)</span><p id="par0030" class="elsevierStylePara elsevierViewall">Carcinoma of the mammary crease</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">d)</span><p id="par0035" class="elsevierStylePara elsevierViewall">Squamous cell carcinoma</p></li></ul></p><p id="par0040" class="elsevierStylePara elsevierViewall">The patient was treated with radiotherapy and hormone therapy with tamoxifen with satisfactory results. However, four years later, she was admitted with respiratory failure and progressive deterioration of the general state. A chest X-ray and CT scan showed pleural effusion and bilateral nodular pattern compatible with metastatic spread, and the patient died two months later.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Carcinoma of the mammary crease (CMC) is an unusual variant of breast carcinoma, in which the skin lesions are usually the presenting sign.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> The true incidence of CMC is difficult to estimate, although it may represent about 1% of breast cancers. Despite skin involvement being a striking feature of CMC, it has been very rarely described in dermatology journals.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The early skin involvement in this particular variant of breast cancer would be related to the anatomical characteristics of the inframammary fold that would explain the tendency of the tumor to invade the dermis or the underlying muscle.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> Moreover, in CMC, the breast nodule is not palpable, and it is difficult to detect in mammography because of its peripheral location; therefore, skin manifestations are usually the initial reason for consultation in these patients.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Clinically, CMC may present itself as an ulcerated nodule or as a plaque, polypoid or verrucous lesion, and can simulate an inflammatory lesion, a benign tumor, or a cutaneous carcinoma.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2,4–6</span></a> To this respect, confusion with morpheaform or ulcerated basal cell carcinoma is frequent due to the clinical appearance and chronic course of the lesion, even after histopathological examination.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,5,6</span></a> In these cases, only complete extirpation and/or immunohistochemical study, as in the case presented herein, allow a definitive diagnosis.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,6</span></a> In the present study’s case, immunostaining showed positivity for ER, PR, and Bcl-2, but negativity for c-erbB-2, corresponding to a luminal A subtype of breast cancer.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In summary, this case highlights the prominent role of the dermatologist in the early diagnosis of CMC, which can contribute significantly to an increase in the survival of these patients.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Financial support</span><p id="par0065" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Authors’ contributions</span><p id="par0070" class="elsevierStylePara elsevierViewall">Sonsoles Yáñez-Díaz: 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="par0075" class="elsevierStylePara elsevierViewall">Marcos A. González-López: Approval of the final version of the manuscript; elaboration and writing of the manuscript; critical review of the manuscript.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1612513" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1441657" "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" => "2021-03-22" "fechaAceptado" => "2021-04-10" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1441657" "palabras" => array:3 [ 0 => "Breast neoplasm" 1 => "Carcinoma, skin appendage" 2 => "Neoplasm metastasis" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Carcinoma of the mammary crease is a very rare variant of breast carcinoma, in which the skin lesions are usually the presenting sign. The authors present the case of an 88-year-old woman with an exophytic plaque in the mammary crease of approximately ten years duration. The histopathological and immunohistochemical studies confirmed the diagnosis of infiltrative breast carcinoma (carcinoma of the mammary crease variant). This case highlights the important role of the dermatologist in the early diagnosis of this rare variant of breast cancer.</p></span>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Yáñez-Díaz S, González-López MA. Case for diagnosis. An exophytic plaque on the chest. Carcinoma of the mammary crease. An Bras Dermatol. 2021;96:771–3.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Dermatology Service, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Cantabria, Spain.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1818 "Ancho" => 900 "Tamanyo" => 169257 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A and B), Clinical Image. A 6 × 4 cm, infiltrated, erythematous-purple plaque in the median mammary crease, spreading to both inframammary creases and upper abdomen.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 557 "Ancho" => 750 "Tamanyo" => 106521 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histopathological examination. Neoplastic cells within a myxoid stroma (Hematoxylin & eosin, ×200).</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 551 "Ancho" => 1500 "Tamanyo" => 150837 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Immunohistochemical staining of the lesion. (a), Positive immunostaining for estrogen receptors (×20). (b), Positive immunostaining for progesterone receptors (×20).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Carcinoma of the mammary crease. A neglected clinical entity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "JR Watson" 1 => "CG Watson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "JAMA." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 4 | 6 |
| 2024 October | 87 | 66 | 153 |
| 2024 September | 129 | 89 | 218 |
| 2024 August | 142 | 120 | 262 |
| 2024 July | 137 | 114 | 251 |
| 2024 June | 104 | 102 | 206 |
| 2024 May | 89 | 70 | 159 |
| 2024 April | 96 | 97 | 193 |
| 2024 March | 86 | 73 | 159 |
| 2024 February | 85 | 70 | 155 |
| 2024 January | 72 | 48 | 120 |
| 2023 December | 69 | 65 | 134 |
| 2023 November | 61 | 81 | 142 |
| 2023 October | 52 | 77 | 129 |
| 2023 September | 70 | 81 | 151 |
| 2023 August | 47 | 35 | 82 |
| 2023 July | 58 | 38 | 96 |
| 2023 June | 58 | 40 | 98 |
| 2023 May | 48 | 30 | 78 |
| 2023 April | 29 | 15 | 44 |
| 2023 March | 61 | 49 | 110 |
| 2023 February | 31 | 32 | 63 |
| 2023 January | 44 | 44 | 88 |
| 2022 December | 51 | 33 | 84 |
| 2022 November | 84 | 58 | 142 |
| 2022 October | 65 | 59 | 124 |
| 2022 September | 60 | 61 | 121 |
| 2022 August | 49 | 48 | 97 |
| 2022 July | 42 | 49 | 91 |
| 2022 June | 58 | 55 | 113 |
| 2022 May | 46 | 51 | 97 |
| 2022 April | 59 | 64 | 123 |
| 2022 March | 57 | 81 | 138 |
| 2022 February | 45 | 39 | 84 |
| 2022 January | 99 | 113 | 212 |
| 2021 December | 150 | 108 | 258 |
| 2021 November | 125 | 76 | 201 |
| 2021 October | 46 | 66 | 112 |
| 2021 September | 1 | 0 | 1 |
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