Letter - Clinical
Case for diagnosis. Unilateral nodule on the nipple: erosive adenomatosis of the nipple
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Multiple nodules on the scrotum: verruciform xanthomas" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "845" "paginaFinal" => "847" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 1275 "Ancho" => 1675 "Tamanyo" => 234240 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Detail of histopathology: The dermal papillae are covered by numerous foamy histiocytes with increased number of capillaries</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Natsuko Matsumura, Toshiyuki Yamamoto" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Natsuko" "apellidos" => "Matsumura" ] 1 => array:2 [ "nombre" => "Toshiyuki" "apellidos" => "Yamamoto" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275223001856" "doi" => "10.1016/j.abdp.2023.06.020" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223001856?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S036505962300154X?idApp=UINPBA00008Z" "url" => "/03650596/0000009800000006/v2_202310301240/S036505962300154X/v2_202310301240/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Clinical</span>" "titulo" => "Case for diagnosis. Unilateral nodule on the nipple: erosive adenomatosis of the nipple" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "847" "paginaFinal" => "849" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Raúl Gerardo Mendez-Flores, Karen Uriarte-Ruiz, María Elisa Vega-Memije, Daniela Ruiz-Gomez, Sonia Toussaint-Caire" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Raúl Gerardo" "apellidos" => "Mendez-Flores" "email" => array:1 [ 0 => "mendezfloresdr@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" => "Karen" "apellidos" => "Uriarte-Ruiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "María Elisa" "apellidos" => "Vega-Memije" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Daniela" "apellidos" => "Ruiz-Gomez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Sonia" "apellidos" => "Toussaint-Caire" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Dermatopathology, General Hospital “Dr. Manuel Gea González”, Mexico City, Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Dermatology, General Hospital “Dr. Manuel Gea González”, Mexico City, Mexico" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1881 "Ancho" => 3341 "Tamanyo" => 1456695 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Histology showing a well-circumscribed, non-encapsulated dermal glandular proliferation (Hematoxylin & eosin, ×100). (B‒C) Ductal structures lined with cuboidal epithelial cells, which present apocrine secretory projections on its luminal border (Hematoxylin & eosin, ×400)</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 44-year-old Hispanic woman came to our dermatology clinic with an asymptomatic exophytic lesion on her right nipple that had been present for two years. There was no family history of breast cancer. The lesion started as a small erythematous plaque that gradually grew and developed a focal erosion. On dermatological examination, a 1.0<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>1.0<span class="elsevierStyleHsp" style=""></span>cm hard erythematous ill-defined lesion with a central erosion was noticed. Dermoscopy showed pink-white clouds and red structureless areas (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). There was no lymphadenopathy or nipple retraction.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">An incisional biopsy of the right nipple was performed. Histopathology revealed a well-circumscribed dermal tumor with adenomatous and papillary configuration. The tumor consisted of multiple ductal structures lined by a double layer of columnar eosinophilic cells, some of which showed secretion by cell decapitation. A basal layer of myoepithelial cells was present. A ductal opening communicated with the surface epithelium at one end. No cellular atypia or pleomorphism was noticed (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">What is your diagnosis?</span><p id="par0105" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">a)</span><p id="par0015" class="elsevierStylePara elsevierViewall">Paget's disease of the breast;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">b)</span><p id="par0020" class="elsevierStylePara elsevierViewall">Contact dermatitis;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">c)</span><p id="par0025" class="elsevierStylePara elsevierViewall">Ductal carcinoma;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">d)</span><p id="par0030" class="elsevierStylePara elsevierViewall">Erosive adenomatosis of the nipple.</p></li></ul></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">Erosive Adenomatosis of the Nipple (EAN), also known as nipple adenoma, papillary adenoma of the nipple, or florid papillomatosis, is an uncommon benign epithelial tumor that originates from the lactotrophic ducts of the nipple-areola complex. It was first reported as a benign intraductal papilloma in 1951 by Haagensen et al.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Like our patient, it affects middle-aged women, with an average age of 43 to 45 years which is uncommon in men.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Clinically it presents as an erythematous unilateral mass with a partial or complete erosion with serous or serosanguineous discharge. In advanced stages, the nipple becomes enlarged, thickened, and indurated and may present as a big exophytic mass.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Mammary Paget disease may also present with a nipple tumor with erosion and serosanguineous discharge, and it is often associated with ductal carcinoma in situ.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Thus, the most important differential diagnoses include mammary Paget's disease and breast ductal carcinoma, however other inflammatory (contact dermatitis eczema) and infectious diseases may mimic EAN.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The histological findings are the most valuable evidence in differentiating EAN from these inflammatory and malignant mammary tumors. Histopathology reveals a glandular, well-circumscribed, non-encapsulated proliferation coated by a characteristic double layer of cells composed of an external layer of cubic or flattened myoepithelial cells and an internal layer of cuboidal or cylindrical epithelial cells, which can present apocrine secretory projections on its luminal border.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The absence of cytologic atypia is an important feature.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Surgical excision with nipple resection is the therapy of choice. The Mohs micrographic surgery and nipple splitting enucleation procedure can entirely remove the tumor while preserving the appearance and functionality of this vital location.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Other authors have reported favorable treatment outcomes with cryosurgery and photodynamic therapy.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Identification of this lesion is critical because of clinical and therapeutic implications, unnecessary mastectomy or extensive surgeries may be carried out if misdiagnosed. Our patient was treated with complete excision of the tumor with no recurrence in a 1-year follow-up.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Financial support</span><p id="par0070" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Authors' contributions</span><p id="par0075" class="elsevierStylePara elsevierViewall">Raúl Gerardo Mendez Flores: Writing of the manuscript or critical review of important intellectual content; effective participation in the research guidance; final approval of the final version of the manuscript.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Karen Uriarte Ruiz: Critical review of the literature; writing of the manuscript or critical review of important intellectual content.</p><p id="par0085" class="elsevierStylePara elsevierViewall">María Elisa Vega Memije: Effective participation in the research guidance; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Daniela Ruiz Gomez: Critical review of the literature; writing of the manuscript or critical review of important intellectual content.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Sonia Toussaint Caire: Critical review of the literature; writing of the manuscript or critical review of important intellectual content.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "What is your diagnosis?" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Financial support" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Authors' contributions" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-07-03" "fechaAceptado" => "2022-09-01" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the General Hospital “Dr. Manuel Gea González”, Mexico City, Mexico.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1648 "Ancho" => 2925 "Tamanyo" => 606580 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) A firm nodule with a central erosion on the right nipple. (B) Dermoscopy showed pink-white clouds and red structureless areas</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" => 1881 "Ancho" => 3341 "Tamanyo" => 1456695 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Histology showing a well-circumscribed, non-encapsulated dermal glandular proliferation (Hematoxylin & eosin, ×100). (B‒C) Ductal structures lined with cuboidal epithelial cells, which present apocrine secretory projections on its luminal border (Hematoxylin & eosin, ×400)</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" => "Adenoma of the nipple: a mimic of breast malignancy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Quintana-Codina" 1 => "N. Pérez-Muñoz" 2 => "M.T. Fernández-Figueras" 3 => "A. Altemir" 4 => "M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 15 | 10 | 25 |
| 2024 October | 140 | 80 | 220 |
| 2024 September | 192 | 90 | 282 |
| 2024 August | 192 | 110 | 302 |
| 2024 July | 184 | 110 | 294 |
| 2024 June | 132 | 70 | 202 |
| 2024 May | 143 | 64 | 207 |
| 2024 April | 134 | 94 | 228 |
| 2024 March | 122 | 65 | 187 |
| 2024 February | 117 | 95 | 212 |
| 2024 January | 132 | 69 | 201 |
| 2023 December | 622 | 76 | 698 |
| 2023 November | 258 | 163 | 421 |
| 2023 October | 273 | 106 | 379 |
| 2023 September | 85 | 75 | 160 |
| 2023 August | 50 | 37 | 87 |
| 2023 July | 59 | 53 | 112 |
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