Pigmented macule on the nipple
Pigmented macule on the nipple
复制标题
乳头上有色素斑
DOI：
10.1111/ced.12647
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发表时间：
2015
影响因子：
4.1
通讯作者：
Okuyama R
中科院分区：
文献类型：
--
作者：
Asai Y;Minagawa A;Koga H;Okuyama R
MPD是一种与潜在乳腺癌相关的乳头肿瘤，由James佩吉特爵士于1874年首次描述。1通常为粉红色鳞状红斑;然而，一种罕见的变体，色素性MPD，表现为褐色斑。迄今为止，已报告了约40例色素性MPD病例。虽然色素沉着的机制尚未完全了解，但一种可能的解释是周围的黑色素细胞将黑色素颗粒转移到佩吉特细胞。2皮肤镜下可见蓝白色的面纱和不规则的点/小球，鉴别诊断为恶性黑色素瘤。然而，皮肤镜下黑色素细胞病变的特征并不一定出现在乳头上，因为它的生理色素沉着。在这种情况下，当色素斑位于乳头上时，也应该考虑色素性MPD。由于MM在乳头上没有显示出特定的特征，因此很难通过皮肤镜将色素性MPD与MM区分开来。3据我们所知，迄今为止已报告了6例色素性MPD的皮肤镜检查结果。其中5例表现为不规则色素沉着，4例表现为不规则点/球和蓝白色结构，包括蓝白色面纱和退化结构。3-6这六个病例的皮肤镜特征与我们的病例相似，在皮肤镜下与MM无法区分。色素性MPD和MM的组织病理学结果也相似。大的非典型肿瘤细胞，核深染，苍白（a）（B）（c）（d）
DiscussionMPD, which is a neoplasm on the nipple associated with underlying breast cancer, was first described in 1874 by Sir James Paget. 1 It is generally a pinkish, scaly erythema; however, a rare variant, pigmented MPD, presents as a brownish macule. Approximately 40 cases of pigmented MPD have been reported to date. Although the mechanism underlying the pigmentation is not yet fully understood, one possible explanation is that the surrounding melanocytes transfer melanin granules to the Paget cells. 2 The differential diagnosis of this case included malignant melanoma (MM) because of the presence of the blue–whitish veil and irregular dots/globules under dermoscopy. However, dermoscopic features specific for melanocytic lesions are not necessarily seen on the nipple because of its physiological pigmentation. As in this case, pigmented MPD should also be considered when the pigmented macule is located on the nipple. Because MM does not show specific features on the nipple, it is difficult to distinguish pigmented MPD from MM by dermoscopy. 3 To our knowledge, six cases of pigmented MPD have been reported to date with dermoscopic findings. Five of these cases presented with irregular pigmentation, and four cases presented with irregular dots/globules and blue–white structures, including blue–white veil and regression structures. 3–6 These six cases showed dermoscopic features similar to our case, and were indistinguishable from MM under dermoscopy. The histopathological findings are also similar between pigmented MPD and MM. Large atypical tumour cells with hyperchromatic nuclei and pale (a)(b)(c)(d)