PMC3699953_01
Case 1: A - A bright-red, lobulated plaque with an oozing-surface on
the left nipple and areola (original presentation in 2004); B -
Bright erythematous, eczematoid plaque with a slightly mamillated surface and
ill-defined hyperchromatic margins (year 2010); C - Psoriasiform
hyperplasia with diffuse clear-cell change of keratinocytes in the Malpighian
layer and fusion of rete ridges (H-E, original magnification 100x); D
- Clear cells stained in red, basal cell layer spared (PAS, original
magnification 100x); E - Clear cells failed to stain with PAS after
diastase digestion (PAS-diastase, original magnification 100x); F -
Intense expression of EMA by clear cells (EMA immunoperoxidase, original
magnification 100x)
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Dermatological examination revealed a well-demarcated, bright-red, lobulated plaque with an oozing surface on the nipple and areola measuring 4x4 cm (Figure 1A). During a follow-up consultation in 2010, the persistent lesion showed a much larger size of approximately 10x8 cm, a slightly raised, mamillated, wet, and scarcely squamous surface, and some expansion to the surrounding skin (Figure 1B). Although a diagnosis of nipple eczema had been clinically favored, a diagnosis of CCA was proposed after a new biopsy with routine PAS/PAS-diastase and immunohistochemical stainings was performed, as well as a reassessment of recuts from the first biopsy block (Figures 1C-F).
PMC3699953_02
Case 2: A - Somewhat raised, infiltrated plaque on the left
nipple/areola with eroded, wet surface and well-defined margins; B -
Elongated, fusioned, club shaped rete ridges with numerous clear cells. Note
papillary-dermal edema, elongated capillaries, and inflammatory cell infiltrate
(H-E, original magnification 100x); C - Eroded epidermis, congestive
capillaries, and erythrocyte extravasation beside an acantotic epidermis with
intense clear-cell change; D - Neutrophils scattered among clear
cells (H-E, original magnification 400x); E - Mixed interstitial and
perivascular inflammatory cell infiltrate composed of lymphocytes and numerous
eosinophils (H-E, original magnification 400x); F - Intense
expression of EMA by clear cells (EMA immunoperoxidase, original magnification
100x)
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On examination, a 2.0 x 2.5 cm erythematous, infiltrated, erosive plaque with distinct borders and scant clear fluid secretion was observed on the left nipple and areola (Figure 2A). Given the previous experience with case #1 , a clinical diagnosis of CCA was considered and finally confirmed by histology and immunohistochemistry (Figures 2B-F).
PMC3699953_03