[Pathoanatomical algorithm for differential diagnosis of Paget's disease of the breast]. / Patologo-anatomicheskii algoritm differentsial'noi diagnostiki bolezni Pedzheta molochnoi zhelezy.

Paget's disease of the breast is a rare type of cancer that affects the skin of the nipple and usually the areola. At the same time, most patients also have one or more tumors in the immediate vicinity of the focus of mammary Paget's disease. This tumor must be distinguished from normal or atypical Toker cells, and also differentiated from diseases such as Bowen's disease of the nipple and melanocytic lesions of the nipple and areola region, including nipple melanoma and BAP1-inactivated nevus (Wiesner nevus). Currently, there is no routine pathological diagnostic algorithm for these conditions. The aim of the work is to formulate a clear clinical and morphological algorithm for diagnosing Paget's disease of the breast and Toker cells, Bowen's disease of the nipple and areola, as well as melanoma and BAP1-inactivated nevi of the above localizations. Surgical material obtained from patients with Paget's disease of the breast (18), Toker cells of the nipple (2), Bowen's disease of the nipple (6), melanoma of the nipple (1), BAP1-inactivated nevus (1) was studied. The material was examined histologically with hematoxylin and eosin staining, Alcian blue and PAS reaction, as well as immunohistochemically with the following panel of antibodies: CD138, p53, CK8, CK7, HER2/neu, EMA, HMB-45, Melan A, S-100, p63, p16 and BAP1. An easy-to-learn pathoanatomical algorithm for diagnosing Paget's cancer has been developed, which will be especially useful for pathologists who encounter pathology of the nipple and areola in their work.

[Vulva anatomopathological peculiarities]. / Particularités anatomo-pathologiques de la vulve.

The vulva is the transition zone between the skin and the lower genital tract. As such, it presents histological specificities, comprises physiological modifications which are specific to it and is characterized by particular artifacts. Knowledge of them prevents many questions or even diagnostic errors.

Toker cell hyperplasia in Zuska disease: A tricky association.

Toker cells (TCs) are sometimes present in the nipple epidermis as oval cells with pale cytoplasm and roundish nuclei. In most cases, TCs may be easily distinguished from cancerous cells of Paget disease of the nipple (PCs). Especially in TC hyperplasia, in which mild-to-moderate atypia may be present, it may be challenging to distinguish between TCs and PCs. The combination of chronic inflammatory changes in the nipple, in the context of Zuska disease, and TC hyperplasia, may easily lead to an erroneous diagnosis of mammary Paget disease.

Mammary Paget's Disease: An Update.

Mammary Paget's Disease is a non-invasive cutaneous malignancy of the breast involving the nipple-areolar complex that is commonly mistaken for benign breast conditions, leading to delay in diagnosis. This review article discusses Paget's disease etiology, clinical presentation, differential diagnosis, diagnostic work-up, natural history and prognosis. This article also discusses evolving strategies for the surgical and non-surgical management of Paget's disease.

Benign breast lesions that mimic malignancy.

Many benign and reactive lesions of the breast show morphological overlap with malignant lesions. These benign mimics of malignancy often present diagnostic challenges to even the most experienced pathologists. This review focuses on several benign lesions of the breast that mimic malignant entities. For each of these lesions, we describe the key morphological and immunohistochemical features, potential diagnostic pitfalls, and our approach to arriving at the correct diagnosis.

Lesions of the Nipple.

Because of the singular anatomic structure of the nipple, some breast lesions only occur at this site. The overlying skin includes normal Toker cells near the duct orifices. These cells are occasionally so numerous as to be called Toker cell hyperplasia. Ductal carcinoma in situ (DCIS) may involve nipple skin by direct extension from the underlying ducts (Paget disease of the nipple). The numerous skin appendages (eg, sebaceous, apocrine, and eccrine glands(1)) in the nipple and areola are the likely origin of syringomatous adenomas. At the duct orifices, the normal squamous epithelium dips into the breast for a short distance and abruptly transitions to glandular luminal and myoepithelial cells. When keratin-producing cells extend deeper into the ducts, the condition of squamous metaplasia of lactiferous ducts (SMOLD) results. With age, the lactiferous sinuses are subject to weakened duct walls, inspissated secretions, and rupture, which result in the inflammatory masses or nipple discharge associated with duct ectasia. Superficial epithelial proliferations within the large lactiferous sinuses form nipple adenomas, and deeper proliferations often result in large-duct papillomas. Below the areola is a supporting smooth muscle layer that can give rise to leiomyomas, although these tumors are extraordinarily rare. The proximity of these lesions to the skin results in the majority of them presenting as palpable masses, skin changes, or nipple discharge. Biopsy specimens from these lesions may be small, superficial, or fragmented because of concern about maintaining the cosmetic appearance of the nipple and areola. Knowledge of the location of the biopsy, and the clinical presentation, is often essential in making the correct diagnosis.