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      Adenomatosis Erosiva Del Pezón: Reporte De Un Caso

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          Abstract

          La adenomatosis erosiva del pezón es una rara entidad benigna de los ductos lactíferos del pezón. Esta enfermedad se ve en la mujer de mediana edad y puede ser asintomática o caracterizada por telorrea, prurito, eritema o nodularidad en el pezón. Esta condición fue reportada por primera vez por Jones en 1955 y desde entonces se han utilizado diferentes términos para describirla, como adenoma papilar, papilomatosis florida, adenoma o adenomatosis del pezón. La enfermedad puede imitar clínicamente e histológicamente diferentes entidades. Las más importantes son el eczema clínico y la enfermedad de Paget. Histológicamente otras condiciones benignas o malignas deben descartarse. Presentamos el caso de una paciente de 47 años de edad con una lesión eritematosa persistente en el pezón derecho, luego de numerosos tratamientos por 18 meses antes de la toma de biopsia incisional. El diagnóstico clínico era enfermedad de Paget. La histología mostró proliferación glandular adenomatosa por lo que se estableció el diagnóstico de adenomatosis erosiva del pezón. La paciente fue sometida a una resección centromamaria amplia incluyendo el pezón.

          Translated abstract

          Erosive adenomatosis of the nipple is a rare benign entity of the lactiferous ducts. The disease arises in middle aged women and can be asymptomatic or characterised by nipple discharge, pruritus, erythema, swelling or nodularity. The condition was first reported by Jones in 1955 and since then numerous terms have been used to describe it, such as papillary adenoma, florid papillomatosis, adenoma or adenomatosis of the nipple. Both clinically and histologically the disease can mimic different conditions. The most important ones are eczema and Paget’s disease. Histologically other benign or malignant tumors must be ruled out. We present the case of a 47 year old female with an 18 month history of a non-healing erythematous lesion of the nipple. The clinical diagnosis was Paget’s disease. The histology showed adenomatous, somewhat atypical glandular proliferation. The diagnosis of erosive adenomatosis of the nipple was established and a central mammary resection that included the nipple was performed.

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          Most cited references26

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          Papillary adenoma of the nipple: analysis of fifteen new cases.

          Fifteen cases of papillary adenoma (florid papillomatosis, erosive adenomatosis) of the nipple were compared with forty examples of syringadenoma papilliferum, twenty-four of hidradenoma papilliferum, and one hundred of breast carcinoma metastatic to skin. Clinically, papillary adenoma of the nipple typically occurred in a female patient as an erosion, ulceration, or mass that was sometimes accompanied by serous or bloody discharge from the nipple and was frequently misdiagnosed as Paget's disease. Histologically, there was usually a papillary and adenomatous growth in the corium that connected with the surface and showed a lining of apocrine type secretory epithelium, a sometimes plasmacytic stroma, and horn cysts in the upper corium. Papillary adenoma of the nipple is often histologically misinterpreted as syringadenoma papilliferum, hidradenoma papilliferum, or low-grade adenocarcinoma, but it has received almost no attention in the dermatology literature.
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            Florid papillomatosis of the nipple. A study of 51 patients, including nine with mammary carcinoma.

            The present study was undertaken to review the pathology of florid papillomatosis (FP) of the nipple and to examine the relationship of FP to breast carcinoma. Clinical features of 49 women studied did not differ appreciably from those noted on prior reports, except that in one instance the lesion was probably congenital. Histologically, three distinct growth patterns were found: sclerosing papillomatosis (17 cases), papillomatosis (12 cases), and adenosis (3 cases). In 17 other cases, mixtures of these proliferative patterns were seen. FP with the sclerosing papillomatosis pattern more frequently had areas of focal necrosis in hyperplastic ducts and scattered mitoses, features that might be interpreted as evidence of carcinoma. No prognostic significance can be attributed to these patterns, since all types were cured by excision with follow-up that averaged 8.3 years. Seven of the 49 women had carcinoma in the same breast as FP: Two women had invasive carcinoma that appeared to arise from FP, and four women had concurrent invasive carcinomas that were separate from the FP; the seventh woman developed diffuse intraductal carcinoma 10 years after FP was excised from the same breast. Three of the seven women were also treated for contralateral breast carcinoma. Also reviewed were lesions from two men who had carcinoma arising in FP. One had intraductal carcinoma with Paget's disease and the other had invasive carcinoma. Appreciation of the diverse histological patterns of FP may be helpful in avoiding an erroneous diagnosis of carcinoma. Features indicative of carcinoma arising in FP are Paget's disease and areas of invasion. FP of the nipple is rarely the substrate for mammary carcinoma and is adequately treated by local excision. Coexistence with carcinoma elsewhere in the same or opposite breast occurs often enough to warrant thorough examination of the breasts when FP of the nipple is diagnosed. The risk of subsequent carcinoma following excision of FP appears to be low, but clinical follow-up is prudent.
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              Papillary adenoma of the nipple (florid papillomatosis, adenoma, adenomatosis). A clinicopathologic study.

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rvo
                Revista Venezolana de Oncología
                Rev. venez. oncol.
                Casa publicadora Ateproca C.A (Caracas )
                0798-0582
                June 2006
                : 18
                : 2
                : 115-119
                Affiliations
                [1 ] INSTITUTO ONCOLÓGICO LUIS RAZETTI
                Article
                S0798-05822006000200009
                3bfae457-cf15-40d1-9d60-7d3f197f007a

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Venezuela

                Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=0798-0582&lng=en
                Categories
                ONCOLOGY

                Oncology & Radiotherapy
                pezón,Breast,adenomatosis,papillary adenoma,papillomatosis,adenoma,nipple,Mama,adenoma papilar,papilomatosis

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