Mammary Paget Disease With Melanocytic Proliferation Mimicking Malignant Melanoma in situ: A Case Report

Rao, S.; Wang, Alun; Liu, Wei; Yin, Hongling; Li, Ji; Tsang, Lemuel Shui‐Lun; Wu, Yahong; Shi, Wei

doi:10.3389/fmed.2022.839954

Cited by 5 publications

(8 citation statements)

References 17 publications

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“…This case demonstrates a rare example of a CD30+ lymphoproliferative disorder masquerading as an atypical melanocytic proliferation, both clinically and histopathologically. There are a small number of non‐melanocytic tumors that can mimic melanoma in situ on histopathologic grounds, including pigmented squamous cell carcinoma in situ (Bowen disease) and extramammary Paget disease 4–6 . However, the differential diagnosis for pigmented neoplasms and epidermotropic CD30+ T‐cells rarely overlap.…”

Section: Discussionmentioning

confidence: 99%

“…There are a small number of non-melanocytic tumors that can mimic melanoma in situ on histopathologic grounds, including pigmented squamous cell carcinoma in situ (Bowen disease) and extramammary Paget disease. [4][5][6] However, the differential diagnosis for pigmented neoplasms and epidermotropic CD30+ T-cells rarely overlap. The latter generally includes ALCL, lymphomatoid papulosis (LyP) type B, mycosis fungoides, and other cutaneous T-cell lymphomas, including primary cutaneous aggressive epidermotropic cytotoxic T-cell lymphoma.…”

Section: Discussionmentioning

confidence: 99%

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CD30+ lymphoproliferative disorder masquerading as an atypical melanocytic proliferation

Hernandez‐Rovira,

Lama,

Musiek

et al. 2023

J Cutan Pathol

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Heuristics are cognitive strategies used to facilitate decision‐making. They can be helpful tools for expediting pathologic diagnoses, however, they can also affect judgment and lead to biases that guide the pathologist astray. We report the case of a 52‐year‐old female who presented with two unusual pigmented lesions on the wrist and thigh that clinically and histopathologically resembled an atypical melanocytic proliferation. A biopsy of the thigh revealed a broad proliferation of large, atypical cells forming nests within a heavily pigmented epidermis. The lesion was initially misdiagnosed as melanoma in situ, despite equivocal staining for melanocytic markers, likely due to anchoring and adjustment as well as availability biases, which restricted the differential diagnosis and limited the selection of immunohistochemical stains. It was later discovered through chart review that the patient had a prior history of a cutaneous CD30+ lymphoproliferative disorder, which eventually led to the appropriate diagnosis in this case. Herein, we highlight a rare and unusual presentation of a pigmented epidermotropic CD30+ lymphoproliferative disorder, along with the biases leading to its misdiagnosis and the steps leading to the revelation of the actual diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

CD30+ lymphoproliferative disorder masquerading as an atypical melanocytic proliferation

Hernandez‐Rovira,

Lama,

Musiek

et al. 2023

J Cutan Pathol

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“…Recently, a similar case was stained with dual-labeling (PHH3 and Melan-A) and showed negative PHH3 labeling for the melanocytes, which indicated that the melanocytes were not undergoing mitosis. 18 Things may get even more complicated in the case of pigmented triple-negative breast cancers, as SOX10 also labels primary breast carcinomas, particularly those with the basal-like, triple-negative phenotype. [19][20][21] In this particular circumstance, it is imperative to meticulously evaluate suitable immunohistochemical stains.…”

Section: Discussionmentioning

confidence: 99%

“…Dendritic melanocytes are seen admixed within neoplastic cells, adding to the confusion, but can be identified using SOX10 and S100. Recently, a similar case was stained with dual‐labeling (PHH3 and Melan‐A) and showed negative PHH3 labeling for the melanocytes, which indicated that the melanocytes were not undergoing mitosis 18 . Things may get even more complicated in the case of pigmented triple‐negative breast cancers, as SOX10 also labels primary breast carcinomas, particularly those with the basal‐like, triple‐negative phenotype 19–21 .…”

Section: Discussionmentioning

confidence: 99%

Melanocyte colonization and pigmentation of breast carcinoma: A case report

Khazaeli,

Maruthi,

See

et al. 2023

J Cutan Pathol

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Pigmented mammary Paget disease is a rare variant of mammary Paget disease that is often clinically misdiagnosed as a melanocytic lesion of the skin or nipple–areolar complex. Careful morphological assessment, along with the performance of adequate immunohistochemical stains, will help in achieving the right diagnosis and avoiding misdiagnosis of the entity as malignant melanoma. We report a rare case of pigmented mammary Paget disease with concomitant colonization of the underlying invasive ductal carcinoma by melanocytes mimicking melanoma.

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“…As it was stated by Rao et al, the combined presence of neoplastic ductal cells and atypical melanocytes in a unique sample might occur due to the existence of a single mammary tumor of breast origin, undergoing bidirectional dedifferentiation [ 23 ]. Furthermore, the melanocytic population objectified in the epidermal layer was one of the prominent elements that raised the differential diagnosis challenge.…”

Section: Discussionmentioning

confidence: 99%

HER2 Negative Mammary Paget’s Disease or In Situ Melanoma? A Case Report and Review of the Literature

Boșoteanu

Aşchie

Orășanu

et al. 2023

Case Reports in Pathology

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Mammary Paget’s disease (MPD) is a rare histological condition, accounting for 1-4% of female breast cancers, which may appear either independently (1.4-13% of the cases), or in association with an in situ or invasive ductal carcinoma (approximately 90% of the cases). The purpose of this article is to highlight the histopathological challenges related to the microscopical polymorphism of this disease and the utmost importance of immunohistochemistry in the thorough process of Paget’s disease differential diagnosis. Moreover, the primary objective of this review of literature was to corroborate the existing data concerning the potential peculiar immunohistochemical profile that mammary Paget’s disease might express. We report the case of a 44-year-old female patient, histopathologically diagnosed with HER2-negative MPD accompanying an invasive mammary carcinoma. The histopathological and immunohistochemical approach is derived from the exigency of excluding the possibility of synchronous tumors—a mammary invasive carcinoma, accompanied by another component with MPD phenotypic mimicry. The unexpected negative HER2 reaction is conducted to a primary focus on excluding a malignant melanoma in situ. The absence of MelanA and S100 immunoexpression and lack of pigmentation and clinical aspects infirmed it. Bowen’s disease was invalidated by its rare presentation in the breast cutaneous tissue and the absence of individual risk factors suggestive of an existing immunosuppressive status. In the case of similar morphoimmunohistochemical aspects, significant expression of Ki-67 signals MPD, an immunoreactivity that helped distinguish the cellular population from Toker cells. The great similarity of MPD with other benign and malignant cutaneous tumors might determine delay or misdiagnosis. Thus, the utmost importance of immunohistochemistry is reflected in its prognostic significance and geared towards extending the therapeutic arsenal.

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Mammary Paget Disease With Melanocytic Proliferation Mimicking Malignant Melanoma in situ: A Case Report

Cited by 5 publications

References 17 publications

CD30+ lymphoproliferative disorder masquerading as an atypical melanocytic proliferation

CD30+ lymphoproliferative disorder masquerading as an atypical melanocytic proliferation

Melanocyte colonization and pigmentation of breast carcinoma: A case report

HER2 Negative Mammary Paget’s Disease or In Situ Melanoma? A Case Report and Review of the Literature

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