Case Report: Papillary-Areola Complex Lesions. How To Solve Them?

Abstract

INTRODUCTION: our daily practice in those public- privates services show us an approach sometimes inadequate for the diagnosis and treatment of the lesions of the papillary-areola complex (MAC), Among the differential diagnoses found on the skin, for example nipple eczema, psoriasis, superficial basal cell carcinoma, melanoma (when pigmented), papillary adenoma, adenoma seringomatoso, syphilitic chancre, scabies, Bowen s disease, Paget s disease. Clinical aspects often can be mistaken, delaying an appropriate treatment for that patient. REPORT: female patient, 42 years old, white, born in Rio de Janeiro, teacher. Menarche at 10 years; child 3, with pruritus and hyperemia periareolar on the left breast, with three years of evolution that did not improve with any anti-inflammatory drugs and antibiotics. The papilla area had mild hyperemia associated with complaints of itching. He had no palpable nodules or spontaneous nipple discharge. A mammogram showed pleomorphic microcalcifications, occupying the central area; and one dense area, irregular, measuring 11 mm in the subareolar region of the left breast. Rating BIRADS 4C. Excised biopsy of the papilla was performed with a diagnosis of Paget s disease of the breast. A simple mastectomy was the surgical choice because of associated pleomorphic microcalcifications. The pathology evaluation was conclusive for infiltrating ductal breast carcinoma with areas of comedo type necrosis, free surgical margins. Commitment of the nipple skin with an appearance of Paget s disease of the breast. DISCUSSION: The differential diagnosis of different lesions of MAC and its forms of treatment should be carefully recognized, as well as different forms of therapeutic approaches.