Acta Dermato-Venereologica 99-13CompleteContent | Page 37

QUIZ SECTION 1317 Eczematous, Pruritic, Brownish Plaque of the Nipple and Areola: A Quiz Gloria ORLANDO 1# , Dennis LINDER 1,2# *, Stefano PIASERICO 1 , Mauro ALAIBAC 1 and Roberto SALMASO 3 1 Unit of Dermatology, Department of Medicine – DIMED, University of Padova, Italy, 2 Ben Gurion University of the Negev, Beer Sheva, Israel, and 3 OUC of Histopathology, University of Padova, Padova, Italy. *E-mail: [email protected] # These authors contributed equally. A 17-year-old Caucasian girl presented with a 1-year history of an eczematous, persistent, slowly growing, pruritic lesion on her left nipple and areola. Clinical examination revealed a well-demarcated brownish plaque sprinkled with multiple punctate vascular spots, slightly scaling on the surface (Fig. 1a). There were no relevant anamnestic data to report. The right breast was not affected. As fungal and bacterial cultures were negative and clini- cal features were consistent with nipple eczema, she was ini- tially treated with topical steroid, but with no improvement. A 6-mm punch biopsy revealed a spongiotic and markedly acanthotic epidermis with proliferation of pale keratinocy- tes easily distinguished from normal ones. The epidermal ridges were elongated in a psoriasiform manner and fused, the granular layer was almost absent and the stratum cor- neum showed parakeratosis and serous exudate (Fig. 2a). Clear cells stained positively with the routine periodic- acid-Schiff, indicating the presence of glycogen (Fig. 2b). Intraepidermal portions of the annexes were normal. The underlying dermal papillae showed dilated capillaries and a scarce inflammatory cell infiltrate with predominantly lymphocytes and some granulocytes. Fig. 1. (a) Eczematous, pruritic, brownish plaque on the left nipple and areola of a 17-year-old girl. (b) Complete regression after 6 months of 0.05% topical tretinoin. What is your diagnosis? See next page for answer. Fig. 2. Histological features: (a) Epidermal acanthosis with elongation of the rete ridges and loss of granular layer. Proliferation of pale keratinocytes (clear cells) with bright cytoplasm and normal nuclei (haematoxylin-eosin ×4). (b) Clear cells are rich in glycogen and stained positively (periodic acid Schiff (PAS) ×10). This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3328 Acta Derm Venereol 2019; 99: 1317–1318