Case and Research Letters
Clear Cell Acanthoma of the Areola and Nipple
Acantoma de células claras de la aréola y el pezón
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Hidalgo-García, P. Gonzálvo, S. Mallo-García, C. Fernández-Sánchez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Y." "apellidos" => "Hidalgo-García" "email" => array:1 [ 0 => "yhidalgog@yahoo.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "P." "apellidos" => "Gonzálvo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "S." "apellidos" => "Mallo-García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "C." "apellidos" => "Fernández-Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital de Cabueñes, Gijón, Asturias, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital de Cabueñes, Gijón, Asturias, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Acantoma de células claras de la aréola y el pezón" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1155 "Ancho" => 851 "Tamanyo" => 124142 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Well-defined, flaking, exudative erythematous plaque in the areola of the right breast. B, Complete resolution of the lesion in the areola of the right breast after 6 months of topical therapy.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Clear-cell acanthoma was described by Degos et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> in 1962 as a benign epidermal tumor. It usually manifests clinically as a single, slow-growing, dome-shaped reddish papule or nodule with a peripheral desquamating collarette. The surface shows fine desquamation and a vascular pinpoint pattern and it has a tendency to bleed on minimal trauma. Clear-cell acanthoma usually arises on the distal areas of the legs of middle-aged or elderly persons, and its diameter varies between 5 and 20<span class="elsevierStyleHsp" style=""></span>mm.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> However, atypical sites and clinical forms and multiple lesions have been described, and even spontaneous regression.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2–4</span></a> This, together with its histological characteristics, has led to a discussion of whether it is a benign tumor or reactive hyperplasia secondary to chronic inflammation; even the term clear-cell acanthosis has been proposed.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> Histology is characteristic, with a well-defined area of psoriasiform epidermal hyperplasia, in which the keratinocytes present a pale cytoplasm. There are interposed thick and thin layers, a tendency to acanthosis, particularly centrally, and fusion of the crests. In addition, mild spongiosis is observed, with neutrophil exocytosis, which can lead to the formation of small intraepidermal abscesses and thinning of the suprapapillary surfaces. The surface shows parakeratotic scales. Staining with periodic acid Schiff (PAS) confirms the presence of glycogen in the palisading cells.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> Lesions arising in the areola of the breast have only been reported very rarely.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Our patient was a 74-year-old woman with no family history of interest. Important findings in her personal past history were congenital hypothyroidism, systemic hypertension, dyslipidemia, and an ischemic stroke in 2012. Her long-term treatment included levothyroxine, simvastatin, omeprazole, enalapril, and acetylsalicylic acid. She did not report any personal history of atopic dermatitis or psoriasis. She was seen in dermatology outpatients for the appearance a year earlier of a reddish, exudative, desquamating lesion in the areola of the right breast. The lesion had bled occasionally. She had been treated with various topical corticosteroids, the names of which she did not remember, with no improvement. She had also been seen in the breast pathology unit of our hospital, and a mammography had been performed, which was reported as normal.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Dermatologic examination revealed the presence of a well-defined, desquamating erythematous plaque with a slightly shiny surface in the upper outer quadrant of the areola of the right breast (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). The plaque measured 5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>cm. Biopsy was performed on a clinical suspicion of Paget disease. This showed psoriasiform hyperplasia of the epidermis with neutrophil exocytosis, thinning of the granular layer, and cells with abundant pale cytoplasm (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A); PAS staining is shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B. The findings were compatible with clear-cell acanthoma.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Given the benign and asymptomatic nature of the lesion, we decided jointly with the patient and her family to adopt a wait-and-see approach. Treatment was started with 0.1% gentamicin sulfate plus 0.05% betamethasone dipropionate cream twice a day for 3 weeks. This achieved a marked improvement, and the treatment was therefore reduced to a single application twice a week, leading to complete resolution of the lesion after 6 months of treatment (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). No recurrence was observed in the 6 months after the interruption of treatment. The patient has not developed any other skin lesions during follow-up.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The first reported case of clear-cell acanthoma localized in the areola was published by Kim et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> in 1999; their patient, who had a history of atopic dermatitis, presented with eczema. Since that time only 7 other cases of clear-cell acanthoma localized in the nipple or areola have been reported.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">6–9</span></a> All have presented as eczematous lesions, except for the one published by Park et al.,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> which had a polypoid morphology. A history of atopy was found in 4 patients, including our patient, though other previous or concomitant dermatoses were not reported.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">5–8</span></a> There is a clear female predominance at this site, with only 1 case occurring in a 26-year-old man.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> The size of the lesions varied between 2<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm and 4<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>cm.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">6,9</span></a> The preferred treatment options have been surgery and cryotherapy, and no recurrences have been observed. Four cases, including the one we report, were treated with corticosteroids, observing complete resolution in our patient and in 1 patient who used 0.5% clobetasol cream twice a day for several weeks.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">7,9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion, we have presented a new case of clear-cell acanthoma in the areola and nipple, a rare site. We draw attention to the need to include this entity in the differential diagnosis of long-standing eczematous lesions of the nipple. The remission observed with a high-potency topical corticosteroid is a finding that supports the idea that clear-cell acanthoma may be a reactive process of the epidermis.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Hidalgo-García Y, Gonzálvo P, Mallo-García S, Fernández-Sánchez C. Acantoma de células claras de la aréola y el pezón. Actas Dermosifiliogr. 2016;107:793–795.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1155 "Ancho" => 851 "Tamanyo" => 124142 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Well-defined, flaking, exudative erythematous plaque in the areola of the right breast. B, Complete resolution of the lesion in the areola of the right breast after 6 months of topical therapy.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1437 "Ancho" => 951 "Tamanyo" => 548003 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Agranulosis, spongiosis, and neutrophil exocytosis with subcorneal microabscesses and sheets of parakeratosis. Hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×100. B, Cells with abundant, clear, periodic acid Schiff-positive cytoplasm. Periodic acid Schiff, original magnification<span class="elsevierStyleHsp" style=""></span>×80.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidermal tumor with an unusual appearance: Clear cell acantoma [Article in French]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Degos" 1 => "J. Delort" 2 => "J. Civatte" 3 => "A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 28 | 17 | 45 |
| 2024 October | 106 | 77 | 183 |
| 2024 September | 103 | 35 | 138 |
| 2024 August | 135 | 66 | 201 |
| 2024 July | 138 | 46 | 184 |
| 2024 June | 140 | 39 | 179 |
| 2024 May | 118 | 43 | 161 |
| 2024 April | 99 | 30 | 129 |
| 2024 March | 90 | 32 | 122 |
| 2024 February | 148 | 37 | 185 |
| 2024 January | 91 | 36 | 127 |
| 2023 December | 106 | 12 | 118 |
| 2023 November | 136 | 35 | 171 |
| 2023 October | 104 | 45 | 149 |
| 2023 September | 115 | 50 | 165 |
| 2023 August | 139 | 18 | 157 |
| 2023 July | 168 | 74 | 242 |
| 2023 June | 245 | 47 | 292 |
| 2023 May | 180 | 55 | 235 |
| 2023 April | 208 | 38 | 246 |
| 2023 March | 237 | 46 | 283 |
| 2023 February | 229 | 40 | 269 |
| 2023 January | 137 | 29 | 166 |
| 2022 December | 125 | 48 | 173 |
| 2022 November | 98 | 40 | 138 |
| 2022 October | 78 | 29 | 107 |
| 2022 September | 74 | 26 | 100 |
| 2022 August | 91 | 40 | 131 |
| 2022 July | 117 | 36 | 153 |
| 2022 June | 141 | 30 | 171 |
| 2022 May | 195 | 43 | 238 |
| 2022 April | 165 | 34 | 199 |
| 2022 March | 195 | 56 | 251 |
| 2022 February | 200 | 43 | 243 |
| 2022 January | 245 | 48 | 293 |
| 2021 December | 162 | 38 | 200 |
| 2021 November | 117 | 43 | 160 |
| 2021 October | 145 | 56 | 201 |
| 2021 September | 125 | 46 | 171 |
| 2021 August | 108 | 24 | 132 |
| 2021 July | 70 | 33 | 103 |
| 2021 June | 125 | 39 | 164 |
| 2021 May | 139 | 50 | 189 |
| 2021 April | 177 | 89 | 266 |
| 2021 March | 131 | 23 | 154 |
| 2021 February | 92 | 31 | 123 |
| 2021 January | 69 | 17 | 86 |
| 2020 December | 72 | 15 | 87 |
| 2020 November | 49 | 21 | 70 |
| 2020 October | 55 | 22 | 77 |
| 2020 September | 74 | 8 | 82 |
| 2020 August | 68 | 17 | 85 |
| 2020 July | 62 | 17 | 79 |
| 2020 June | 65 | 34 | 99 |
| 2020 May | 51 | 9 | 60 |
| 2020 April | 61 | 17 | 78 |
| 2020 March | 37 | 11 | 48 |
| 2020 February | 8 | 0 | 8 |
| 2020 January | 4 | 0 | 4 |
| 2019 December | 8 | 0 | 8 |
| 2019 November | 2 | 0 | 2 |
| 2019 September | 8 | 0 | 8 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 4 | 0 | 4 |
| 2019 June | 4 | 0 | 4 |
| 2019 May | 7 | 1 | 8 |
| 2019 April | 3 | 7 | 10 |
| 2019 March | 2 | 0 | 2 |
| 2019 February | 7 | 0 | 7 |
| 2019 January | 3 | 0 | 3 |
| 2018 December | 10 | 0 | 10 |
| 2018 November | 5 | 0 | 5 |
| 2018 October | 3 | 0 | 3 |
| 2018 September | 6 | 0 | 6 |
| 2018 February | 61 | 4 | 65 |
| 2018 January | 87 | 8 | 95 |
| 2017 December | 95 | 8 | 103 |
| 2017 November | 97 | 10 | 107 |
| 2017 October | 89 | 14 | 103 |
| 2017 September | 75 | 51 | 126 |
| 2017 August | 62 | 10 | 72 |
| 2017 July | 70 | 17 | 87 |
| 2017 June | 59 | 25 | 84 |
| 2017 May | 42 | 9 | 51 |
| 2017 April | 28 | 15 | 43 |
| 2017 March | 25 | 37 | 62 |
| 2017 February | 84 | 22 | 106 |
| 2017 January | 28 | 14 | 42 |
| 2016 December | 42 | 24 | 66 |
| 2016 November | 52 | 32 | 84 |
| 2016 October | 5 | 6 | 11 |
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