Case for Diagnosis
Long-Standing Nodule of the Nipple
Nódulo en pezón de largo tiempo de evolución
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Brugués, L. Alós, I. Fuertes de Vega" "autores" => array:3 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Brugués" "email" => array:1 [ 0 => "albert_brugues1@hotmail.com" ] "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" => "L." "apellidos" => "Alós" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "I." "apellidos" => "Fuertes de Vega" "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 Clínic, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Clínic, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nódulo en pezón de largo tiempo de evolución" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 439 "Ancho" => 586 "Tamanyo" => 111301 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 56-year-old man attended our unit because he had noticed an increase in the size of his right nipple over the previous 4 years. His past medical and drug history were unremarkable.</p><p id="par0010" class="elsevierStylePara elsevierViewall">He denied both trauma and application of topical products to the area. While he reported a general absence of pain in the region, he did mention that he sometimes experienced local irritation he attributed to friction from clothing.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The findings of an ultrasound performed at another hospital were unremarkable, and showed skin with smooth, regular outlines and normal thickness of the subcutaneous tissue.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The physical examination showed a slightly erythematous papule on the right nipple (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) that was hard to the touch but not painful when palpated. The intramammary and axillary lymph nodes were not enlarged.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Histopathology</span><p id="par0025" class="elsevierStylePara elsevierViewall">Hematoxylin-eosin staining showed a noncapsulated poorly circumscribed proliferation of interlaced spindle cells with an irregular eosinophilic cytoplasm in the dermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> A,B). There was no mitosis or cellular atypia. In the immunohistochemical study, the cells stained positive for desmin (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis?</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Diagnosis</span><p id="par0035" class="elsevierStylePara elsevierViewall">Leiomyoma of the nipple.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Clinical Course and Treatment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Given the benign nature of the condition and the fact that the lesion was asymptomatic, it was decided to take a watch-and-wait approach.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Comment</span><p id="par0045" class="elsevierStylePara elsevierViewall">Leiomyomas are rare benign smooth muscle tumors that typically develop in the genitourinary or gastrointestinal tract, and less frequently in the skin.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Cutaneous leiomyomas are classified as piloleiomyomas (derived from the arrector pili muscle), angioleiomyomas (derived from vascular wall smooth muscle), and genital leiomyomas (derived from scrotal, vulvar, or nipple smooth muscle).</p><p id="par0050" class="elsevierStylePara elsevierViewall">Based on reports in the literature, leiomyoma of the nipple appears to be more common in women,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> and tends to present as a long-standing papule that is asymptomatic or causes occasional episodes of sharp pain. This pain is thought to be due to the contraction of neoplastic smooth muscle fibers in the tumor bed and is induced by friction or can appear spontaneously.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The nipples are typically asymmetric in the physical examination and the tumor is the same color as the surrounding skin and firm to the touch The differential diagnosis should include Paget disease, leiomyosarcoma, adenoma, fibroma, and papilloma of the nipple.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2–4</span></a> These entities must be ruled out histologically.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The most remarkable histologic finding is the presence of a noncapsulated, irregular mass in the dermis comprising an anomalous proliferation of smooth muscle spindle cells with an eosinophilic cytoplasm that stain positive with the muscle differentiation markers actin and desmin in the immunohistochemical study. These cells are arranged as interlacing bundles within a stroma of connective tissue. The absence of cellular atypia and mitosis is an important finding for differentiating leiomyoma from leiomyosarcoma.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Recent reports have described the identification of estrogen and progesterone receptors in nipple leiomyoma biopsy specimens and the development of leiomyoma in patients receiving hormonal drugs, such as tamoxifen, although more studies are necessary to confirm these observations.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,4–6</span></a> Although we did not study the association between leiomyoma and hormones in our patient, the above findings suggest that the association between genital leiomyoma and sex hormones is indeed a possibility.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Treatment of leiomyoma of the nipple varies according to symptoms. Calcium-channel and alpha-adrenergic blockers have proven effective in controlling pain induced by smooth muscle contraction, and surgery and even carbon dioxide laser therapy are also an option for symptomatic lesions.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2–4</span></a></p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Histopathology" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Diagnosis" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Clinical Course and Treatment" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Comment" ] 5 => 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: Brugués A, Alós L, Fuertes de Vega I. Nódulo en pezón de largo tiempo de evolución. Actas Dermosifiliogr. 2015;106:501–502.</p>" ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 439 "Ancho" => 586 "Tamanyo" => 111301 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 404 "Ancho" => 900 "Tamanyo" => 256501 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Hematoxylin-eosin, original magnification ×40. B, Hematoxylin-eosin, original magnification ×100.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 720 "Ancho" => 540 "Tamanyo" => 283856 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Desmin staining, original magnification ×40.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Leiomyoma of the nipple" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Ku" 1 => "C. Campbell" 2 => "I. 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Shousha" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2559.2004.01810.x" "Revista" => array:6 [ "tituloSerie" => "Histopathology" "fecha" => "2004" "volumen" => "44" "paginaInicial" => "626" "paginaFinal" => "628" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15186281" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rapid growth of leiomyoma in a patient receiving tamoxifen" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P.V. Dilts Jr." 1 => "M.P. Hopkins" 2 => "A.E. Chang" 3 => "R.L. Cody" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Obstet Gynecol" "fecha" => "1992" "volumen" => "166" "paginaInicial" => "167" "paginaFinal" => "168" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1733191" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010600000006/v1_201506260207/S1578219015001559/v1_201506260207/en/main.assets" "Apartado" => array:4 [ "identificador" => "6154" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010600000006/v1_201506260207/S1578219015001559/v1_201506260207/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015001559?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 18 | 9 | 27 |
| 2024 Octubre | 205 | 56 | 261 |
| 2024 Septiembre | 193 | 45 | 238 |
| 2024 Agosto | 186 | 49 | 235 |
| 2024 Julio | 132 | 48 | 180 |
| 2024 Junio | 99 | 53 | 152 |
| 2024 Mayo | 94 | 39 | 133 |
| 2024 Abril | 79 | 38 | 117 |
| 2024 Marzo | 85 | 38 | 123 |
| 2024 Febrero | 76 | 34 | 110 |
| 2024 Enero | 70 | 36 | 106 |
| 2023 Diciembre | 88 | 31 | 119 |
| 2023 Noviembre | 82 | 41 | 123 |
| 2023 Octubre | 94 | 38 | 132 |
| 2023 Septiembre | 89 | 64 | 153 |
| 2023 Agosto | 72 | 48 | 120 |
| 2023 Julio | 150 | 65 | 215 |
| 2023 Junio | 105 | 46 | 151 |
| 2023 Mayo | 133 | 73 | 206 |
| 2023 Abril | 85 | 42 | 127 |
| 2023 Marzo | 94 | 46 | 140 |
| 2023 Febrero | 113 | 51 | 164 |
| 2023 Enero | 77 | 40 | 117 |
| 2022 Diciembre | 83 | 39 | 122 |
| 2022 Noviembre | 79 | 32 | 111 |
| 2022 Octubre | 109 | 26 | 135 |
| 2022 Septiembre | 87 | 47 | 134 |
| 2022 Agosto | 93 | 46 | 139 |
| 2022 Julio | 33 | 31 | 64 |
| 2022 Junio | 43 | 60 | 103 |
| 2022 Mayo | 61 | 42 | 103 |
| 2022 Abril | 93 | 47 | 140 |
| 2022 Marzo | 94 | 61 | 155 |
| 2022 Febrero | 71 | 34 | 105 |
| 2022 Enero | 98 | 44 | 142 |
| 2021 Diciembre | 55 | 59 | 114 |
| 2021 Noviembre | 67 | 49 | 116 |
| 2021 Octubre | 53 | 76 | 129 |
| 2021 Septiembre | 71 | 43 | 114 |
| 2021 Agosto | 112 | 38 | 150 |
| 2021 Julio | 77 | 29 | 106 |
| 2021 Junio | 44 | 36 | 80 |
| 2021 Mayo | 40 | 36 | 76 |
| 2021 Abril | 69 | 38 | 107 |
| 2021 Marzo | 63 | 39 | 102 |
| 2021 Febrero | 51 | 32 | 83 |
| 2021 Enero | 34 | 25 | 59 |
| 2020 Diciembre | 31 | 34 | 65 |
| 2020 Noviembre | 26 | 32 | 58 |
| 2020 Octubre | 31 | 26 | 57 |
| 2020 Septiembre | 40 | 24 | 64 |
| 2020 Agosto | 23 | 35 | 58 |
| 2020 Julio | 17 | 22 | 39 |
| 2020 Junio | 30 | 41 | 71 |
| 2020 Mayo | 30 | 29 | 59 |
| 2020 Abril | 20 | 26 | 46 |
| 2020 Marzo | 31 | 23 | 54 |
| 2020 Febrero | 1 | 13 | 14 |
| 2020 Enero | 0 | 3 | 3 |
| 2019 Diciembre | 0 | 7 | 7 |
| 2019 Noviembre | 0 | 5 | 5 |
| 2019 Octubre | 0 | 6 | 6 |
| 2019 Septiembre | 0 | 11 | 11 |
| 2019 Agosto | 0 | 10 | 10 |
| 2019 Julio | 0 | 14 | 14 |
| 2019 Junio | 0 | 16 | 16 |
| 2019 Mayo | 0 | 30 | 30 |
| 2019 Abril | 0 | 14 | 14 |
| 2019 Marzo | 0 | 3 | 3 |
| 2019 Febrero | 0 | 3 | 3 |
| 2019 Enero | 0 | 1 | 1 |
| 2018 Diciembre | 1 | 8 | 9 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Febrero | 38 | 3 | 41 |
| 2018 Enero | 30 | 5 | 35 |
| 2017 Diciembre | 51 | 8 | 59 |
| 2017 Noviembre | 29 | 3 | 32 |
| 2017 Octubre | 22 | 3 | 25 |
| 2017 Septiembre | 17 | 0 | 17 |
| 2017 Agosto | 27 | 5 | 32 |
| 2017 Julio | 13 | 6 | 19 |
| 2017 Junio | 29 | 6 | 35 |
| 2017 Mayo | 17 | 6 | 23 |
| 2017 Abril | 22 | 8 | 30 |
| 2017 Marzo | 22 | 11 | 33 |
| 2017 Febrero | 15 | 7 | 22 |
| 2017 Enero | 18 | 4 | 22 |
| 2016 Diciembre | 22 | 9 | 31 |
| 2016 Noviembre | 34 | 11 | 45 |
| 2016 Octubre | 27 | 8 | 35 |
| 2016 Septiembre | 0 | 5 | 5 |
| 2016 Julio | 6 | 1 | 7 |
| 2016 Junio | 11 | 1 | 12 |
| 2016 Mayo | 8 | 6 | 14 |
| 2016 Abril | 9 | 5 | 14 |
| 2016 Marzo | 4 | 1 | 5 |
| 2016 Febrero | 9 | 1 | 10 |
| 2016 Enero | 1 | 3 | 4 |
| 2015 Octubre | 0 | 1 | 1 |
| 2015 Septiembre | 0 | 2 | 2 |
| 2015 Agosto | 0 | 2 | 2 |
| 2015 Julio | 0 | 2 | 2 |
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