pathology report for unilateral nipple issue

Sylvain19

Hello everyone, I have one nipple issue several months ago, with dry and scaly skin, constant pruritus, tried middle strong cortisone without success.

I checked with different dermatologists, based on the normal mammo and ultrasound, without typical clinical symptom for paget's, they gave the diagnosis is nipple eczema

I insist on nipple skin biopsy, I got the pathology report, it shows dermatitis.

I'm not sure the pathology report is accurate or the pathologist verified paget's cell.

as I saw on the pathology report, the dermatologist mentioned in his clinical diagnostic is eczema, elimination of paget's

my questions is did pathologist would check paget's as well or just based on dermatologist's diagnosis and won't look for paget's.

It doesn't show paget's negative in the report, just mentioned PASD stain is negative for fungal elements.

I don't know who I could turn to ask the questions, someone in this community could help?

thanks

djmammo

Sylvain19

"dermatologist mentioned in his clinical diagnostic is eczema, elimination of paget's"

Is this the exact wording? Did it say "Eczema, exclude Paget's" or "Rule out Paget's" ?

This is the form one doc uses to relate their concerns to the next doc

"Cough, rule out pneumonia", "Enlarged nodes, rule out lymphoma"

The translation is "This looks like eczema let's make sure its not Paget's" so yes the pathologist would look for Paget's.

In fact I think any pathologist that gets a sample of skin from the nipple/areola would know to look for Paget's even if it were not accompanied by a history.

Sylvain19

Thank you Sir Djmammo for the detailed explanation.

I have no knowledge on the field, but I just want to be sure the report is accurate.

The dermatologist made his clinical diagnosis is eczema, the nipple skin pathology report shows firstly the clinical diagnosis by the dermatologist with the wording: eczema of the nipple, elimination of paget's.

The pathology report shows some superficial changes of nipple skin, diagnosis is subaccute spongiotic dermatitis, it says the PASD is negative for fungal elements.

The pathology report was signed by dermatology pathologist.

I checked PASD is a special stain for several diseases, also could used for paget's. So I wondering if it's negative in fungal elements for skin infection, would it also means negative for Paget's?

I totally agreed any pathologist see nipple skin sample should think about possibility to rule out paget's, I would be less worried if the dermatologist wording as ruling out for this disease

Unfortunately, the paper doesn't show this way. I have a firm diagnosis from dermatologist on clinical diagnosis is not Paget's.

I knew it's stupid to quesion and have doubt on the report, but I just want to be sure the pathologist looked every possibility to have the result, not only because the dermatologist said clinically not paget's then the pathologist won't check this part.

I can't go back ask dermatologist as he firmly confirmed eczema even mentioned with sample send to hospital, I certainly can't contact pathologist as they won't contact directly with patient.

Could you pls give some suggestions? Thanks again.

djmammo

Sylvain19

You can contact the pathologist. Their name should be on the report.

Sylvain19

Thanks Sir for the help, I will try to mail the pathologist just to be sure.