Korean J Dermatol.  2022 Sep;60(8):527-531.

Toker Cell Hyperplasia in Zuska’s Disease Mimicking Paget’s Disease: A Case Report

  • 1Departments of Dermatology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
  • 2Departments of Pathology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
  • 3Department of Dermatology, Yongin Severance Hospital, Yonsei University School of Medicine, Yongin, Korea


Toker cells are epithelial cells, consisting of pale cytoplasm with a polygonal or oval shape. They are found in 10% of the nipple epidermis and require differentiation from Paget cells. However, the Toker cell hyperplasia observed in Zuska’s disease can be difficult to distinguish from Paget cells. In this case report, a 17-year-old girl presented with recurrent erythematous erosion of the right areola. Biopsy specimens showed numerous large epidermal cells with abundant pale cytoplasm. Immunohistochemical staining for CK7 and estrogen receptor were positive, whereas that of HER2/NEU and Ki-67 were negative. Breast ultrasonography showed signs of abscesses and fistulas without suspicious findings of underlying breast cancer. Based on these findings, the patient was diagnosed with Zuska’s disease with Toker cell hyperplasia. Herein, we report a case of Toker cell hyperplasia in Zuska’s disease, thereby highlighting the need to differentiate Toker cells from Paget cells based on clinical, histological, and immunohistochemical characteristics.


Paget's disease; Toker cell; Zuska’s disease
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