Paget’s disease of the breast: a case series

Paget’s disease of the nipple is a rare disease with a rather bizarre presentation which makes the diagnosis easily missed. Three cases are presented here with different modes of presentation and histological findings. A biopsy provided the definitive diagnosis in the three patients and the treatments offered was based on the histological findings - modified radical mastectomy and simple mastectomy for invasive carcinoma and carcinoma in-situ respectively.

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Thirty Year Old Female Presented with Nipple Destruction: A Case Report

Journal of Shaheed Suhrawardy Medical College ◽

10.3329/jssmc.v11i1.43187 ◽

2019 ◽

Vol 11 (1) ◽

pp. 81-83

Author(s):

Md Mustafizur Rahman ◽

Nadim Ahmed ◽

Sami Ahmad ◽

Shoaeb Imtiaz Alam ◽

Mohammad Rashedul Hassan ◽

...

Keyword(s):

Invasive Carcinoma ◽

Paget’S Disease ◽

Radical Mastectomy ◽

Paget's Disease ◽

College Hospital ◽

Rare Type ◽

Medical College ◽

Ductal Cell ◽

Areola Complex

Paget’s disease of the breast is a rare type of cancer of the nipple–areola complex and that is often associated with an underlying in situ or invasive carcinoma. It is often misdiagnosed as eczema of breast and treatment is delayed. Here we present a case where a 30 year old female presented with itching ulceration and destruction of her left nipple. She was treated initially by local physicians by applying local ointments but as her condition did not improve she was admitted to department of surgery Shaheed Suhrawardy Medical College hospital where she was diagnosed as Paget’s disease with infiltrating ductal cell carcinoma. She underwent modified radical mastectomy with axillary clearance and referred to oncology department for further management. J Shaheed Suhrawardy Med Coll, June 2019, Vol.11(1); 81-83

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Paget’s Disease of the Breast and Our Clinical Experience at Ain Shams University Hospitals

QJM ◽

10.1093/qjmed/hcab097.054 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Ashraf abd el Moghny Mostafa ◽

Karim Fahmy abd el Moaty ◽

Paula Samir Nazim Sadary

Keyword(s):

Breast Cancer ◽

Paget’S Disease ◽

Radical Mastectomy ◽

Paget's Disease ◽

Treatment Modalities ◽

Pathological Features ◽

University Hospitals ◽

Simple Mastectomy ◽

Delays In Diagnosis

Abstract Background Worldwide, breast cancer comprises 10.4% of all cancer incidences among women, making it the second most common type of non-skin cancer (after lung cancer) and the fifth most common cause of cancer death. In 2004, breast cancer caused 519,000 deaths worldwide (7% of cancer deaths; almost 1% of all deaths). Breast cancer is about 100 times more common in women than in men, although males tend to have poorer outcomes due to delays in diagnosis. Aim of the Work To clarify clinical, pathological features and outcomes of the treatment modalities for Paget’s disease of the breast at Ain Shams University Hospitals. Materials and Methods Our study was held as a retrospective cohort study to clarify clinical, pathological features and outcomes of the treatment modalities for Paget’s disease of the breast at Ain Shams University Hospitals. Results At Ain Shams university hospitals patients having pagetoid cells by biopsy and no mass radiologically underwent simple mastectomy and if pathology proved any malignancy in breast tissue axillary clearance was done and might be followed by radiotherapy. Conclusion Patients having pagetoid cells by biopsy and a mass radiologically which is invasive or insitu with microinvasion will undergo modified radical mastectomy and may be followed by radiotherapy. But if pagetoid cells and mass radiologically which is in situ simple mastectomy will be done.

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Practical consensus recommendatons for Paget’s disease in breast cancer

South Asian Journal of Cancer ◽

10.4103/sajc.sajc_107_18 ◽

2018 ◽

Vol 07 (02) ◽

pp. 083-086 ◽

Cited By ~ 4

Author(s):

A. Gaurav ◽

V. Gupta ◽

R. Koul ◽

S. Dabas ◽

R. Sareen ◽

...

Keyword(s):

Invasive Carcinoma ◽

Treatment Options ◽

Paget’S Disease ◽

Practical Experience ◽

Disease Diagnosis ◽

Paget's Disease ◽

Expert Group ◽

Rare Type ◽

Areola Complex

AbstractPaget's disease of the breast is a rare type of cancer of the nipple–areola complex and that is often associated with an underlying in situ or invasive carcinoma. Diagnosis and treatment of Paget's disease is controversial. Expert oncologists discuss on the update on the approaches of Paget's disease diagnosis and its treatment options. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.

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Practical approach to extensive cutaneous spread without any underlying malignancy: a rare presentation of Paget’s disease of breast

BMJ Case Reports ◽

10.1136/bcr-2019-233600 ◽

2020 ◽

Vol 13 (4) ◽

pp. e233600

Author(s):

Kamal Kishore Lakhera ◽

Sanjeev Patni ◽

Nidhi Patni ◽

Rohit Jindal

Keyword(s):

Abdominal Wall ◽

Invasive Carcinoma ◽

Paget’S Disease ◽

Paget's Disease ◽

Breast Pathology ◽

Rare Presentation ◽

Breast Parenchyma ◽

Areola Complex ◽

Underlying Malignancy

Paget’s disease of the breast is a rare intraepithelial malignancy involving the nipple–areola complex, often associated with an underlying in-situ or invasive carcinoma in the breast parenchyma. Most of the cases disease is usually limited to nipple–areola or surrounding periareolar skin. We are reporting a case of extensive Paget’s disease, involving entire breast skin and even part of abdominal wall skin without any underlining breast pathology, which is a rare presentation.

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Paget’s disease of male breast, a rare but rising ailment

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v20i2.24381 ◽

2017 ◽

Vol 20 (2) ◽

pp. 49-52

Author(s):

Randhir Sagar Yadav ◽

Shumneva Shrestha ◽

Prabesh Bikram Singh ◽

Sadikshya Sharma ◽

Bikash Nepal ◽

...

Keyword(s):

Management Strategies ◽

Paget’S Disease ◽

Radical Mastectomy ◽

Paget's Disease ◽

Male Breast ◽

Delayed Presentation ◽

Breast Cancers ◽

Breast Carcinomas ◽

Modified Radical Mastectomy ◽

Hormonal Factors

Male breast cancer constitutes less than 1% of all breast carcinomas whereas Paget’s disease accounts for less than 1% of entire breast cancers. Unawareness and misdiagnosis lead to delayed presentation at a higher grade making the prognosis worse than females. Genetics and hormonal factors are strongly linked to its occurrence. Investigations, diagnosis, staging and management strategies for male breast cancers are concluded from studies done in female cases. We present a case of a 65 years literate gentleman who presented with fungating right breast mass with bleeding ulcer who underwent modified radical mastectomy, chemotherapy, radiotherapy and hormonal therapy.

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Not All Cases of Mammary Paget’s Disease are Cytokeratin-7 Positive: A Challenging Diagnosis!

International Journal of Surgical Pathology ◽

10.1177/10668969211002920 ◽

2021 ◽

pp. 106689692110029

Author(s):

Kerschen Anja ◽

Dano Hélène ◽

Van Eeckhout Pascal ◽

Marot Liliane ◽

Van Bockstal Mieke

Keyword(s):

Present Report ◽

Paget’S Disease ◽

Growth Factor Receptor ◽

Punch Biopsy ◽

Paget's Disease ◽

Cytokeratin 7 ◽

In Situ Carcinoma ◽

Epidermal Growth ◽

Mammary Paget’S Disease

Mammary Paget’s disease accounts for 1% to 3% of all breast tumors and manifests as a chronic eczematous lesion of the areolar skin. It can occur without any underlying neoplasia or can be present in association with an underlying invasive and/or in situ carcinoma of the breast. The present report describes a challenging nipple punch biopsy showing an infiltration of the lower third to two-thirds of the epidermis by large, ovoid, neoplastic cells. The morphology was consistent with mammary Paget's disease, although immunohistochemistry for cytokeratin-7 (CK7) was repeatedly negative. This resulted in an initial misdiagnosis and, subsequently, a delay in the patient's follow-up. Additional immunohistochemistry for GATA binding protein 3 (GATA3) and human epidermal growth factor receptor 2 (HER2), as well as a second opinion of a breast pathologist, resulted in the diagnosis of mammary Paget's disease. The aim of this article is to raise awareness among pathologists and prevent them from misdiagnosing CK7-negative Paget disease of the breast.

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