Paget's disease of the breast

Abstract

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. This article provides an overview and we review the main clinicopathological and therapeutic features of mammary Paget's disease.

Keywords: Breast; Paget's disease; nipple.

Figure 1

(a and b) Paget's disease of the nipple. The clinical appearance is usually a thickened, eczematoid crusted lesion with irregular borders. (c) Scaly, erythematous, crusty pigmentation and thickened plaques on the nipple, spreading to the surrounding areolar areas. (d) Advanced lesions show skin thickening, redness, erythema, erosion of the nipple and scaling around the nipple–areola

Figure 2

Paget's disease of the nipple. Nests and groups of malignant Paget's cells predominantly involving the lower layers of the epidermis. Epidermis may be eroded and hyperplastic (H and E, ×40)

Figure 3

Paget's disease of the nipple with superficial ulceration. The tumor cells have abundant pale cytoplasm, pleomorphic and hyperchromatic nuclei with prominent nucleoli. Mitotic figures are seen (H and E, ×100)

Figure 4

Carcinoma cells form a band in the deep epidermis and they are scattered individually throughout the squamous epithelium. The lacunar arrangement of carcinoma cells is commonly seen in Paget's disease. An extensive lymphocytic infiltrate with involvement largely concentrated in the deep epidermis (H and E, ×40)

Figure 5

Paget's cells are highlighted by an immunostain for (CK7, ×200)