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Case Reports
. 2017 Oct 23:4:51.
doi: 10.3389/fsurg.2017.00051. eCollection 2017.

Paget's Breast Disease: A Case Report and Review of the Literature

S Dubar  1 , M Boukrid  1 , Jean Bouquet de Joliniere  1 , L Guillou  1 , Quoc Duy Vo  1 , A Major  1 , N Ben Ali  1 , F Khomsi  1 , A Feki  1
Affiliations
Case Reports

Paget's Breast Disease: A Case Report and Review of the Literature

S Dubar et al. Front Surg. .

Abstract

Paget's disease of the breast is a rare cancer. This typical clinical case illustrates the different epidemiological, clinical, histological, therapeutic, and evolving aspects of the disease. We report a case of Paget's disease in a 43-year-old woman who presented eczema of the nipple. Mammography and ultrasounds did reveal a lesion in situ. The patient was scheduled for mastectomy and sentinel node biopsy. She had chosen a radical bilateral surgery. The histological diagnosis was Paget's disease of the breast with a carcinoma in situ. There was no metastasis in either of the sentinel nodes. Paget's disease must be considered with the presence of a persistent eczematous involvement of the nipple, which does not respond to local treatment. Ultrasounds, mammography, and magnetic resonance imaging can allow searching an underlying cancer and guiding the surgical management. There is no evidence at this time that one of the two surgical techniques (conservative or mastectomy) would improve survival. The prognosis depends on the presence of a palpable mass and the invasiveness of the cancer.

Keywords: biopsy; breast Paget’s disease; female breast cancer; imagery; sentinel lymph node biopsy; surgery.

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Figures

Figure 1
Figure 1
Initial presentation of the patient: (A) the right nipple lesion. Initial presentation of the patient: (B) macroscopic right nipple lesion, erosion, and redness of the nipple were noted.
Figure 2
Figure 2
Mammography showed a dense ovoid opacity of 14 mm with irregular suspicious micro calcifications.
Figure 3
Figure 3
Ultrasound right nipple: suspect galactophoric dilatation of the right supero-external quadrant.
Figure 4
Figure 4
(A,B) Images coupe de biopsie. Biopsy concluded to a ductal multicentric carcinoma in situ, nuclear grade 2–3, HER2 (+), ER, and PRG (−), classification as B5a. Microscopic examination of the specimen using H&E staining. (A) The epidermis of the nipple infiltrated by large Paget’s cells with pale abundant cytoplasm (magnification, ×100). (B) Single groups of Paget’s cells with vesicular nuclei and prominent nucleoli (magnification, ×400).
Figure 5
Figure 5
Breast magnetic resonance imaging revealed several multicentric tumoral lesions of the right breast with extension to the nipple–areola complex.
Figure 6
Figure 6
Surgery management’s algorithm of Paget disease.
See this image and copyright information in PMC

References

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    1. Khothari AS, Beechey-Newman N, Hamed H, Fentiman IS, D’Arrigo C, Hanby AM, et al. Paget disease of the nipple: a multifocal manifestation of higher-risk disease. Cancer (2002) 95(1):1–7. 10.1002/cncr.10638 - DOI - PubMed
    1. Vercambre-Darras S, Bertrand M, Daussay D, Mortier L. Paget disease. Dermatology (2012) 7(2):1–9.

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