Imprint Cytology Can Be a Better Option for Diagnosis of Mammary Paget's Disease!!!: A Case Report with Review

Abstract

Mammary Paget's disease (MPD) is a rare form of pruritic eczematous skin lesion involving the nipple areola complex usually associated with an underlying in-situ or invasive carcinoma of breast, accounting ≤ 4% of overall breast carcinoma. The patient may present with nipple discharge, eczema, plaque, or nipple destruction with or without a lump which is resistant to common remedies. Diagnosis of MPD is usually accomplished by a punch biopsy, but imprint cytology is found to be an effective modern technique yet less explored. Cytological diagnosis is advantageous over surgical excisional biopsy; advantages being easy practicability, cost-effective, quick non-invasive, and above all can lead the physician for breast-preserving surgeries in selective cases rather than more aggressive standard mastectomies. We report one such case of MPD in a 52-year-old female diagnosed on imprint cytology with the aim to emphasize that imprint cytology can be a better option to improve the treatment protocol.

Keywords: Breast-conserving surgery; imprint cytology; mammary Paget.

Figure 1

(A and B) Cytology showing Paget’s cells in an inflammatory background (Diff Quik, ×100). (C-E) Photomicrograph showing large polygonal to round Paget’s cells with hyperchromatic nuclei (H&E, ×400)

Figure 2

(A) PAS is negative in tumor cells (PAS, ×100). (B-D) Immunohistochemistry showing strong membranous positivity for CK7, EMA, and Her-2-neu, respectively (IHC, ×400)