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Mammary Paget’s Disease: An Update. Cancers (Basel) 2022; 14:cancers14102422. [PMID: 35626023 PMCID: PMC9139704 DOI: 10.3390/cancers14102422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/27/2022] [Accepted: 05/06/2022] [Indexed: 11/21/2022] Open
Abstract
Simple Summary Mammary Paget’s disease of the breast is an uncommon and often misdiagnosed breast malignancy. The review discusses the diagnosis, work-up, treatment, and prognosis of mammary Paget’s disease. Abstract Mammary Paget’s Disease is a non-invasive cutaneous malignancy of the breast involving the nipple-areolar complex that is commonly mistaken for benign breast conditions, leading to delay in diagnosis. This review article discusses Paget’s disease etiology, clinical presentation, differential diagnosis, diagnostic work-up, natural history and prognosis. This article also discusses evolving strategies for the surgical and non-surgical management of Paget’s disease.
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Maharjan R, Shrestha S, Shakya P, Kharel S, Shrestha AK, Singh M. Paget's disease of nipple with dermal invasion: A case report. Cancer Rep (Hoboken) 2021; 5:e1572. [PMID: 34708580 PMCID: PMC9351671 DOI: 10.1002/cnr2.1572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/07/2021] [Accepted: 09/21/2021] [Indexed: 11/15/2022] Open
Abstract
Background Invasive mammary Paget's disease (MPD) is an extremely rare eczematous eruption on the nipple and areola with an invasion of the dermis by Paget cells. This entity can often be misdiagnosed and overtreated for invasive carcinoma of the breast. Case A 34‐year woman presented with a 2‐year history of right nipple eczema and right axillary lump for a month. Breast ultrasound revealed dilated intra‐nipple lactiferous duct and an enlarged right axillary lymph node. Histopathology from biopsy revealed MPD with ductal carcinoma in situ (DCIS) whereas final histopathology after right modified radical mastectomy revealed Invasive MPD with DCIS and axillary metastasis. She underwent adjuvant chemotherapy and is under hormonal therapy with complete remission for 18 months. Conclusion Awareness of invasive MPD is important to avoid misdiagnosis and probable radical treatment. Close follow‐up is warranted due to limited knowledge regarding treatment and prognosis of invasive MPD.
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Affiliation(s)
- Rubina Maharjan
- Department of Oncology, Nepal Cancer Hospital and Research Center, Harisiddhi, Lalitpur, Nepal
| | - Suraj Shrestha
- Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
| | - Prafulla Shakya
- Department of Surgical Oncology (Breast Unit), Nepal Cancer Hospital and Research Center, Harisiddhi, Lalitpur, Nepal
| | - Sanjeev Kharel
- Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
| | - Aagon Krishna Shrestha
- Department of Surgical Oncology (Breast Unit), Nepal Cancer Hospital and Research Center, Harisiddhi, Lalitpur, Nepal
| | - Moushami Singh
- Department of Pathology, Nepal Cancer Hospital and Research Center, Harisiddhi, Lalitpur, Nepal
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Samreen N, Madsen LB, Chacko C, Heller SL. Magnetic resonance imaging in the evaluation of pathologic nipple discharge: indications and imaging findings. Br J Radiol 2021; 94:20201013. [PMID: 33544650 DOI: 10.1259/bjr.20201013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pathologic nipple discharge (PND) is typically unilateral, spontaneous, involves a single duct, and is serous or bloody in appearance. In patients with PND, breast MRI can be helpful as an additional diagnostic tool when conventional imaging with mammogram and ultrasound are negative. MRI is able to detect the etiology of nipple discharge in 56-61% of cases when initial imaging with mammogram and ultrasound are negative. Advantages to using MRI in evaluation of PND include good visualization of the retroareolar breast and better evaluation of posterior lesions which may not be well evaluated on mammograms and galactograms. It is also less invasive compared to central duct excision. Papillomas and nipple adenomas are benign breast masses that can cause PND and are well visualized on MRI. Ductal ectasia, and infectious etiologies such as mastitis, abscess, and fistulas are additional benign causes of PND that are well evaluated with MRI. MRI is also excellent for evaluation of malignant causes of PND including Paget's disease, ductal carcinoma in-situ and invasive carcinoma. MRI's high negative predictive value of 87-98.2% is helpful in excluding malignant etiologies of PND.
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Affiliation(s)
- Naziya Samreen
- New York University Long Island Division, Long Island, NY, USA
| | | | - Celin Chacko
- New York University Long Island Division, Long Island, NY, USA
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Abstract
Mammary Paget disease (MPD) comprises 1.45% all male breast cancers, compared with only 0.68% of all female breast cancers. Patients usually present in the fifth and sixth decades of life with ulceration, eczematous changes, discharge, bleeding, itching, and induration of the nipple and areola. Typically, there is a delay in definitive diagnosis and treatment from the onset of symptoms because most patients are initially treated for a rash. At the time of diagnosis, about half of the patients may have palpable breast mass, positive lymph nodes, or both. In this article, we present 2 cases of male MPD representing the extremes of clinical, radiologic, and histopathologic spectrum of the disease. One patient presented with a rash of the nipple of several months duration without an underlying lesion, whereas the other presented with sensitivity and pain of the nipple for 1 year and an underlying mass. Biopsies were diagnostic of MPD in both cases, and definitive surgery revealed an underlying ductal carcinoma in situ in the first case and an invasive ductal carcinoma in the second, highlighting the importance of early biopsy to initiate appropriate management.
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Del Riego J, Pitarch M, Codina C, Nebot L, Andreu FJ, Aparicio O, Medina A, Martín A. Multimodality approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Insights Imaging 2020; 11:89. [PMID: 32757082 PMCID: PMC7406635 DOI: 10.1186/s13244-020-00896-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/16/2020] [Indexed: 12/29/2022] Open
Abstract
The anatomic and histologic characteristics of the nipple-areolar complex make this breast region special. The nipple-areolar complex can be affected by abnormal development and a wide spectrum of pathological conditions, many of which have unspecific clinical and radiological presentations that can present a challenge for radiologists. The nipple-areolar complex requires a specific imaging workup in which a multimodal approach is essential. Radiologists need to know the different imaging modalities used to study the nipple-areolar complex, as well as their advantages and limitations. It is essential to get acquainted with the acquisition technique for each modality and the spectrum of findings for the different conditions. This review describes and illustrates a combined clinical and radiological approach to evaluate the nipple-areolar complex, emphasizing the findings for the normal morphology, developmental abnormalities, and the most common benign and malignant diseases that can affect this region. We also present a diagnostic algorithm that enables a rapid, practical approach to diagnosing condition involving the nipple-areolar complex.
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Affiliation(s)
- Javier Del Riego
- Department of Radiology, Women's Imaging, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, 1 Parc Tauli, Sabadell, Barcelona, Spain. .,Women's Imaging, Grup Duran Diagnòstic per la Imatge, Sabadell, Barcelona, Spain.
| | - Mireia Pitarch
- Department of Radiology, Women's Imaging, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, 1 Parc Tauli, Sabadell, Barcelona, Spain
| | - Clara Codina
- Department of Radiology, Women's Imaging, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, 1 Parc Tauli, Sabadell, Barcelona, Spain
| | - Laura Nebot
- Department of Pathology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Oscar Aparicio
- Department of Surgery, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, Barcelona, Spain
| | - Alexandra Medina
- Department of Gynecology and Obstetrics, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, Barcelona, Spain
| | - Amaya Martín
- Department of Radiology, Women's Imaging, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, 1 Parc Tauli, Sabadell, Barcelona, Spain.,Women's Imaging, Grup Duran Diagnòstic per la Imatge, Sabadell, Barcelona, Spain
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Choridah L, Sari WK, Dwianingsih EK, Widodo I, Suwardjo, Anwar SL. Advanced lesions of synchronous bilateral mammary Paget's disease: a case report. J Med Case Rep 2020; 14:119. [PMID: 32753069 PMCID: PMC7401214 DOI: 10.1186/s13256-020-02442-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/30/2020] [Indexed: 12/02/2022] Open
Abstract
Background Mammary Paget’s disease is an eczematous eruption on the nipple and areola with underlying breast malignancy. It is often misinterpreted as chronic dermatitis or psoriasis causing a delayed diagnosis. Synchronous bilateral mammary Paget’s disease is exceptionally rare and an advanced case with underlying invasive carcinoma might require long-term treatment and follow-up that could affect a patient’s physical, psychological, and social aspects of well-being. Case presentation A 54-year-old Javanese woman presented in our clinic with a 2-year history of itching and chronic eczema in both areolae. Bilateral nipple retraction and retro-areolar palpable lumps were observed during the first presentation. Breast ultrasound revealed hypoechoic lesions in her left and right breasts. Mammograms showed an irregular hyperdense lesion and multiple microcalcifications. Histopathology from biopsy and bilateral mastectomy demonstrated infiltration of large Paget’s cells in the epidermis of the areola with underlying lesions of invasive ductal carcinoma, diagnosed solid type with high nuclear grade and negative expression of estrogen receptor and progesterone receptor, with positive expression of human epidermal growth receptor-2(HER2) and Ki-67 (45%). Conclusions In a patient with suspicious chronic inflammation of the nipple and areolae, prompt biopsy should be performed to avoid a delayed diagnosis of any malignant breast lesion.
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Affiliation(s)
- Lina Choridah
- Department of Radiology, Dr Sardjito Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Wida Kartika Sari
- Department of Radiology, Dr Sardjito Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Ery Kus Dwianingsih
- Department of Anatomical Pathology, Dr Sardjito Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Irianiwati Widodo
- Department of Anatomical Pathology, Dr Sardjito Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Suwardjo
- Division of Surgical Oncology - Department of Surgery - Dr Sardjito Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Jl Kesehatan No. 1, Yogyakarta, 55281, Indonesia
| | - Sumadi Lukman Anwar
- Division of Surgical Oncology - Department of Surgery - Dr Sardjito Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Jl Kesehatan No. 1, Yogyakarta, 55281, Indonesia.
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Babu B, Dev B, Mohanapriya T, Shalini CNS. Bilateral mammary Paget disease in a young adult female. Radiol Case Rep 2018; 13:586-591. [PMID: 30008979 PMCID: PMC6043634 DOI: 10.1016/j.radcr.2018.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 02/07/2018] [Indexed: 11/30/2022] Open
Abstract
Mammary Paget disease is an uncommon malignancy of the breast that presents with ulceration or eczema of the nipple and is almost always associated with an underlying breast carcinoma. This disease is most commonly seen in the fifth and sixth decades of life and is almost always unilateral. The diagnosis of mammary Paget disease is generally based on clinical findings, confirmed by histopathologic examination. Mammographic and ultrasonographic findings may be nonspecific for malignancy, with 50% of cases showing negative findings. Magnetic resonance imaging can be used as a diagnostic tool to detect clinically occult cancer with nonspecific findings on mammogram and ultrasonogram. In this article, we are presenting a rare case of a young woman with biopsy-proven bilateral mammary Paget disease, for which bilateral modified radical mastectomy was done, followed by adjuvant chemotherapy and radiotherapy.
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Affiliation(s)
- Biji Babu
- Department of Radiology and Imaging Sciences, Sri Ramachandra University, Chennai, Tamil Nadu, 600116, India
| | - Bhawna Dev
- Department of Radiology and Imaging Sciences, Sri Ramachandra University, Chennai, Tamil Nadu, 600116, India
| | - T Mohanapriya
- Department of General Surgery, Sri Ramachandra University, Chennai, Tamil Nadu, India
| | - C N Sai Shalini
- Department of Pathology, Sri Ramachandra University, Chennai, Tamil Nadu, India
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Sorace AG, Harvey S, Syed A, Yankeelov TE. Imaging Considerations and Interprofessional Opportunities in the Care of Breast Cancer Patients in the Neoadjuvant Setting. Semin Oncol Nurs 2017; 33:425-439. [PMID: 28927763 DOI: 10.1016/j.soncn.2017.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To discuss standard-of-care and emerging imaging techniques employed for screening and detection, diagnosis and staging, monitoring response to therapy, and guiding cancer treatments. DATA SOURCES Published journal articles indexed in the National Library of Medicine database and relevant websites. CONCLUSION Imaging plays a fundamental role in the care of cancer patients and specifically, breast cancer patients in the neoadjuvant setting, providing an excellent opportunity for interprofessional collaboration between oncologists, researchers, radiologists, and oncology nurses. Quantitative imaging strategies to assess cellular, molecular, and vascular characteristics within the tumor is needed to better evaluate initial diagnosis and treatment response. IMPLICATIONS FOR NURSING PRACTICE Nurses caring for patients in all settings must continue to seek education on emerging imaging techniques. Oncology nurses provide education about the test, ensure the patient has appropriate pre-testing instructions, and manage patient expectations about timing of results availability.
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