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Afzal RJ, Basree MM, Howard SP, Xu J, Wilke LG, Anderson BM. Mammary Paget's Disease as a Sign of Local Recurrence Two Decades Following Breast Conservation and Adjuvant Therapy for Early Stage Breast Cancer. Cureus 2024; 16:e61521. [PMID: 38957233 PMCID: PMC11218596 DOI: 10.7759/cureus.61521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/02/2024] [Indexed: 07/04/2024] Open
Abstract
Reports of mammary Paget's disease (MPD) as a manifestation of breast cancer recurrence are rare. MPD presents a particular challenge when emerging more than two decades after a breast cancer treated with evidence-based therapy. There is a broad spectrum of non-malignant causes for dermatitis of the nipple during the initial presentation that may delay cancer work-up. This case highlights the MPD work-up and management in the context of a personal history of breast cancer. This unique clinical presentation emphasizes the importance of vigilant cancer surveillance for timely intervention, especially for a presumed cured cancer.
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Affiliation(s)
- Rimsha J Afzal
- Medical Education, University of Pikeville - Kentucky College of Osteopathic Medicine, Pikeville, USA
| | - Mustafa M Basree
- Radiation Oncology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Steven P Howard
- Radiation Oncology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Jin Xu
- Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Lee G Wilke
- Breast Surgery, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Bethany M Anderson
- Radiation Oncology, University of Wisconsin School of Medicine and Public Health, Madison, USA
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Mousa-Doust D, Warburton R, Pao JS, Dingee C, Bazzarelli A, Newman-Bremang J, McKevitt E. Paget's disease of the breast: Presentation, treatment, and outcomes in a modern cohort. Am J Surg 2024; 231:18-23. [PMID: 38641371 DOI: 10.1016/j.amjsurg.2024.01.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/05/2024] [Accepted: 01/24/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Surgical management for Paget's disease (PD) of the breast is controversial. This study aims to assess outcomes of PD patients based on procedure type and determine the reliability of imaging in estimating disease extent. METHODS A retrospective review analyzed clinicopathologic data of PD patients between 2009 and 2022. Pre-operative imaging size (PIS) was compared to post-operative pathology size (PPS) looking at concordance. RESULTS Thirty patients had PD, 21 underwent total mastectomy (TM) and 9 breast conserving surgery (BCS). Seventeen patients (56.7 %) had a final diagnosis of invasive cancer (14 TM, 3 BCS), with no local recurrences. Only 6/19 (31.6 %) patients with positive findings on ultrasound/mammogram had concordance between PIS and PPS. There were no breast/chest wall recurrences with a median follow up of 35.9 months. CONCLUSION Ultrasound and mammogram had poor concordance with pathological size. BCS is feasible in select patients. MRI may help guide management.
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Affiliation(s)
- Dorsa Mousa-Doust
- Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Rebecca Warburton
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Jin-Si Pao
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Carol Dingee
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Amy Bazzarelli
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Jieun Newman-Bremang
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Elaine McKevitt
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
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Guirguis MS, Arribas EM, Kapoor MM, Patel MM, Perez F, Nia ES, Ding Q, Moseley TW, Adrada BE. Multimodality Imaging of Benign and Malignant Diseases of the Nipple-Areolar Complex. Radiographics 2024; 44:e230113. [PMID: 38483829 DOI: 10.1148/rg.230113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
The nipple-areolar complex (NAC), a unique anatomic structure of the breast, encompasses the terminal intramammary ducts and skin appendages. Several benign and malignant diseases can arise within the NAC. As several conditions have overlapping symptoms and imaging findings, understanding the distinctive nipple anatomy, as well as the clinical and imaging features of each NAC disease process, is essential. A multimodality imaging approach is optimal in the presence or absence of clinical symptoms. The authors review the ductal anatomy and anomalies, including congenital abnormalities and nipple retraction. They then discuss the causes of nipple discharge and highlight best practices for the imaging workup of pathologic nipple discharge, a common condition that can pose a diagnostic challenge and may be the presenting symptom of breast cancer. The imaging modalities used to evaluate and differentiate benign conditions (eg, dermatologic conditions, epidermal inclusion cyst, mammary ductal ectasia, periductal mastitis, and nonpuerperal abscess), benign tumors (eg, papilloma, nipple adenoma, and syringomatous tumor of the nipple), and malignant conditions (eg, breast cancer and Paget disease of the breast) are reviewed. Breast MRI is the current preferred imaging modality used to evaluate for NAC involvement by breast cancer and select suitable candidates for nipple-sparing mastectomy. Different biopsy techniques (US -guided biopsy and stereotactic biopsy) for sampling NAC masses and calcifications are described. This multimodality imaging approach ensures an accurate diagnosis, enabling optimal clinical management and patient outcomes. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Mary S Guirguis
- From the Departments of Breast Imaging (M.S.G., E.M.A., M.M.K., M.M.P., F.P., E.S.N., T.W.M., B.E.A.), Pathology-Anatomical (Q.D.), and Breast Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| | - Elsa M Arribas
- From the Departments of Breast Imaging (M.S.G., E.M.A., M.M.K., M.M.P., F.P., E.S.N., T.W.M., B.E.A.), Pathology-Anatomical (Q.D.), and Breast Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| | - Megha M Kapoor
- From the Departments of Breast Imaging (M.S.G., E.M.A., M.M.K., M.M.P., F.P., E.S.N., T.W.M., B.E.A.), Pathology-Anatomical (Q.D.), and Breast Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| | - Miral M Patel
- From the Departments of Breast Imaging (M.S.G., E.M.A., M.M.K., M.M.P., F.P., E.S.N., T.W.M., B.E.A.), Pathology-Anatomical (Q.D.), and Breast Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| | - Frances Perez
- From the Departments of Breast Imaging (M.S.G., E.M.A., M.M.K., M.M.P., F.P., E.S.N., T.W.M., B.E.A.), Pathology-Anatomical (Q.D.), and Breast Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| | - Emily S Nia
- From the Departments of Breast Imaging (M.S.G., E.M.A., M.M.K., M.M.P., F.P., E.S.N., T.W.M., B.E.A.), Pathology-Anatomical (Q.D.), and Breast Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| | - Qingqing Ding
- From the Departments of Breast Imaging (M.S.G., E.M.A., M.M.K., M.M.P., F.P., E.S.N., T.W.M., B.E.A.), Pathology-Anatomical (Q.D.), and Breast Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| | - Tanya W Moseley
- From the Departments of Breast Imaging (M.S.G., E.M.A., M.M.K., M.M.P., F.P., E.S.N., T.W.M., B.E.A.), Pathology-Anatomical (Q.D.), and Breast Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| | - Beatriz E Adrada
- From the Departments of Breast Imaging (M.S.G., E.M.A., M.M.K., M.M.P., F.P., E.S.N., T.W.M., B.E.A.), Pathology-Anatomical (Q.D.), and Breast Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
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Li HM, Huang TY, Chang TH, Wen TN. Paget's disease of the nipple with underlying occult invasive carcinoma detected by magnetic resonance imaging and second-look ultrasound: Case report. Int J Surg Case Rep 2024; 114:109139. [PMID: 38100925 PMCID: PMC10762364 DOI: 10.1016/j.ijscr.2023.109139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Paget's disease of the nipple (PDN) is a rare and often misdiagnosed condition characterized by the infiltration of adenocarcinoma cells into the nipple epidermis. It poses substantial diagnostic and therapeutic challenges due to its similarity to benign dermatological conditions and its association with in situ or invasive carcinoma. CASE PRESENTATION This report details the case of a 47-year-old woman with persistent nipple itching, rash, and occasional bloody discharge. No abnormalities were seen on the mammogram and ultrasound scans; punch biopsy was performed to confirm PDN. A small lesion missed by other imaging methods was detected via breast magnetic resonance imaging (MRI). A second-look ultrasound with needle localization enabled precise surgery. The pathology report after breast-conserving surgery (BCS) revealed invasive ductal carcinoma with no metastasis in the sentinel lymph node biopsy. DISCUSSION PDN often mimics benign skin conditions, leading to delayed diagnosis. Furthermore, timely identification is crucial as PDN is frequently associated with underlying breast malignancies. Additional imaging, such as breast MRI, is essential for comprehensive evaluation, as it can reveal hidden lesions previously undetected by conventional mammography and ultrasound. A second-look ultrasound guided needle placement for tumor localization, enhancing surgical precision, aesthetics, and reducing patient harm. Surgical management, including mastectomy, BCS with radiotherapy, and oncoplastic surgery, offers suitable options without affecting recurrence or survival in selected patients. CONCLUSION This case emphasizes the importance of employing additional imaging tools, such as breast MRI and second-look ultrasound for the early detection and surgical management of PDN.
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Affiliation(s)
- Hao-Ming Li
- Department of Surgery, Taoyuan Armed Forced General Hospital, Taoyuan City, Taiwan; Department of Surgery, Hsinchu Branch, Taipei Veterans General Hospital, Hsinchu County, Taiwan
| | - Tzu-Yu Huang
- Department of Pathology, Hsinchu Branch, Taipei Veterans General Hospital, Hsinchu County, Taiwan
| | - Tsun-Hou Chang
- Department of Radiology, Hsinchu Branch, Taipei Veterans General Hospital, Hsinchu County, Taiwan
| | - Tzu-Ning Wen
- Department of Nursing, Fu Jen Catholic University, New Taipei City, Taiwan.
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Mariano L, Nicosia L, Pupo D, Olivieri AM, Scolari S, Pesapane F, Latronico A, Bozzini AC, Fusco N, Blanco MC, Mazzarol G, Corso G, Galimberti VE, Venturini M, Pizzamiglio M, Cassano E. A Pictorial Exploration of Mammary Paget Disease: Insights and Perspectives. Cancers (Basel) 2023; 15:5276. [PMID: 37958452 PMCID: PMC10650713 DOI: 10.3390/cancers15215276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
Mammary Paget disease (MPD) is a rare condition primarily affecting adult women, characterized by unilateral skin changes in the nipple-areolar complex (NAC) and frequently associated with underlying breast carcinoma. Histologically, MPD is identified by large intraepidermal epithelial cells (Paget cells) with distinct characteristics. Immunohistochemical profiles aid in distinguishing MPD from other skin conditions. Clinical evaluation and imaging techniques, including magnetic resonance imaging (MRI), are recommended if MPD is suspected, although definitive diagnosis always requires histological examination. This review delves into the historical context, epidemiology, pathogenesis, clinical manifestations, and diagnosis of MPD, emphasizing the need for early detection. The classification of MPD based on pathogenesis is explored, shedding light on its varied presentations. Treatment options, including mastectomy and breast-conserving surgery, are discussed with clear guidelines for different scenarios. Adjuvant therapies are considered, particularly in cases with underlying breast cancer. Prognostic factors are outlined, underlining the importance of early intervention. Looking to the future, emerging techniques, like liquid biopsy, new immunohistochemical and molecular markers, and artificial intelligence-based image analysis, hold the potential to transform MPD diagnosis and treatment. These innovations offer hope for early detection and improved patient care, though validation through large-scale clinical trials is needed.
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Affiliation(s)
- Luciano Mariano
- Breast Imaging Division, AOU Città della Scienza e della Salute di Torino, 10126 Turin, Italy;
| | - Luca Nicosia
- Department of Biotechnology and Life Sciences, University of Insubria, Via J.H. Dunant, 3, 21100 Varese, Italy
- Breast Imaging Division, IEO—European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy; (F.P.); (A.L.); (A.C.B.); (M.P.); (E.C.)
| | - Davide Pupo
- Radiology Division, Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80138 Naples, Italy;
| | - Antonia Maria Olivieri
- Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy;
| | - Sofia Scolari
- Postgraduation School in Radiodiagnostics, Faculty of Medicine and Surgery, University of Milan, 20122 Milan, Italy;
| | - Filippo Pesapane
- Breast Imaging Division, IEO—European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy; (F.P.); (A.L.); (A.C.B.); (M.P.); (E.C.)
| | - Antuono Latronico
- Breast Imaging Division, IEO—European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy; (F.P.); (A.L.); (A.C.B.); (M.P.); (E.C.)
| | - Anna Carla Bozzini
- Breast Imaging Division, IEO—European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy; (F.P.); (A.L.); (A.C.B.); (M.P.); (E.C.)
| | - Nicola Fusco
- Division of Pathology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (N.F.); (M.C.B.); (G.M.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy;
| | - Marta Cruz Blanco
- Division of Pathology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (N.F.); (M.C.B.); (G.M.)
| | - Giovanni Mazzarol
- Division of Pathology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (N.F.); (M.C.B.); (G.M.)
| | - Giovanni Corso
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy;
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, Via Ripamonti, 435, 20141 Milan, Italy;
- European Cancer Prevention Organization (ECP), 20122 Milan, Italy
| | - Viviana Enrica Galimberti
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, Via Ripamonti, 435, 20141 Milan, Italy;
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy;
| | - Maria Pizzamiglio
- Breast Imaging Division, IEO—European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy; (F.P.); (A.L.); (A.C.B.); (M.P.); (E.C.)
| | - Enrico Cassano
- Breast Imaging Division, IEO—European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy; (F.P.); (A.L.); (A.C.B.); (M.P.); (E.C.)
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Gulati M, Singla V, Singh T, Bal A, Irrinki RNNS. Nipple Discharge: When is it Worrisome? Curr Probl Diagn Radiol 2023; 52:560-569. [PMID: 37460358 DOI: 10.1067/j.cpradiol.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/25/2023] [Accepted: 06/28/2023] [Indexed: 10/16/2023]
Abstract
Nipple discharge is the third most common breast related complaint seen in the breast clinics. Although the majority of cases are due to a benign etiology, 5%-12% cases of pathological nipple discharge may be harboring an underlying malignancy. A thorough radiological workup in cases of pathological nipple discharge is thus of utmost importance, with the initial imaging modality depending on the age of the patient. The imaging modalities include mammogram (MG) and ultrasound (US) with addition of breast MRI if the nipple discharge is clinically suspicious and no MG or US correlate is identified. Magnetic Resonance Imaging (MRI) also holds promise in demonstrating the exact extent of a pathology detected on US and thus aids in the planning of further management.
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Affiliation(s)
- Malvika Gulati
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Sciences and Research, Chandigarh, India
| | - Veenu Singla
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Sciences and Research, Chandigarh, India.
| | - Tulika Singh
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Sciences and Research, Chandigarh, India
| | - Amanjit Bal
- Department of Histopathology, Post Graduate Institute of Medical Sciences and Research, Chandigarh, India
| | - R N Naga Santhosh Irrinki
- Department of General Surgery, Post Graduate Institute of Medical Sciences and Research, Chandigarh, India
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Reig B, Kim E, Chhor CM, Moy L, Lewin AA, Heacock L. Problem-solving Breast MRI. Radiographics 2023; 43:e230026. [PMID: 37733618 DOI: 10.1148/rg.230026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Breast MRI has high sensitivity and negative predictive value, making it well suited to problem solving when other imaging modalities or physical examinations yield results that are inconclusive for the presence of breast cancer. Indications for problem-solving MRI include equivocal or uncertain imaging findings at mammography and/or US; suspicious nipple discharge or skin changes suspected to represent an abnormality when conventional imaging results are negative for cancer; lesions categorized as Breast Imaging Reporting and Data System 4, which are not amenable to biopsy; and discordant radiologic-pathologic findings after biopsy. MRI should not precede or replace careful diagnostic workup with mammography and US and should not be used when a biopsy can be safely performed. The role of MRI in characterizing calcifications is controversial, and management of calcifications should depend on their mammographic appearance because ductal carcinoma in situ may not appear enhancing on MR images. In addition, ductal carcinoma in situ detected solely with MRI is not associated with a higher likelihood of an upgrade to invasive cancer compared with ductal carcinoma in situ detected with other modalities. MRI for triage of high-risk lesions is a subject of ongoing investigation, with a possible future role for MRI in decreasing excisional biopsies. The accuracy of MRI is likely to increase with the use of advanced techniques such as deep learning, which will likely expand the indications for problem-solving MRI. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Beatriu Reig
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016
| | - Eric Kim
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016
| | - Chloe M Chhor
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016
| | - Linda Moy
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016
| | - Alana A Lewin
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016
| | - Laura Heacock
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016
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Pelorca RJF, de Oliveira-Junior I, da Costa Vieira RA. Oncoplastic surgery for Paget's disease of the breast. Front Oncol 2023; 13:1151932. [PMID: 37265790 PMCID: PMC10231681 DOI: 10.3389/fonc.2023.1151932] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/02/2023] [Indexed: 06/03/2023] Open
Abstract
Introduction Paget's disease of the breast (PDB) is a rare nipple entity associated with multifocality. Due to its location, resection of the entire nipple-areolar complex is necessary. Historically central quadrantectomy and mastectomy have the surgical treatments of choice. The feasibility of oncoplastic breast surgery (OBS) for PDB is unknown. Methods This was a retrospective study performed in a Brazilian oncological hospital. We evaluated the factors related to the performance of OBS in PDB. In addition, the impact of OBS on local recurrence and survival was analysed. Comparisons were made between groups using the chi-square test, Mann-Whitney U test, and Kaplan-Meier method. To assess the impact factor of the variables on the performance of OBS, logistic regression was performed. Results Eighty-five patients were evaluated. OBS was performed in 69.4% (n=59), and of these, 16 (27.2%) were symmetrized with contralateral surgery. Mastectomy without reconstruction was performed in 28.3% of the patients. The primary procedure performed was mastectomy with reconstruction (n=38; 44.7%), and the preferential technique for immediate reconstruction was skin-sparing mastectomy with prosthesis; for late reconstruction, the preferred technique was using the latissimus dorsi. Breast conserving-surgery was performed in 27.0% (n=23), primarily using the plug-flap technique (OBS). Age was associated with the use of OBS; as patients aged 40-49 exhibited a higher rate of OBS (p = 0.002; odds ratio 3.22). OBS did not influence local recurrence (p=1.000), overall survival (p=0.185), or cancer-specific survival (p=0.418). Conclusion OBS improves options related to surgical treatment in PDB without affecting local recurrence or survival rates.
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Affiliation(s)
- Rafael José Fábio Pelorca
- Programa de Pós-Graduação em Tocoginecologia, Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil
| | - Idam de Oliveira-Junior
- Programa de Pós-Graduação em Tocoginecologia, Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil
- Programa de Pós-Graduação em Oncologia, Barretos Cancer Hospital, Barretos, SP, Brazil
- Departamento de Mastologia e Reconstrução Mamária, Barretos Cancer Hospital, Barretos, SP, Brazil
| | - René Aloisio da Costa Vieira
- Programa de Pós-Graduação em Tocoginecologia, Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil
- Programa de Pós-Graduação em Oncologia, Barretos Cancer Hospital, Barretos, SP, Brazil
- Departamento de Cirurgia Oncológica, Divisão de Mastologia, Hospital de Câncer de Muriaé, Muriaé, MG, Brazil
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Luigi B, Carlo V, Corrado C, Orlando C. The nipple-areolar complex: anatomy, methods and pathologic findings, between senologist and dermatologist. J Ultrasound 2023; 26:239-247. [PMID: 36085438 PMCID: PMC10063719 DOI: 10.1007/s40477-022-00722-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/22/2022] [Indexed: 10/14/2022] Open
Abstract
The purpose of this presentation is to show the ultrasonography findings of normal variants and benign and malignant diseases that affect the nipple-areolar complex. Many of which have unspecific clinical and radiological presentations that can present a challenge for medical specialists. Experienced specialists need to know the different imaging modalities used to study the nipple-areolar complex and the aspect not exactly senology, as well as dermatologist who approach the ultrasound must know the anatomy of this complex area. We will show you a combined clinical and radiological approach to evaluate the nipple-areolar complex, the findings for the normal morphology and the most common benign and malignant diseases that can affect this region. We discuss the characteristics of the different ultrasonography findings and provide guidance on how to avoid artifacts and pitfalls.
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Affiliation(s)
- Basile Luigi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, via Pansini 5, 80138, Naples, Italy.
| | - Varelli Carlo
- Radiology Unit, Istituto Diagnostico Varelli, Naples, Italy
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Robrahn I, Maimone S, Edgar MA. Arthropod Bite Mastitis as a Mimicker of Breast Cancer. Cureus 2022; 14:e28541. [PMID: 36185886 PMCID: PMC9518816 DOI: 10.7759/cureus.28541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2022] [Indexed: 11/05/2022] Open
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Forrai G, Kovács E, Ambrózay É, Barta M, Borbély K, Lengyel Z, Ormándi K, Péntek Z, Tünde T, Sebő É. Use of Diagnostic Imaging Modalities in Modern Screening, Diagnostics and Management of Breast Tumours 1st Central-Eastern European Professional Consensus Statement on Breast Cancer. Pathol Oncol Res 2022; 28:1610382. [PMID: 35755417 PMCID: PMC9214693 DOI: 10.3389/pore.2022.1610382] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/29/2022] [Indexed: 12/11/2022]
Abstract
Breast radiologists and nuclear medicine specialists updated their previous recommendation/guidance at the 4th Hungarian Breast Cancer Consensus Conference in Kecskemét. A recommendation is hereby made that breast tumours should be screened, diagnosed and treated according to these guidelines. These professional guidelines include the latest technical developments and research findings, including the role of imaging methods in therapy and follow-up. It includes details on domestic development proposals and also addresses related areas (forensic medicine, media, regulations, reimbursement). The entire material has been agreed with the related medical disciplines.
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Affiliation(s)
- Gábor Forrai
- GÉ-RAD Kft., Budapest, Hungary
- Duna Medical Center, Budapest, Hungary
| | - Eszter Kovács
- GÉ-RAD Kft., Budapest, Hungary
- Duna Medical Center, Budapest, Hungary
| | | | | | - Katalin Borbély
- National Institute of Oncology, Budapest, Hungary
- Ministry of Human Capacities, Budapest, Hungary
| | | | | | | | - Tasnádi Tünde
- Dr Réthy Pál Member Hospital of Békés County Central Hospital, Békéscsaba, Hungary
| | - Éva Sebő
- Kenézy Gyula University Hospital, University of Debrecen, Debrecen, Hungary
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12
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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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Jha A, Shrivastav S, Kasyap AK. Calciphylaxis and Ulcerative Lesions of Bilateral Nipple–Areolar Complex Due to Alcoholic Liver Disease. Indian J Radiol Imaging 2022; 32:142-144. [PMID: 35722637 PMCID: PMC9200483 DOI: 10.1055/s-0041-1739385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
When faced with eczematous lesions involving the nipple–areolar complex (NAC), Paget's disease is assumed to be the diagnosis, anything else being considered a “Zebra” necessitating its exclusion on pathology. A middle-aged lady presented with synchronous asymmetrical ulceration of bilateral NAC with pleomorphic calcifications on mammography and simultaneous extensive vascular calcification in bilateral breasts that suggested systemic cause. Calciphylaxis is a rare diagnosis occurring usually due to underlying end-stage renal disease or hyperparathyroidism. There are very few case reports of calciphylaxis due to alcoholic liver disease and no cases to the best of our knowledge involving NAC. We report an extremely rare case of breast and NAC calciphylaxis due to alcoholic liver disease, highlighting need to consider benign etiology when bilateral involvement is present.
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Affiliation(s)
- Anamika Jha
- Department of Radiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Shreya Shrivastav
- Department of Pathology, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Akhilesh K. Kasyap
- Department of Gastroenterology and Hepatology, Grande International Hospital, Dhapasi, Kathmandu, Nepal
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14
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Han BY, Xu XL, Zhu XZ, Han XC, Hu X, Ling H. Clinicopathological Characteristics and Survival Outcomes of Mammary Paget’s Disease: A Retrospective Study Based on a Chinese Population. Cancer Manag Res 2022; 14:237-247. [PMID: 35125891 PMCID: PMC8807864 DOI: 10.2147/cmar.s338788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 12/28/2021] [Indexed: 11/23/2022] Open
Abstract
Background Mammary Paget’s disease (PD) is a rare type of breast cancer. Most cases of PD are presented with underlying ductal carcinoma in situ (DCIS) or invasive breast carcinoma (IDC). This study aimed to investigate the clinicopathological characteristics and survival outcomes of PD patients. Materials and Methods A total of 406 patients diagnosed with PD with IDC/DCIS at Fudan University Shanghai Cancer Center (FUSCC) were recruited as the PD group, 1218 patients diagnosed with IDC/DCIS alone during the same period were selected as the non-PD group, and the clinicopathological results of these two groups were compared. The Surveillance, Epidemiology, and End Results (SEER) database was used to investigate the clinicopathological features between PD and non-PD patients for validation. Results Compared with the non-PD group, the PD group was much more likely to have larger (≥2 cm: 43.1% vs 35.5%, P < 0.001), less hormone receptor (HR)-positive (68.5% vs 26.6%, P < 0.001), more human epidermal growth factor receptor-2 (HER-2)-positive (70.7% vs 27.5%, P < 0.001) and higher Ki-67 proportion (51.5% vs 42.5%, P < 0.001) tumors. The HER-2 overexpression subtype accounted for the largest proportion in the PD-IDC group and the lowest proportion in the non-PD-IDC group (54% vs 8%, P < 0.01). Moreover, the PD group had significantly worse disease-free survival (DFS) than the non-PD group (5-year DFS: 91.8% vs 97.3%, P = 0.001), and the SEER database showed a similar trend. Univariate and multivariate Cox regression analyses demonstrated that PD was an independent poor-risk factor. Our matched study showed that the PD group had worse survival than the non-PD group after excluding age, HR, HER-2, tumor size and lymph node status. Conclusion PD with IDC/DCIS is associated with more aggressive tumor characteristics and worse survival outcomes. More than half of PD breast cancers are HER-2 overexpression subtype. PD is an independent poor-risk factor for breast cancer survival.
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Affiliation(s)
- Bo-Yue Han
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032, People’s Republic of China
- Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Xiao-Li Xu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People’s Republic of China
- Department of Pathology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Xiu-Zhi Zhu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032, People’s Republic of China
- Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Xiang-Chen Han
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032, People’s Republic of China
- Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Xin Hu
- Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People’s Republic of China
- Correspondence: Xin Hu; Hong Ling, Tel +86 18017317652; +86 18017312656, Email ;
| | - Hong Ling
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People’s Republic of China
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15
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Liu X, Xu Y, Liu J, Sun S, Zhu Y, Lu H. Pathological and imaging features of Paget's disease and nipple adenoma: a comparative study. Gland Surg 2022; 11:207-215. [PMID: 35242682 PMCID: PMC8825522 DOI: 10.21037/gs-21-862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/07/2022] [Indexed: 09/27/2023]
Abstract
BACKGROUND Both Paget's disease (PD) and nipple adenoma (NA) are rare lesions occurred on nipple and share some similarities in clinical manifestations, but there are have different pathological manifestations and imaging findings. This study analyzed the clinicopathological and imaging features of PD in nipple and NA to improve our knowledge about these two diseases and to provide guidance for clinical diagnosis and treatment. METHODS Retrospectively analyzed 99 female patients confirmed by surgery and pathology from January 2014 to December 2018. The features of imaging examination included 95 cases of breast ultrasound, 83 cases of breast X-ray and 24 cases of magnetic resonance imaging (MRI) were analyzed and compered the detection rate and diagnostic accuracy. RESULTS The 99 patients consisted of 76 patients with PD and 23 patients with NA. Despite the similarity of clinical manifestations between PD and NA, the pathological features of these diseases were completely different. Differences in various imaging manifestations were found to facilitate differential diagnosis. Breast X-ray and ultrasound can discover the nipple areola changes such as mass and calcification, but some cases still show negative. Breast MRI can clearly show the areola lesions of nipple PD and NA, accurately evaluate the degree and size of breast lesions, and help clinicians choose appropriate and personalized diagnosis and treatment methods. CONCLUSIONS The combination of multiple breast imaging examinations (including X-ray, ultrasound, and MRI) can improve the diagnosis of PD and NA and play a guiding role in the options for clinical treatment.
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Affiliation(s)
- Xuejing Liu
- Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
| | - Yilin Xu
- Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
| | - Junjun Liu
- Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
| | - Shumeng Sun
- Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
| | - Ying Zhu
- Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
| | - Hong Lu
- Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
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16
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Salih AM, Hammood ZD, Kakamad FH, Othman S, Ali RK, Latif S. Paget's disease of the breast in male with underlying invasive ductal carcinoma: A case report with review of literature. Ann Med Surg (Lond) 2021; 72:103035. [PMID: 34820122 PMCID: PMC8599100 DOI: 10.1016/j.amsu.2021.103035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 11/14/2022] Open
Abstract
Introduction Paget's disease of the breast is a rare cutaneous eczema-like condition that occurs in the nipple-areolar complex of the breast. The current study aims to report a rare case of Paget's disease of the breast associated with invasive ductal carcinoma in a male breast. Case report A 54-year-old male presented with ulceration of the left nipple-areolar complex that has been progressing over the last 6 months. On examination; there was a palpable axillary lymph node. On ultrasound, a small hypoechoic heterogenous mass was seen beneath the areola (8*4 mm) with surrounding vascularity, and a few axillary lymph nodes with normal morphology and cortical thickness. The mammography revealed some points of calcification arranged in clusters. The patient underwent left side mastectomy and sentinel lymph node biopsy. The result of histopathological examination showed left side unifocal invasive ductal carcinoma. Discussion There are two main theories that explain the histogenesis of Paget's disease of the breast with and without underlying malignancy: epidermotropic theory, which suggests an epidermal infiltration of the nipple with Paget cells, and transformative theory, which proposes a malignant transformation of normal glandular cells of the epidermis. Conclusion The clinical presentation of Paget's disease of the breast is characteristic and should always warn the surgeon of the possibility of underlying malignancy. Paget's disease of the breast (or nipple) is a very rare cutaneous entity. Paget's disease of the male breast is an extremely rare clinicopathologic condition. Breast cancer in male is likewise very rare.
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Affiliation(s)
- Abdulwahid M Salih
- Department of Surgery, College of Medicine, University of Sulaimani, Sulaimani, Iraq.,Smart Health Tower, Madam Mittarand Str., Sulaimani, Iraq
| | | | - Fahmi H Kakamad
- Department of Surgery, College of Medicine, University of Sulaimani, Sulaimani, Iraq.,Smart Health Tower, Madam Mittarand Str., Sulaimani, Iraq.,Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Iraq
| | - Snur Othman
- Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Iraq
| | - Razhan K Ali
- Department of Cardiothoracic Surgery, Shar Hospital, Sulaimani, Iraq
| | - Shaban Latif
- Smart Health Tower, Madam Mittarand Str., Sulaimani, Iraq
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17
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Goto W, Kashiwagi S, Kawano Y, Komoda A, Ishihara S, Asano Y, Morisaki T, Hirakawa K, Ohira M. Pathological Complete Response following Neoadjuvant Chemotherapy in Invasive Ductal Carcinoma with Mammary Paget's Disease: A Case Report. Case Rep Oncol 2021; 14:1242-1247. [PMID: 34703442 PMCID: PMC8460882 DOI: 10.1159/000516762] [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: 04/06/2021] [Accepted: 04/14/2021] [Indexed: 11/19/2022] Open
Abstract
Mammary Paget's disease is a rare malignancy. Mastectomy or breast-conserving surgery has been considered as the standard treatment, while there have been few reports of neoadjuvant chemotherapy (NAC). A 53-year-old woman with erythema and skin ulceration of the left breast was admitted to our institution. Breast examinations revealed left invasive ductal carcinoma (cT1bN0M0, cStage I), and a punch biopsy of the left mammary erythema indicated Paget's disease (cTisN0M0, cStage0). The patient received NAC because of multiple lesions. Consequently, the breast tumor clinically disappeared, and the erythema improved. These outcomes made it easier to perform surgery (left mastectomy and sentinel node biopsy). Histopathological examination revealed no residual cancer cells in either the mammary gland or breast skin, and no metastasis was found in the sentinel lymph node. Therefore, NAC may be a useful treatment for mammary Paget's disease.
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Affiliation(s)
- Wataru Goto
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinichiro Kashiwagi
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yuko Kawano
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Asuka Komoda
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Sae Ishihara
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yuka Asano
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tamami Morisaki
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kosei Hirakawa
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.,Department of Gastrointestinal Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masaichi Ohira
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.,Department of Gastrointestinal Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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18
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A new search pattern for emergency breast exams: the clinical picture. Emerg Radiol 2021; 29:207-213. [PMID: 34533665 DOI: 10.1007/s10140-021-01958-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/17/2021] [Indexed: 10/20/2022]
Abstract
Distinct breast diseases are readily diagnosed by clinical and ultrasound appearance that radiologists and sonographers may encounter in emergency room and urgent care patient presentations. While it may be impractical or impossible for the on-call emergency radiologist to examine a patient with breast complaints, radiologists can and should adopt the practice pattern to routinely seek out the clinical photographs in the patient's medical record while interpreting breast examinations. Imaging should be interpreted in the context of both the history and the physical findings. Sonographers play important roles in the documentation of visual inspection findings, in addition to performing high quality targeted ultrasound where applicable. This pictorial offers resources to emergency radiologists and sonographers that facilitate rapid accurate diagnosis of ten distinct breast diseases.
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Coşkun Bilge A, Aydın H, Bostancı IE, Tanişman Ö, Saygılı Öz D. Comparison of the Magnetic Resonance Imaging Findings of Paget's Disease of the Breast and Malignant Tumor Invasion of the Nipple-Areola Complex. Eur J Breast Health 2021; 17:265-273. [PMID: 34263155 DOI: 10.4274/ejbh.galenos.2021.6091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/30/2021] [Indexed: 12/01/2022]
Abstract
Objective We aimed to investigate the distinction between Paget's disease of the breast (PDB) and malignant tumor invasion of nipple-areolar complex (MTION) with Magnetic resonance imaging (MRI) findings without the need for skin punch biopsy. Materials and Methods MRI findings of 16 patients with pathologically proven PDB and 11 patients with pathologically proven MTION were reviewed retrospectively. MRI images were assessed for nipple morphological changes; areolar-periareolar skin changes; thickness, classification, and kinetic characteristics of the nipple-areolar complex (NAC) enhancement; morphological pattern, size, and pathological diagnosis of concomitant malignant lesions; kinetic characteristics of the concomitant malignant lesions enhancement; continuity of enhancement between the nipple and closest concomitant malignant lesion; similarity of enhancement kinetics of the NAC and concomitant malignant lesions; and nipple-to-malignant lesion distance in both patient groups. Results Areolar-periareolar skin thickening was statistically different between the patient groups. Enhancement kinetic pattern was classified as persistent in four patients with MTION and plateau in seven patients with PDB. Moreover, NAC enhancement kinetic characteristics were statistically different between the groups. Invasive ductal carcinoma was detected in three patients with PDB and five patients with MTION. A statistically significant difference in malignant lesion pathological types was detected between the patient groups. Conclusion The significant MRI findings in patients with MTION diagnosed as invasive ductal carcinoma were areolar-periareolar skin thickening and asymmetric NAC enhancement with persistent kinetics pattern. In patients diagnosed with ductal carcinoma in situ, a plateau pattern of asymmetric NAC enhancement without any areolar-periareolar skin changes on MRI may indicate PDB.
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Affiliation(s)
- Almila Coşkun Bilge
- Department of Radiology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Hale Aydın
- Department of Radiology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Işıl Esen Bostancı
- Department of Radiology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Özge Tanişman
- Department of Radiology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Diba Saygılı Öz
- Department of Radiology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
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Nori J, Bicchierai G, Amato F, De Benedetto D, Boeri C, Vanzi E, Di Naro F, Bianchi S, Miele V. A new technique for the histological diagnosis of Paget's disease of the breast using a semiautomated core needle biopsy with a 14-gauge needle. Radiol Med 2021; 126:936-945. [PMID: 33900526 DOI: 10.1007/s11547-021-01358-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/14/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of our work is to illustrate a new technique for the histological diagnosis of Paget's disease (PD) using a core needle biopsy with a semiautomated 14-gauge needle called nipple-core needle biopsy (N-CNB). We report 3 years' experience in our senology unit. MATERIALS AND METHODS Twenty-six women with 26 clinical of nipple-areola complex (NAC) changes with suspected PD and subjected to core needle biopsy using our new 14G semiautomated needle technique were included in our study group. Institutional review board approval was obtained for this retrospective analysis. A semiautomated biopsy gun with a 14-gauge, 15-cm-long needle was used for this new procedure. After a subcutaneous injection of anesthetic and spray-ice application to the NAC, the 14G needle was opened with the cradle exposed and positioned on the NAC with considerable pressure exerted on the same. The cradle was then closed by triggering the needle spring, and 2-4 core samples were withdrawn by moving the needle position each time. Clinical, instrumental and histological differences between the lesions that gave benign results after N-CNB and those that resulted PD were analyzed by applying the Fisher's exact test. RESULTS After N-CNB, 13/26 lesions were found to be PD (50%) while 13/26 alterations were benign (50%). No malignant lesions were detected during the follow-up in patients with benign N-CNB results. The diagnosis of PD obtained with N-CNB was confirmed in all 13 cases by means of a histological analysis of the surgical specimens. No significant post-biopsy complications were recorded. Patients with PD more frequently presented nipple retraction (ρ = 0.0407) and associated suspicious (i.e., BI-RADS 4 and 5) mammographic (ρ = 0.0006) findings compared to patients whose N-CNB had given benign results and the difference was statistically significant. CONCLUSIONS In conclusion, with this novel technique, we were able to obtain an easy, painless, major complication-free and accurate diagnosis of PD of the NAC using a semiautomated core needle biopsy with a 14-gauge needle.
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Affiliation(s)
- Jacopo Nori
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - Giulia Bicchierai
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy.
| | - Francesco Amato
- Radiology Department, Ospedale San Giovanni Di Dio, Agrigento, Italy
| | - Diego De Benedetto
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - Cecilia Boeri
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - Ermanno Vanzi
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - Federica Di Naro
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - Simonetta Bianchi
- Division of Pathological Anatomy, University of Florence, Florence, Italy
| | - Vittorio Miele
- Emergency Radiology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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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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Geffroy D. La peau des seins, première frontière anatomique. IMAGERIE DE LA FEMME 2020. [DOI: 10.1016/j.femme.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rodríguez-Fernández V, Cameselle-Cortizo L, Lamas González MJ, De Castro Parga GJ, Valdés-Pons J, Novo Domínguez A, Cameselle-Teijeiro JF, Schmitt FC. Paget´s disease of the male breast: An unusual case in a young man and literature review. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2020. [DOI: 10.1016/j.cpccr.2020.100019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Chiorean A, Pintican RM, Szep M, Feier D, Rogojan L, Fetica B, Dindelegan G, Vlad B, Duma M. Nipple Ultrasound: A Pictorial Essay. Korean J Radiol 2020; 21:955-966. [PMID: 32677380 PMCID: PMC7369201 DOI: 10.3348/kjr.2019.0831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/07/2020] [Accepted: 03/09/2020] [Indexed: 11/15/2022] Open
Abstract
Ultrasound (US) is an attractive diagnostic approach to identify both common and uncommon nipple pathologies, such as duct ectasia, nipple abscess, nipple leiomyoma, nipple adenoma, fibroepithelial polyp, ductal carcinoma in situ (restricted to nipple), invasive carcinoma, and Paget's disease. US is the reliable first-line imaging technique to assess nipple pathologies. It is useful to identify and characterize nipple lesions. Additionally, we have presented the mammography and MRI outcomes correlated with histopathologic features for the relevant cases.
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Affiliation(s)
- Angelica Chiorean
- Department of Radiology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Medimages Breast Center, Cluj-Napoca, Romania
| | - Roxana Maria Pintican
- Department of Radiology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Radiology and Medical Imaging, County Clinical Emergency Hospital, Cluj-Napoca, Romania.
| | - Madalina Szep
- Department of Radiology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Medimages Breast Center, Cluj-Napoca, Romania
| | - Diana Feier
- Department of Radiology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Medimages Breast Center, Cluj-Napoca, Romania
| | - Liliana Rogojan
- Department of Pathology, County Clinical Emergency Hospital, Cluj-Napoca, Romania
| | - Bogdan Fetica
- Department of Pathology, County Clinical Emergency Hospital, Cluj-Napoca, Romania.,Department of Pathology, Ion Chiricuţă, Oncology Institute, Cluj-Napoca, Romania
| | - George Dindelegan
- Department of Surgery, County Clinical Emergency Hospital, Cluj-Napoca, Romania
| | - Bura Vlad
- Department of Radiology and Medical Imaging, County Clinical Emergency Hospital, Cluj-Napoca, Romania
| | - Magdalena Duma
- Department of Radiology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Medimages Breast Center, Cluj-Napoca, Romania.,Department of Radiology, Micromedica Clinic, Piatra Neamt, Romania
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25
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Lyons D, Wahab RA, Vijapura C, Mahoney MC. The nipple-areolar complex: comprehensive imaging review. Clin Radiol 2020; 76:172-184. [PMID: 33077158 DOI: 10.1016/j.crad.2020.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
The nipple-areolar complex can be affected by a variety of benign and malignant entities that can present with non-specific symptoms. Benign pathologies commonly affecting the nipple-areolar complex include nipple calcifications, nipple adenoma, abscess of Montgomery tubercles, ductal ectasia, periductal mastitis, and papilloma. Malignant pathologies that affect the nipple-areolar complex include Paget's disease of the breast, ductal carcinoma in-situ, and invasive ductal carcinoma. Clinical history and examination, imaging, and tissue sampling when appropriate are co-dependent factors that guide the assessment of nipple-areolar pathologies. This article provides a review of the normal anatomy, common anatomical variants, benign and malignant pathologies, and imaging techniques to guide the diagnostic assessment of the nipple-areolar complex.
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Affiliation(s)
- D Lyons
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, ML 0772, Cincinnati, OH, 45219-0772, USA.
| | - R A Wahab
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, ML 0772, Cincinnati, OH, 45219-0772, USA
| | - C Vijapura
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, ML 0772, Cincinnati, OH, 45219-0772, USA
| | - M C Mahoney
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, ML 0772, Cincinnati, OH, 45219-0772, USA
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26
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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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27
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Akishima-Fukasawa Y, Honma N, Ogata H, Akasaka Y, Mikami T. Angiogenesis in mammary Paget disease: histopathological analyses of blood vessel density and angiogenic factors. Diagn Pathol 2020; 15:75. [PMID: 32527320 PMCID: PMC7288480 DOI: 10.1186/s13000-020-00988-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/02/2020] [Indexed: 11/23/2022] Open
Abstract
Background We examined the vascularity of mammary Paget disease histologically to confirm the increased blood flow observed previously by clinical imaging. The relationships among blood vessel density (BVD), histopathological parameters of blood flow in the nipple, and the expression of angiogenic factors such as basic fibroblast growth factor (bFGF) and vascular endothelial growth factor A (VEGFA) were examined. Methods We calculated the average CD34-positive BVD and podoplanin (D2–40)-positive lymphatic vessel density (LVD) and the proportion of proliferating of endothelial cells in 14 Paget disease, 3 dermatitis biopsy, and 14 age-matched control cases. As a parameter related to blood flow in the nipple, the total CD34-positive blood vessel lumen area relative to the entire nipple area was measured in each Paget disease and control case using an automated image analysis system. Immunohistochemical expression of bFGF and VEGFA in Paget cells was also examined. Results The average BVD and LVD were significantly higher in the Paget disease cases than in the dermatitis (p = 0.003) and control (p < 0.001) cases. The proportion of proliferating endothelial cells was also increased in the Paget disease cases. The ratio of the CD34-positive blood vessel lumen area to nipple area was also significantly higher in the Paget disease than control cases (p = 0.003). The average BVD was correlated with the average LVD (r = 0.734, p < 0.001) and ratio of the blood vessel lumen area to nipple area (r = 0.692, p < 0.001). Immunohistochemical expression of bFGF was strong in all Paget disease cases, with a significantly higher expression score in the Paget disease than dermatitis (p = 0.003) and control (p < 0.001) cases. The bFGF, but not VEGFA, expression score, was strongly correlated with the average BVD (r = 0.818, p < 0.001) and ratio of the blood vessel lumen area to nipple area (r = 0.503, p = 0.006). Conclusion These results provide direct histopathological evidence of a marked increase in nipple blood flow in Paget disease detected by clinical imaging. bFGF is considered to play a pivotal role in angiogenesis in mammary Paget disease.
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Affiliation(s)
- Yuri Akishima-Fukasawa
- Department of Pathology, Toho University School of Medicine, 5-21-16, Omori-Nishi, Ota-ku, Tokyo, 143-8540, Japan.
| | - Naoko Honma
- Department of Pathology, Toho University School of Medicine, 5-21-16, Omori-Nishi, Ota-ku, Tokyo, 143-8540, Japan
| | - Hideaki Ogata
- Division of Breast and Endocrine Surgery (Omori), Department of Surgery, Toho University School of Medicine, Ota-ku, Tokyo, 143-8540, Japan
| | - Yoshikiyo Akasaka
- Department of Pathology, Toho University School of Medicine, 5-21-16, Omori-Nishi, Ota-ku, Tokyo, 143-8540, Japan
| | - Tetuo Mikami
- Department of Pathology, Toho University School of Medicine, 5-21-16, Omori-Nishi, Ota-ku, Tokyo, 143-8540, Japan
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28
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Sisti A, Huayllani MT, Restrepo DJ, Boczar D, Advani P, Lu X, Spaulding AC, Ball CT, McLaughlin SA, Forte AJ. Paget disease of the breast: A national retrospective analysis of the US population. Breast Dis 2020; 39:119-126. [PMID: 32390594 DOI: 10.3233/bd-200439] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Paget's disease of the breast is rare. The National Cancer Database (NCDB) is one of the largest tumor databases in the United States. METHODS We queried the NCDB to identify male and female patients with Paget's disease of the breast who were treated from January 1, 2004, through December 31, 2015. No age limitations were applied. Descriptive statistical analysis and survival analysis were performed. RESULTS We analyzed the demographic, disease, and treatment characteristics of 7,191 patients with Paget's disease of the breast. The median (range) age was 64 (20-90) years. Only 2.1% of patients were men, and 85.4% were white. The most common treatment was complete mastectomy (65.3%), followed by partial mastectomy (30.3%). Tumor destruction was performed in 0.1% of patients, and 4.3% of patients did not undergo any surgery. We examined survival in the subset of 6,864 patients who were treated surgically with complete mastectomy or partial mastectomy. The 5-year survival rate after surgery was 82.5% (95% CI, 81.1%-83.9%). Factors associated with shorter survival were older age, black race/ethnicity, higher tumor grade, regional lymph node metastasis, higher cancer stage, metastatic cancer, and larger tumor size. CONCLUSIONS Paget's disease of the breast usually affects patients older than 60 years, and the most common treatment is complete mastectomy. The 5-year overall survival rate of patients with Paget's disease of the breast is greater than 80% but is lower among older and black people.
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Affiliation(s)
- Andrea Sisti
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Daniel Boczar
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Pooja Advani
- Department of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Xiaona Lu
- Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Aaron C Spaulding
- Department of Health Science Research, Mayo Clinic, Jacksonville, FL, USA
| | - Colleen T Ball
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | | | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
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29
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Kim SK, Seo BK, Oh HE. Herpes Simplex Mastitis in an Adolescent Woman: Clinical and Ultrasound Features. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:714-718. [PMID: 36238612 PMCID: PMC9431909 DOI: 10.3348/jksr.2020.81.3.714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 06/17/2019] [Accepted: 09/30/2019] [Indexed: 11/16/2022]
Abstract
Herpetic mastitis is extremely rare, and its imaging findings remain unclear. We report a case of herpes simplex mastitis in an adolescent woman and describe the clinical and ultrasound features. The patient showed unilateral nipple and areolar skin thickening and axillary lymphadenopathy on B-mode ultrasonography. Doppler ultrasonography revealed multiple linear and branching blood flows in the areolar area. The lesion was verified as herpes simplex mastitis via a skin biopsy. This report shows that the radiologic features of herpes simplex mastitis may be similar to those of Paget's disease because of localized nipple and areolar skin thickening and increased vascularity.
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Affiliation(s)
- Seung Kwan Kim
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Bo Kyoung Seo
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hwa Eun Oh
- Department of Pathology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
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30
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Drews-Elger K, Sandoval-Leon AC, Ergonul AB, Jegg AM, Gomez-Fernandez C, Miller PC, El-Ashry D, Lippman ME. Paget's disease of the nipple in a Her2-positive breast cancer xenograft model. Breast Cancer Res Treat 2019; 179:577-584. [PMID: 31720992 DOI: 10.1007/s10549-019-05490-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/30/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Paget's disease (PD) of the breast is an uncommon disease of the nipple usually accompanied by an underlying carcinoma, often HER2 + , and accounting for 0.5-5% of all breast cancer. To date, histogenesis of PD of the breast remains controversial, as two theories-transformation and epidermotropic-have been proposed to explain this disease. Currently, animal models recapitulating PD of the nipple have not been described. METHODS HER2-enriched DT13 breast cancer cells were injected into the mammary fat pad of NOD scid gamma null (NSG) female mice. Immunohistochemical staining and pathological studies were performed on tumor samples, and diagnosis of PD of the nipple was confirmed by expression of proteins characteristic of Paget cells (epidermal growth factor 2 (HER2), androgen receptor (AR), cytokeratin 7 (CK7), cytokeratin 8/18 (CK8/18), and mucin 1 (MUC1)). In addition, DT13 cells grown in 2D culture and in soft agar assays were sensitive to in vitro treatment with pharmacological inhibitors targeting Her2, adenylyl cyclase, mTOR, and PI3K signaling pathways. RESULTS Mice developed tumors and nipple lesions that were detected exclusively on the tumor-bearing mammary fat pad. Tumor cells were positive for proteins characteristic of Paget cells. In vitro, DT13 cells were sensitive to inhibition of Her2, adenylyl cyclase, mTOR, and PI3K signaling pathways. CONCLUSIONS Our results suggest that injection of HER2 + DT13 cells into the mammary fat pad of NSG mice recapitulates critical aspects of the pathophysiology of PD of the nipple, supporting the epidermotropic theory as the more likely to explain the histogenesis of this disease.
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Affiliation(s)
- Katherine Drews-Elger
- Department of Medicine, Division of Hematology/Oncology, University of Miami, Miller School of Medicine, Miami, FL, 33136, USA
| | - Ana Cristina Sandoval-Leon
- Department of Medicine, Division of Hematology/Oncology, University of Miami, Miller School of Medicine, Miami, FL, 33136, USA
| | - Ayse Burcu Ergonul
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, 3970 Reservoir Rd NW, NRB E507A, Miami, FL, 33136, USA
| | - Anna M Jegg
- Department of Medicine, Division of Hematology/Oncology, University of Miami, Miller School of Medicine, Miami, FL, 33136, USA
| | - Carmen Gomez-Fernandez
- Department of Pathology, University of Miami, Miller School of Medicine, Miami, FL, 33136, USA
| | - Philip C Miller
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, 3970 Reservoir Rd NW, NRB E507A, Miami, FL, 33136, USA.,Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University School of Medicine, Washington, DC, 20007, USA
| | - Dorraya El-Ashry
- Department of Medicine, Division of Hematology/Oncology, University of Miami, Miller School of Medicine, Miami, FL, 33136, USA. .,Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, 3970 Reservoir Rd NW, NRB E507A, Miami, FL, 33136, USA. .,Breast Cancer Research Foundation, 28 West 44th Street, Suite 609, New York, NY, 10036, USA. .,Department of Laboratory Medicine and Pathology, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, 55455, USA.
| | - Marc E Lippman
- Department of Medicine, Division of Hematology/Oncology, University of Miami, Miller School of Medicine, Miami, FL, 33136, USA. .,Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, 3970 Reservoir Rd NW, NRB E507A, Miami, FL, 33136, USA. .,Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University School of Medicine, Washington, DC, 20007, USA.
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31
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Şendur HN, Gültekin S, Salimli L, Cindil E, Cerit M, Şendur AB. Determination of Normal Breast and Areolar Skin Elasticity Using Shear Wave Elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1815-1822. [PMID: 30472800 DOI: 10.1002/jum.14877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/22/2018] [Accepted: 10/24/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES In this study, we aimed to determine reference values for normal breast and areolar skin elasticity using shear wave elastography. METHODS The right breasts of 200 female participants were evaluated. The age, weight, body mass index, menopausal status, and parity number of all participants were noted. The elasticity values and thickness of the areolar skin and 4 quadrants of the breast skin of all participants were measured. To assess the reproducibility of shear wave elastography, a randomly selected subgroup of 35 participants was reevaluated by a second observer. RESULTS The mean age of the participants ± SD was 48.79 ± 10.74 years (range, 18-79 years). The mean elasticity measurements for the superior, inferior, lateral, and medial regions of the breast and areolar skin were 33.54, 29.84, 30.16, 29.20, and 31.35 kPa, respectively. The mean of the 4-quadrant measurements of breast skin elasticity was 30.68 ± 9.11 kPa. Age had a moderate negative correlation with breast skin elasticity (r = -0.353; P < .001) and a weak negative correlation with areolar skin elasticity (r = -0.237; P = .001). The parity number had weak negative correlations with breast (r = -0.150; P = .034) and areolar (r = -0.207; P < .001) skin elasticity. The interobserver agreement varied from good to excellent (intraclass correlation coefficients, 0.67-0.91) for the breast and areolar skin elasticity measurements. CONCLUSIONS Shear wave elastography is a reproducible imaging modality for evaluations of breast and areolar skin elasticity, and our results may provide important pilot data for evaluations of clinical entities that affect the breast and areolar skin structures.
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Affiliation(s)
- Halit Nahit Şendur
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Serap Gültekin
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Leyla Salimli
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Emetullah Cindil
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Mahinur Cerit
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
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32
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Chen S, Chen H, Yi Y, Jiang X, Lei H, Luo X, Chen Y, Liu S, Yuan D, Jia X, Li J. Comparative study of breast cancer with or without concomitant Paget disease: An analysis of the SEER database. Cancer Med 2019; 8:4043-4054. [PMID: 31134761 PMCID: PMC6639179 DOI: 10.1002/cam4.2242] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 04/15/2019] [Accepted: 04/26/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Most mammary Paget disease (MPD) is associated with underlying in situ or invasive breast cancer. The objective of this study was to compare the clinicopathological characteristics and survival outcomes between breast cancer with Paget disease (PD) and breast cancer alone. METHODS From the Surveillance, Epidemiology, and End Results (SEER) database, 2000-2015, of the US National Cancer Institute, we identified 1569 women who had PD with invasive ductal carcinoma (PD-IDC) and 1489 women who had PD with ductal carcinoma in situ (PD-DCIS). Independent demographic and clinicopathological variables as well as survival outcomes of these patients were compared to patients with the corresponding breast cancer without concomitant PD. RESULTS PD-IDC and PD-DCIS both had worse survival outcomes and poorer tumor characteristics than the corresponding disease without PD. Contrary to in the breast cancer alone groups, in the breast cancer with PD groups, the HR status (P = 0.182 in PD-IDC and P = 0.371 in PD-DCIS), HER2 status (P = 0.788 in PD-IDC and P = 0.643 in PD-DCIS), and combined molecular subtype (P = 0.196 in PD-IDC and P = 0.853 in PD-DCIS) were not found to affect disease prognosis. After matching tumor characteristics and treatment approaches, PD-IDC as well as PD-DCIS exhibited no significant difference in disease prognosis with corresponding IDC and DCIS. Finally, by comparative analysis, a kind of PD-DCIS (ICD-O-3 code 8543/3) showed many invasive behaviors (31.8% of 8543/3 patients had stage I-III cancer) and was associated with worse survival outcomes than the other type of PD-DCIS. CONCLUSIONS Breast cancer with concomitant PD was associated with more aggressive tumor characteristics and worse survival outcomes. The HR status, HER2 status, and combined molecular subtype could not affect the prognosis of breast cancer with PD. Moreover, a portion of the PD-DCIS cases were invasive breast cancer cases that required special treatment.
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Affiliation(s)
- Shijing Chen
- Department of Dermatology, People's Hospital of DeYang City, Deyang, China
| | - Huaquan Chen
- Department of Dermatology, People's Hospital of DeYang City, Deyang, China
| | - Ying Yi
- Department of Br, Surgery, People's Hospital of DeYang City, Deyang, China
| | - Xuemei Jiang
- Department of Br, Surgery, People's Hospital of DeYang City, Deyang, China
| | - Hai Lei
- Department of Br, Surgery, People's Hospital of DeYang City, Deyang, China
| | - Xue Luo
- Department of Br, Surgery, People's Hospital of DeYang City, Deyang, China
| | - Yu Chen
- Department of Br, Surgery, People's Hospital of DeYang City, Deyang, China
| | - Sha Liu
- Department of Br, Surgery, People's Hospital of DeYang City, Deyang, China
| | - Dan Yuan
- Department of Dermatology, People's Hospital of DeYang City, Deyang, China
| | - Xinjian Jia
- Department of Br, Surgery, People's Hospital of DeYang City, Deyang, China
| | - Junyan Li
- Department of Br, Surgery, People's Hospital of DeYang City, Deyang, China
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33
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Matsubayashi RN, Iwasaki H, Iwakuma N, Momosaki S. Methotrexate (MTX)-associated malignant lymphoma of the bilateral breast: imaging features in comparison to other nipple-areolar tumors. Clin Imaging 2019; 53:120-125. [DOI: 10.1016/j.clinimag.2018.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/06/2018] [Accepted: 10/02/2018] [Indexed: 11/28/2022]
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34
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Gao Y, Brachtel EF, Hernandez O, Heller SL. An Analysis of Nipple Enhancement at Breast MRI with Radiologic-Pathologic Correlation. Radiographics 2019; 39:10-27. [DOI: 10.1148/rg.2019180039] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yiming Gao
- From the Departments of Radiology (Y.G., S.L.H.) and Pathology (O.H.), New York University Langone Medical Center, 160 E 34th St, New York, NY 10016; and Department of Pathology, Massachusetts General Hospital, Boston, Mass (E.F.B.)
| | - Elena F. Brachtel
- From the Departments of Radiology (Y.G., S.L.H.) and Pathology (O.H.), New York University Langone Medical Center, 160 E 34th St, New York, NY 10016; and Department of Pathology, Massachusetts General Hospital, Boston, Mass (E.F.B.)
| | - Osvaldo Hernandez
- From the Departments of Radiology (Y.G., S.L.H.) and Pathology (O.H.), New York University Langone Medical Center, 160 E 34th St, New York, NY 10016; and Department of Pathology, Massachusetts General Hospital, Boston, Mass (E.F.B.)
| | - Samantha L. Heller
- From the Departments of Radiology (Y.G., S.L.H.) and Pathology (O.H.), New York University Langone Medical Center, 160 E 34th St, New York, NY 10016; and Department of Pathology, Massachusetts General Hospital, Boston, Mass (E.F.B.)
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35
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Zhou H, Lu K, Zheng L, Guo L, Gao Y, Miao X, Chen Z, Wang X. Prognostic significance of mammary Paget's disease in Chinese women: a 10-year, population-based, matched cohort study. Onco Targets Ther 2018; 11:8319-8326. [PMID: 30538501 PMCID: PMC6260180 DOI: 10.2147/ott.s171710] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose To explore the prognostic significance of mammary Paget’s disease (PD) in breast cancer (BC) patients and to investigate the association between clinical manifestation and outcome in invasive ductal carcinoma patients with PD (PD-IDC). Patients and methods Eighty-five patients diagnosed with mammary PD with underlying BC from 2006 to 2012 at Zhejiang Cancer Hospital were recruited. A matched group comprised 85 patients diagnosed with BC without PD. Patients were matched according to four variables: stage (0–IV), age at diagnosis (within 5 years), histologic subtype, and the year of surgery. The 74 patients diagnosed with PD-IDC were divided into three groups based on their clinical presentation. Results Compared with the matched group, the PD group had more HER2 positivity (P<0.01) and hormone receptor negativity (P<0.01), and a worse outcome (Kaplan–Meier analysis, P<0.001 for disease-free survival and P=0.002 for overall survival). Multivariate Cox regression analyses showed that PD was an independent prognostic predictor for BC patients with PD. In addition, the 22 PD-IDC patients who presented with skin lesions in the nipple/areola and a mass in the breast or axilla had a higher risk of disease relapse than patients who presented with a mass in the breast without skin lesions or patients who presented with skin changes without a palpable mass (adjusted hazards ratio, 0.24; 95% CI, 0.08–0.73; P=0.012 and adjusted hazard ratio, 0.30; 95% CI, 0.06–1.40; P=0.124, respectively). Conclusion PD is an independent prognostic indicator of outcome in BC patients with PD. Furthermore, the primary symptoms at presentation may be an available indicator of prognosis in PD-IDC.
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Affiliation(s)
- Huanhuan Zhou
- Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, People's Republic of China, ;
| | - Kongbeng Lu
- Department of Medical Oncology, Shaoxing Second Hospital, Shaoxing, Zhejiang, People's Republic of China
| | - Lei Zheng
- Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, People's Republic of China, ;
| | - Liwei Guo
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Yun Gao
- Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, People's Republic of China, ;
| | - Xianyuan Miao
- Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, People's Republic of China, ;
| | - Zhanhong Chen
- Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, People's Republic of China, ;
| | - Xiaojia Wang
- Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, People's Republic of China, ;
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Squamous Cell Carcinoma Arising within Verruca Vulgaris on the Nipple. Case Rep Dermatol Med 2018; 2018:1984593. [PMID: 30026989 PMCID: PMC6031089 DOI: 10.1155/2018/1984593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/15/2018] [Accepted: 05/23/2018] [Indexed: 11/17/2022] Open
Abstract
Cutaneous squamous cell carcinoma (SCC) is a common form of skin cancer and often appears as a hard, scaly lump that occasionally ulcerates. It is usually associated with cumulative exposure to ultraviolet light, although prior scarring, chronic wounds, exposure to radiation, HPV infection, and immunosuppression are also associated risk factors. Primary SCC of the nipple is very rare and only a few cases have been reported. We present a case of a 49-year-old female with concerns of a right nipple lesion with erythema and pain. She was initially evaluated for Paget's disease with an underlying malignancy and cellulitis, but, after biopsy and investigation, she was found to have a well-differentiated SCC arising from a verruca vulgaris. Current literature does not provide distinct guidelines on management of SCC or its variants on the nipple, and the case was managed based off of SCC at other cutaneous sites as well as other cases of SCC on the nipple.
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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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Jang N, Kang S, Bae YK. Mammary Paget's disease without underlying malignancy of the breast. Yeungnam Univ J Med 2018; 35:99-103. [PMID: 31620578 PMCID: PMC6784678 DOI: 10.12701/yujm.2018.35.1.99] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/08/2017] [Accepted: 08/29/2017] [Indexed: 11/16/2022] Open
Abstract
Mammary Paget’s disease (MPD) is usually accompanied by underlying breast malignancy; however, a few cases have been reported as only skin lesions without any evidence of malignancy of the breast on imaging tests and microscopic examination of surgical specimen. Here, we describe a 47-year-old woman who visited our hospital who had an eczematous lesion on right nipple and areola for over 10 years. The lesion was diagnosed as Paget’s disease by punch biopsy; however, imaging studies demonstrated no breast malignancy or lymph node metastasis. The patient underwent surgery of on the nipple and areola including underlying breast tissue. No underlying malignancy was found upon microscopic examination, except for Paget’s disease. Immunohistochemical stains revealed that the tumor cells were positive for cytokeratin 7, and negativity for p63, cytokeratin 5/6, estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2. We report a case of MPD without underlying malignancy. To the best of our knowledge, this is the third case reported in Korea.
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Affiliation(s)
- Nuri Jang
- Department of Pathology, Yeungnam University College of Medicine, Daegu, Korea
| | - Suhwan Kang
- Department of General Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Young Kyung Bae
- Department of Pathology, Yeungnam University College of Medicine, Daegu, Korea
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Ogata H, Mitsuzuka Y, Honma N, Yoshida M, Sumazaki M, Saito F, Kobayashi M, Shibuya K, Mikami T, Kaneko H. Sonographic visualization of nipple blood flow can help differentiate Paget disease from benign eczematous nipple lesions. PLoS One 2018; 13:e0197156. [PMID: 29768474 PMCID: PMC5955580 DOI: 10.1371/journal.pone.0197156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 04/27/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose Paget disease of the breast is a rare cancer that originates from the nipple–areolar complex. It is often overlooked and misdiagnosed as benign chronic eczema of the nipple. We aimed to retrospectively verify whether blood flow analysis using Doppler sonography was useful for detecting the presence of Paget disease. Methods In this retrospective study, 12 patients with pathologically proven unilateral nipple eczematous lesions (seven with Paget disease and five with simple dermatitis) were included. Nipple blood flow signal was observed using Doppler sonography, and the detected blood flow signals were quantified using digitally recorded images. Quantified blood flow ratio and pathologically examined capillary density were evaluated between affected and unaffected nipples. Findings of mammography, grayscale sonography, and contrast-enhanced magnetic resonance imaging (CE-MRI) were reviewed. Results In patients with Paget disease, Doppler effects in the affected nipple were more clearly visible than those in the unaffected nipple. These effects were sufficiently visible to identify Paget disease. No obvious effects were observed in the affected and unaffected nipples of simple dermatitis. The quantified blood flow ratio and pathologically examined capillary density were significantly higher for the Paget lesion than those for the non-Paget lesion. The sensitivity of CE-MRI and Doppler sonography was markedly correlated, revealing blood flow changes in the nipple lesions of Paget disease. Conclusion Doppler sonography visualized the proliferation of blood vessels in Paget lesions. The visualization of increased nipple blood flow using Doppler sonography is a simple and low-cost method that provides useful data for identifying Paget disease during routine medical care.
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Affiliation(s)
- Hideaki Ogata
- Division of Breast and Endocrine Surgery (Omori), Department of Surgery, School of Medicine, Toho University, Omorinishi, Ota-ku, Tokyo, Japan
- * E-mail:
| | - Yukio Mitsuzuka
- Department of Clinical Physiology, Toho University Medical Center Omori Hospital, Omorinishi, Ota-ku, Tokyo, Japan
| | - Naoko Honma
- Department of Pathology, School of Medicine, Toho University, Omorinishi, Ota-ku, Tokyo, Japan
| | - Miho Yoshida
- Division of Breast and Endocrine Surgery (Omori), Department of Surgery, School of Medicine, Toho University, Omorinishi, Ota-ku, Tokyo, Japan
| | - Makoto Sumazaki
- Division of Breast and Endocrine Surgery (Omori), Department of Surgery, School of Medicine, Toho University, Omorinishi, Ota-ku, Tokyo, Japan
| | - Fumi Saito
- Division of Breast and Endocrine Surgery (Omori), Department of Surgery, School of Medicine, Toho University, Omorinishi, Ota-ku, Tokyo, Japan
| | - Masahiro Kobayashi
- Department of Radiology, School of Medicine, Toho University, Omorinishi, Ota-ku, Tokyo, Japan
| | - Kazutoshi Shibuya
- Department of Surgical Pathology, School of Medicine, Toho University, Omorinishi, Ota-ku, Tokyo, Japan
| | - Tetsuo Mikami
- Department of Pathology, School of Medicine, Toho University, Omorinishi, Ota-ku, Tokyo, Japan
| | - Hironori Kaneko
- Division of Breast and Endocrine Surgery (Omori), Department of Surgery, School of Medicine, Toho University, Omorinishi, Ota-ku, Tokyo, Japan
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Abstract
Breast magnetic resonance imaging (MRI) is the most sensitive of the available imaging modalities to characterize breast cancer. Breast MRI has gained clinical acceptance for screening high-risk patients, but its role in the preoperative imaging of breast cancer patients remains controversial. This review focuses on the current indications for staging breast MRI, the evidence for and against the role of breast MRI in the preoperative staging workup, and the evaluation of treatment response of breast cancer patients.
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41
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Lim GH, Chinthala JP, Gudi MA. Invasive papillary breast cancer with Paget's disease: first reported association and literature review. BMJ Case Rep 2018; 2018:bcr-2017-222817. [PMID: 29301809 DOI: 10.1136/bcr-2017-222817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Invasive papillary carcinoma of the breast and Paget's disease are both rare entities. We report the first known case of invasive papillary carcinoma associated with Paget's disease in a woman who presented clinically with a nipple mass. While invasive papillary carcinoma has been reported to have an indolent course without need for overtreatment, our patient had unusual unfavourable histological features. Literature review of this rare subtype was performed.
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Affiliation(s)
- Geok Hoon Lim
- Breast Department, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore
| | | | - Mihir Ananta Gudi
- Department of Pathology, KK Women's and Children's Hospital, Singapore
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Dye K, Saucedo M, Raju D, Aydin N. A common cancer in an uncommon location: A case report of squamous cell carcinoma of the nipple. Int J Surg Case Rep 2017; 36:94-97. [PMID: 28551484 PMCID: PMC5447389 DOI: 10.1016/j.ijscr.2017.05.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 05/12/2017] [Accepted: 05/14/2017] [Indexed: 11/29/2022] Open
Abstract
Squamous cell cancer of the nipple is rare but should be included in the differential diagnoses of pathologies of the nipple. Patients with former history of skin cancer may present with skin cancers in unusual locations. Thorough clinical and diagnostic evaluations are mandatory to rule out pathologiesand direct management decisions.
Introduction Cutaneous squamous cell carcinoma (SCC) is common however SCC is rarely seen on the nipple, with only ten cases of SCC of the nipple in literature (American Cancer Society, 2015; Scotto et al., 1983; Pendse and O’Connor, 2015; Loveland-Jones et al., 2010; Brookes et al., 2005; Sofos et al., 2013; King and Kremer, 2012; Venkataseshan et al., 1994; Hosaka et al., 2011) [1–9]. Case An 80 year old female presenting with a chief complaint of an abnormal lesion on the medial portion of her right nipple areola complex. A biopsy showed well-differentiated squamous cell carcinoma. She had an extensive history of prolonged sun exposure predisposing her to cutaneous SCC however none to the breast region. Her mammogram was negative for any invasive disease so a wide local excision was performed with no complications. Discussion Due to the rarity of SCC of the breast or nipple, a biopsy is necessary to rule out other more common types of malignancies on the nipple that present with a similar physical appearance. We then examined the many different risk factors for SCC and the different methods for treating SCC whether it is cutaneous or of the nipple or breast. We also discussed the treatment of Paget’s disease of the breast (PDB) as SCC of the nipple or breast can be mistaken for PDB. Conclusion The cases of SCC of the Nipple demonstrate the importance of recognizing changes of the skin even in locations not typically associated with SCC (American Cancer Society, 2015; Scotto et al., 1983; Pendse and O’Connor, 2015; Loveland-Jones et al., 2010; Brookes et al., 2005; Sofos et al., 2013; King and Kremer, 2012; Venkataseshan et al., 1994; Hosaka et al., 2011) [1–9]. We concluded with a future suggestion of investigating possible risk factors specific to SCC of the breast or nipple.
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Affiliation(s)
- Kelly Dye
- Texas Tech University Health Sciences Center School of Medicine, Amarillo, TX, United States.
| | - Melissa Saucedo
- Texas Tech University Health Sciences Center School of Medicine, Amarillo, TX, United States.
| | - Divya Raju
- Texas Tech University Health Sciences Center School of Medicine, Amarillo, TX, United States.
| | - Nail Aydin
- Department of Surgery, Division of Surgical Oncology, Texas Tech University Health Sciences Center School of Medicine, 1400 S. Coulter St. Amarillo, TX 79106, United States.
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44
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Paget's disease of the male breast in the 21st century: A systematic review. Breast 2016; 29:14-23. [DOI: 10.1016/j.breast.2016.06.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/13/2016] [Accepted: 06/14/2016] [Indexed: 11/23/2022] Open
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45
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Boulanger L, Demetz J. [How to explore breast skin lesion?: Guidelines]. ACTA ACUST UNITED AC 2015; 44:921-6. [PMID: 26527029 DOI: 10.1016/j.jgyn.2015.09.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 09/18/2015] [Indexed: 11/30/2022]
Abstract
A change in the shape or appearance of the nipple-areola complex, especially if it is unilateral and recent appearance, is a sign of underlying breast tumor. Breast imaging is then required (grade C). Any erythematous lesion of the nipple or nipple-areola can be a Paget's disease, an adenoma of the nipple or a nipple eczema. Clinical course and pattern can point to a diagnosis without sufficient specificity (LE4). If nipple eczema is suspected, it is recommended to perform a test treatment with topical corticosteroids. In case of failure or if a Paget's disease of the breast is suspected, a biopsy must be done. When indicated, it is not possible to recommend a biopsy modality (scrape cytology, punch biopsy, nipple core biopsy and surgical excision) compared to another. When imaging exploration of the nipple-areola complex is necessary, ultrasound and mammography are recommended as first-line. In the absence of signal, an MRI is recommended as second-line (grade C).
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Affiliation(s)
- L Boulanger
- Service de chirurgie gynécologique, cancérologie gynécologique et mammaire, clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France.
| | - J Demetz
- Service de chirurgie gynécologique, cancérologie gynécologique et mammaire, clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France
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Sripathi S, Ayachit A, Kadavigere R, Kumar S, Eleti A, Sraj A. Spectrum of Imaging Findings in Paget's Disease of the Breast-A Pictorial Review. Insights Imaging 2015; 6:419-29. [PMID: 26142549 PMCID: PMC4519816 DOI: 10.1007/s13244-015-0415-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/08/2015] [Accepted: 06/12/2015] [Indexed: 11/29/2022] Open
Abstract
PURPOSE We aimed to demonstrate imaging features of Paget's disease of breast, which is an extremely uncommon malignancy that presents with changes in the nipple-areolar region that may or may not be associated with an underlying in situ component or invasive cancer. METHODS AND RESULTS Mammography is the initial investigation of choice, having a high sensitivity especially in cases where a palpable mass is present. The addition of ultrasound improves the accuracy of mammography. When both mammography and ultrasound are negative, MRI may detect an underlying mass or ductal carcinoma in situ (DCIS). CONCLUSION The surgical management of Paget's disease includes mastectomy with or without axillary dissection, though breast conservation surgery in the form of wide local excision can also be done in a selected group of patients. Management should be based on both clinical and imaging findings, including mammography and ultrasound, with MRI playing a crucial role in defining the extent of involvement. Teaching Points • To differentiate Paget's disease from other chronic skin conditions. • Mammographic and ultrasound findings of histopathologically established Paget's disease. • When ultrasound and mammogram are negative, MRI may detect underlying malignancy.
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Affiliation(s)
- Smiti Sripathi
- Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal, Karnataka, India,
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Rodríguez Garnica M, Martínez Gómez E, García Pineda V, de Valle Corredor C, Santana Acosta A, Cano Cuetos A, Arnanz Velasco F, Zapico Goñi A, Perez Luengo E. La enfermedad de Paget de la mama en nuestra área: revisión 1998-2012. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2014. [DOI: 10.1016/j.gine.2013.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Pilewskie M, King TA. Magnetic resonance imaging in patients with newly diagnosed breast cancer: a review of the literature. Cancer 2014; 120:2080-9. [PMID: 24752817 DOI: 10.1002/cncr.28700] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/21/2014] [Accepted: 03/14/2014] [Indexed: 12/14/2022]
Abstract
The use of magnetic resonance imaging (MRI) in patients with newly diagnosed breast cancer remains controversial. Here we review the current use of breast MRI and the impact of MRI on short-term surgical outcomes and rates of local recurrence. In addition, we address the use of MRI in specific patient populations, such as those with ductal carcinoma in situ, invasive lobular carcinoma, and occult primary breast cancer, and discuss the potential role of MRI for assessing response to neoadjuvant chemotherapy. Although MRI has improved sensitivity compared with conventional imaging, this has not translated into improved short-term surgical outcomes or long-term patient benefit, such as improved local control or survival, in any patient population. MRI is an important diagnostic test in the evaluation of patients presenting with occult primary breast cancer and has shown promise in monitoring response to neoadjuvant chemotherapy; however, the data do not support the routine use of perioperative MRI in patients with newly diagnosed breast cancer. Cancer 2014;120:120:2080-2089. © 2014 American Cancer Society.
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Affiliation(s)
- Melissa Pilewskie
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Sandoval-Leon AC, Drews-Elger K, Gomez-Fernandez CR, Yepes MM, Lippman ME. Paget’s disease of the nipple. Breast Cancer Res Treat 2013; 141:1-12. [DOI: 10.1007/s10549-013-2661-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 08/02/2013] [Indexed: 11/24/2022]
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50
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Malignant Invasion of the Nipple-Areolar Complex of the Breast: Usefulness of Breast MRI. AJR Am J Roentgenol 2013; 201:448-55. [DOI: 10.2214/ajr.12.9186] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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