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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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Li C, Wang Y, Liu M, Qu J, Zhang S. Time for detailed clinical management of Paget's disease of the breast. Int J Surg 2024; 110:1266-1267. [PMID: 37889547 PMCID: PMC10871616 DOI: 10.1097/js9.0000000000000855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Affiliation(s)
| | - Yusheng Wang
- Department of Otolaryngology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
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Butala S, Forestier C, Nithiananthan S, Defran AJ, Kuwajerwala NK. Paget's Presentation of High-Grade Ductal Carcinoma In Situ (DCIS) in a Very Young Female With Breast Cancer 2 (BRCA2) Mutation. Cureus 2024; 16:e54678. [PMID: 38524061 PMCID: PMC10960524 DOI: 10.7759/cureus.54678] [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] [Accepted: 02/20/2024] [Indexed: 03/26/2024] Open
Abstract
This is a case of a previously healthy 29-year-old female with erythema and skin excoriations of the left breast nipple-areolar complex (NAC). After a repeat trial and failure of topical hydrocortisone, a diagnostic mammogram and nipple biopsy revealed Paget's disease (PD) of the nipple with ductal carcinoma in situ (DCIS). A subsequent genetic analysis found a breast cancer 2 (BRCA2) gene mutation. Treatment consisted of a left breast skin-sparing simple mastectomy with sentinel lymph node (SLN) biopsy and immediate tissue expander placement for implant reconstruction. Further management involved right breast short-interval surveillance with annual mammography and magnetic resonance imaging (MRI) with the possibility of prophylactic surgery along with oophorectomy after childbearing.
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Affiliation(s)
- Sneha Butala
- Pediatrics, Rainbow Babies & Children's Hospital, Cleveland, USA
| | - Chancée Forestier
- Medicine, American University of the Caribbean School of Medicine, Cupecoy, SXM
- Obstetrics and Gynecology, Ascension Providence Hospital, Southfield, USA
| | | | - Asilis J Defran
- General Surgery, Ascension Providence Hospital, Southfield, USA
| | - Nafisa K Kuwajerwala
- Breast Surgery, Ascension Providence Hospital, Southfield, USA
- Breast Surgery, Ascension Rochester Hills, Rochester Hills, USA
- Breast Surgery, Corewell Health, Troy, USA
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Qu J, Li C, Liu M, Wang Y, Sun S, Feng Z, Wu F, Zhang S, Zhao X. A novel web-based prognostic nomogram and the features influencing the curative effect of chemotherapy and radiotherapy for Paget's disease with invasive ductal carcinoma. Am J Cancer Res 2023; 13:4508-4530. [PMID: 37970339 PMCID: PMC10636690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/09/2023] [Indexed: 11/17/2023] Open
Abstract
Paget's disease (PD) of the breast is a rare underlying malignant tumor. Approximately 50% to 60% of patients with mammary PD are concurrently diagnosed with invasive ductal carcinoma (PD-IDC), a condition associated with a worse prognosis than IDC without PD. Thus far, there has been a lack of an accurate and efficient prognostic model for PD-IDC, and the factors influencing the effectiveness of chemotherapy and radiotherapy for these patients remain unknown. In this study, we developed a web-based nomogram based on the data from the Surveillance Epidemiology and End Results (SEER) database. We subjected the model to a series of validation methods, including area under the curve (AUC) values, receiver operating characteristic curve (ROC) analysis, calibration curves, and decision curve analysis (DCA). Our results demonstrated that our model exhibited high discrimination, accuracy, and clinical applicability in predicting the overall survival (OS) of patients with PD-IDC (testing set: three- and five-year AUCs, 0.831 and 0.841, respectively). To further validate our nomogram, we used external data from both our institution and sister hospitals (external data: three- and five-year AUCs, 0.892 and 0.914, respectively). Multivariable Cox regression analysis identified several independent unfavorable prognostic factors for the OS of patients with PD-IDC, including increasing age, high grade, widowed status, higher T stages, and the presence of bone metastases. Furthermore, propensity score matching (PSM)-adjusted analysis was conducted, revealing that chemotherapy did not significantly improve the survival of patients with PD-IDC across molecular subtypes, except for those in the grade III/IV group, where it improved both OS and breast cancer-specific survival (BCSS). Additionally, our findings indicated that only patients with PD-IDC with T4 and N3 stages benefited from radiotherapy, leading to improvements in both OS and BCSS. In conclusion, we have comprehensively analyzed the clinical characteristics and prognosis of patients with PD-IDC, culminating in the development of a user-friendly web-based nomogram for predicting their survival. Our predictive model is not only highly accurate but also offers simplicity, making it accessible for healthcare providers and patients. Furthermore, our stratified analysis highlights that the pathological grade, rather than the molecular subtype, plays a pivotal role in determining the efficacy of chemotherapy in improving the prognosis for patients with PD-IDC, while radiotherapy confers survival benefits to patients with PD-IDC in T4 and N3 stages.
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Affiliation(s)
- Jingkun Qu
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University157 West Fifth Street, Xi’an, Shaanxi, P. R. China
| | - Chaofan Li
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University157 West Fifth Street, Xi’an, Shaanxi, P. R. China
| | - Mengjie Liu
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University157 West Fifth Street, Xi’an, Shaanxi, P. R. China
| | - Yusheng Wang
- Department of Otolaryngology, The Second Affiliated Hospital of Xi’an Jiaotong University157 West Fifth Street, Xi’an, Shaanxi, P. R. China
| | - Shiyu Sun
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University157 West Fifth Street, Xi’an, Shaanxi, P. R. China
| | - Zeyao Feng
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University157 West Fifth Street, Xi’an, Shaanxi, P. R. China
| | - Fei Wu
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University157 West Fifth Street, Xi’an, Shaanxi, P. R. China
| | - Shuqun Zhang
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University157 West Fifth Street, Xi’an, Shaanxi, P. R. China
| | - Xixi Zhao
- Department of Radiation Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University157 West Fifth Street, Xi’an, Shaanxi, P. R. China
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Goh SSN, Syn NLX, Lim CJE, Lee RE, Samuel M, Ng CWQ. Oncologic outcomes after breast-conserving surgery with radiotherapy versus mastectomy in patients with Paget's disease of the breast: systematic review and meta-analysis. Br J Surg 2023; 110:1451-1457. [PMID: 37682691 DOI: 10.1093/bjs/znad199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/09/2023] [Accepted: 06/11/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND The conventional approach to treatment for Paget's disease of the breast has been mastectomy, but there is an increasing trend to consider breast-conserving surgery (BCS) followed by radiotherapy (RT) in these patients. This study aimed to provide an updated systematic review and meta-analysis comparing outcomes after BCS with RT versus mastectomy in the treatment of Paget's disease of the breast. METHODS Studies before May 2021 were included. Primary outcomes were overall survival and local recurrence. Separate analyses of Paget's disease associated with ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC) were undertaken. Meta-regression was used to adjust for imbalance in the proportion of IDC among patients selected to undergo BCS versus mastectomy. RESULTS Overall survival in patients with Paget's disease who underwent BCS with RT was higher than for those who underwent mastectomy with pooled mortality hazard ratio (HR) of 0.68, (95% per cent c.i. 0.45 to 1.01). Patients with Paget's disease with DCIS had higher overall survival after BCS with or without RT versus mastectomy, with adjusted HR of 0.14 (0.10 to 0.20) and 0.28 (0.22 to 0.36), respectively. For patients with Paget's disease and IDC, overall survival was lower for BCS with or without RT versus mastectomy, with adjusted HR of 0.84 (0.57 to 1.25) and 1.64 (1.04 to 2.58), respectively. In Paget's disease and IDC, local recurrence risk was much higher for BCS with RT, RR 26.8 (1.60 to 456) versus without RT, RR 51.8 (6.80 to 391). In patients with Paget's disease and DCIS, risk of local recurrence versus mastectomy was lower for BCS with RT 0.72 (0.11 to 4.50) but slightly higher for BCS alone 1.38 (0.09 to 21.20). CONCLUSION BCS with RT may be a comparable treatment alternative to mastectomy for patients with Paget's disease with DCIS, and for selected patients with Paget's disease and IDC.
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Affiliation(s)
- Serene S N Goh
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore
| | - Nicholas L X Syn
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore
| | - Cheryl J E Lim
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore
| | - Rui En Lee
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore
| | - Miny Samuel
- Research Support Unit, National University of Singapore, Singapore
| | - Celene W Q Ng
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore
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Baysal H, Erol CI, Baysal B, Ozemir IA, Ozsoy MS, Buyuker F, Kir G, Alimoglu O. The effects of clinicopathological and imaging findings on recurrence and survival in mammary Paget's disease. North Clin Istanb 2023; 10:541-549. [PMID: 37829736 PMCID: PMC10565753 DOI: 10.14744/nci.2023.77010] [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: 08/17/2023] [Accepted: 08/30/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE Mammary Paget's disease (MPD) is a rare presentation type of breast cancer. The aim of this study was to evaluate the clinicopathological and imaging features affecting the invasive component, loco-regional recurrence, prognosis, and survival of MPD. METHODS Patients who had undergone surgery due to MPD in a 10-year period were included. Parameters including mammography and magnetic resonance imaging (MRI) findings, tumor stage, molecular subtype, axillary involvement, presence of invasive carcinoma, loco-regional recurrence, overall survival (OS), and disease-free survival (DFS) were recorded and statistically analyzed. P<0.05 was determined as statistically significant. RESULTS The study group consisted of 49 women with a mean age of 67.05±14.43 (range: 23-90) years. There was a significant association between the presence of invasive carcinoma and a mass lesion in the MRI (p=0.002). The frequency of sentinel lymph node (SLN) metastasis was significantly higher in patients with multicentric tumors (p=0.029; p<0.05). Locoregional recurrence and distant metastasis were significantly more frequent in patients with axillary involvement (p=0.0336; p<0.05). The mean DFS was 115.02±7.28 months, while the mean OS was 119.29±6.57 months. CONCLUSION The presence of a mass lesion on MRI was determined to be significant in recognizing invasive carcinoma in MPD. The rate of SLN metastasis was higher in patients with multicentric tumors than in patients with unifocal tumors. Axillary involvement was associated with impaired DFS.
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Affiliation(s)
- Hakan Baysal
- Department of General Surgery, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkiye
| | - Cem Ilgin Erol
- Department of General Surgery, Erzurum City Hospital, Erzurum, Turkiye
| | - Begumhan Baysal
- Department of Radiology, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkiye
| | - Ibrahim Ali Ozemir
- Department of General Surgery, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkiye
| | - Mehmet Sait Ozsoy
- Department of General Surgery, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkiye
| | - Fatih Buyuker
- Department of General Surgery, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkiye
| | - Gozde Kir
- Department of Pathology, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkiye
| | - Orhan Alimoglu
- Department of General Surgery, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkiye
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Jatoi I, Shaaban AM, Jou E, Benson JR. The Biology and Management of Ductal Carcinoma in Situ of the Breast. Curr Probl Surg 2023; 60:101361. [PMID: 37596033 DOI: 10.1016/j.cpsurg.2023.101361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 06/27/2023] [Indexed: 08/20/2023]
Affiliation(s)
- Ismail Jatoi
- Division of Surgical Oncology and Endocrine Surgery, University of Texas Health Science Center, San Antonio, TX.
| | - Abeer M Shaaban
- Department of Cellular Pathology, Queen Elizabeth Hospital Birmingham and Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Eric Jou
- Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK
| | - John R Benson
- Addenbrooke's Hospital, University of Cambridge, Cambridge; School of Medicine, Anglia Ruskin University, Cambridge and Chelmsford, UK
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Grewal IS, Rajagopal T. Studying the Presentation of Paget Disease of the Breast. Cureus 2023; 15:e41057. [PMID: 37519599 PMCID: PMC10374979 DOI: 10.7759/cureus.41057] [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] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Paget disease of the breast is a rare breast cancer that accounts for 1-3% of all new presentations of breast cancer. It is characterized by an eczematous and ulcerative lesion of the nipple that may extend to the areola. Nearly 90% of cases are associated with underlying breast cancer. We report the presentation of Paget disease of the breast in a 41-year-old female, who presented due to a one-year history of an eczematous lesion of the left nipple area with no palpable mass, who was later found to have high-grade invasive ductal carcinoma treated with unilateral mastectomy and sentinel node biopsy.
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Affiliation(s)
- Iqbal S Grewal
- College of Medicine, California Northstate University College of Medicine, Elk Grove, USA
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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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Bradley M, Miles B, Young P, He J, Nguyen QD. Rare Paget's Disease Associated With Breast Cancer in a 70-Year-Old Male. Cureus 2023; 15:e38225. [PMID: 37252610 PMCID: PMC10225020 DOI: 10.7759/cureus.38225] [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] [Accepted: 04/27/2023] [Indexed: 05/31/2023] Open
Abstract
Male breast cancer is far less common compared to female breast cancer. Paget's disease of the breast (PDB) is a rare disease, making it even rarer in men. It often presents with eczematous patches over the nipple and areola region, mimics benign dermatological conditions, and can result in a greatly delayed diagnosis. This report presents a rare case of PDB in a 70-year-old male and includes a review of its clinical presentation, radiographic findings, histology, carcinogenic potential, and management.
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Affiliation(s)
- Megan Bradley
- Radiology, University of Texas Medical Branch, Galveston, USA
| | - Brittany Miles
- Radiology, University of Texas Medical Branch, Galveston, USA
| | - Peter Young
- Radiology, University of Texas Medical Branch, Galveston, USA
| | - Jing He
- Pathology, University of Texas Medical Branch, Galveston, USA
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