|Print Date:||May 24, 2013, 12:54 pm|
|Title||Breast, Paget's Disease of the Nipple|
|Text||Paget's Disease of the Nipple
This malignant breast neoplasm has an occurance rate between 0.5% to 4.3%. Rare in the first three decades of life, the peak incidence is between 50 and 60 years of age. Paget's disease usually presents as a unilateral lesion on the nipple and areola. It is described as being well-delineated, erythematous, with an exudative/scaly area. Pruritis and burning are frequent complaints. The lesion starts from the nipple and spreads to the areola, but rarely involves the surrounding skin. Serous/bloody discharge is occasionally present but more common in the later stages of the disease when ulceration and nipple destruction occur. Nipple retraction may also be present secondary to adhesions to an underlying tumor. Most cases of Paget's disease are associated with an underlying DCIS(ductal carcinoma in situ) or sometimes an invasive carcinoma. The histologic hallmark of Paget's disease is the Paget's cell -- a large rounded/ovoid intraepidermal cell with abundant pale cytoplasm and enlarged pleomorphic and hyperchromatic nuclei with large nucleoli. Differential diagnoses to be considered are: chronic eczema, benign intraductal papillomna, basal cell carcinoma, malignant melanoma, syphilitic chancre, Bowen's disease of the skin, and mammary duct ectasia. Therefore any eczema or vesicular eruption on the nipple must be regarded as Paget's disease until proven otherwise. Mammography is important, especially in the absence of palpable mass in the breast. It is used to detect and locate subclinical underlying tumors, clusters of suspicious microcalcifications, or both. However, the sensitivity of mammography appears to be significantly higher in the presence of palpable mass(97%) as opposed to disease in the absence of palpable mass(50%). Treatment has ranged from radical mastectomy to more recent breast conservative measures including lumpectomy and radiation therapy for those patients without palpable tumor. The prognosis is good with early detection and treatment. 5-and 10-year survival rates of those patients without palpable tumor range from 90-100% following mastectomy.
**To view ultrasound images, please click on the link below.
|References:||"Controversies in the Treatment of Ductal Carcinoma In Situ." Surgical Clinics of North America. April 1996: 76:2.
"Paget's Disease of the Nipple-Areola Complex." Surgical Clinics of North America. April 1996: 76:2.
Ultrasound images courtesy of website by Adnan Tuncbilak, MD
|Contributor||Jennifer Park (Western University of Health Sciences)|
|Peer Reviewer||James G. Smirniotopoulos, M.D. (Uniformed Services University)|
|Record Number||: 1149|
|Location:||Breast and Mammography|
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