CASE 844: MAMMARY PAGET'S DISEASE, Dr PHAN THANH HẢI, Dr NẠI THỊ HƯƠNG THOANG, MEDIC MEDICAL CENTER, HCMC VIETNAM

 A 60 year-old woman with an erosive inflamed right nipple and bad feelings of searing, prutitus, hemorrhagia for one year which was failed in treatment. 

 

Ultrasound revealed the right nipple swollen and edema of the tissue underneath but no tumor of the right breast. A right axillary lymph node was noted.

Mammography detected no tumor.

Results of biopsy in the second time were Paget disease of the right breast nipple and a ductal breast carcinoma in situ grade 3.

Surgery was done for the right mastectomy.

REFERENCE:

From Wiki 

Paget's disease of the breast is difficult to diagnose by physical exam alone due to its resemblance to dermatitis and eczema. One helpful differentiator is that eczema tends to affect the areola first, and then the nipple, whereas Paget's disease of the breast typically begins at the nipple and spreads outwards. In addition, nipple eczema is typically responsive to topical steroid application, while Paget's disease of the breast will not improve with topical steroid use.^[4]

Mammogram and biopsy with cytopathology are common confirmatory tests.^[11] In biopsy, a tissue sample removed from the affected area is then examined under the microscope by a pathologist, who distinguishes Paget cells from other cell types by staining tissues to identify specific cells (immunohistochemistry).^[5]