Ann Dermatol.  2008 Dec;20(4):240-243. 10.5021/ad.2008.20.4.240.

A Case of Pigmented Mammary Paget's Disease

• Kim JE
• Kang MS
• Kim JS
• Yu HJ

• KMID: 2156404
• DOI: http://doi.org/10.5021/ad.2008.20.4.240

Abstract

Pigmented mammary Paget's disease is a uncommon clinicopathologic variant of mammary Paget's disease, and this mimics malignant melanoma both clinically and histopathologically. Herein, we report on a rare case of pigmented mammary Paget's disease. An 81-year-old woman presented with 2.5x1 cm sized, red and brown, eczematous plaque on her right areola, and she'd had this lesion for 3 years. Histopathology showed large, atypical cells with large nuclei and abundant pale cytoplasm throughout the epidermis. Dispersed melanocytes were noted in the epidermis and some of the Paget's cells contained melanin within their cytoplasm. Immunohistochemical studies demonstrated that the intraepidermal pagetoid cells were positive for cytokeratin 7; in contrast, they were negative for S-100, Periodic-acid Schiff (PAS), Alcian blue at PH 2.5, HMB-45 and carninoembryonic antigen (CEA). We recommend that pigmented mammary Paget's disease should be included in the differential diagnosis of pigmented lesions on the nipple.

Keyword

Pigmented mammary Paget's disease

MeSH Terms

Aged, 80 and over
Alcian Blue
Cytoplasm
Diagnosis, Differential
Epidermis
Female
Humans
Hydrogen-Ion Concentration
Keratins
Melanins
Melanocytes
Melanoma
Paget's Disease, Mammary
Alcian Blue
Keratins
Melanins

Figure

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  Fig. 1 Clinical appearance at admission.

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  Fig. 2 The Paget's cells with large hyperchromatic nuclei and abundant pale cytoplasm were present throughout the epidermis. Dispersed melanocytes were noted in the epidermis and some of the Paget's cells contained melanin within their cytoplasm (A) (H&E, ×200). The tumor cells were also found in the lactiferous ducts, where they formed clusters (B) (H&E, ×200). The intraepidermal pagetoid cells and intraductal pagetoid cell were positive for cytokeratin 7 (C, D) (cytokeratin 7, ×400). In contrast, they were negative for S-100 (E) (S-100, ×200), Periodic-acid Schiff (F) (PAS, ×200), Alcian blue at PH 2.5 (G) (Alcian blue at PH 2.5, ×200), HMB-45 (H) (HMB45, ×200) and carninoembryonic antigen (I) (CEA, ×200).

Reference

1. Requena L, Sangueza M, Sangueza OP, Kutzner H. Pigmented mammary Paget disease and pigmented epidermotropic metastases from breast carcinoma. Am J Dermatopathol. 2002; 24:189–198.

2. Nakamura S, Ishida-Yamamoto A, Takahashi H, Hashimoto Y, Yokoo H, Iizuka H. Pigmented Paget's disease of the male breast: report of a case. Dermatology. 2001; 202:134–137.

3. Ho TC, St Jacques M, Schopflocher P. Pigmented Paget's disease of the male breast. J Am Acad Dermatol. 1990; 23:338–341.

4. Stretch JR, Denton KJ, Millard PR, Horak E. Paget's disease of the male breast clinically and histopathologically mimicking melanoma. Histopathology. 1991; 19:470–472.

5. Kutzner H, Hugel H, Embacher G. Pigmented Paget's disease and pigmented breast cancer metastasis. Clinical and histologic simulation of malignant melanoma of the breast. Hautarzt. 1992; 43:28–31.

6. Menet E, Vabres P, Brecheteau P, Bonneau-Herve F, Duport G, Levillain P, et al. Pigmented Paget's disease of the male nipple. Ann Dermatol Venereol. 2001; 128:649–652.

7. Perez A, Sanchez JL, Colon AL. Pigmented mammary Paget's disease in a man. Bol Asoc Med P R. 2003; 95:36–39.

8. Pizzichetta MA, Canzonieri V, Massarut S, Gloghini A, Trevisan G, Veronesi A, et al. Pigmented mammary Paget's disease mimicking melanoma. Melanoma Res. 2004; 14:S13–S15.

9. Mitchell S, Lachica R, Randall MB, Beech DJ. Paget's disease of the breast areola mimicking cutaneous melanoma. Breast J. 2006; 12:233–236.

10. Pimentel CL, Barnadas MA, Dalmau J, Puig L, Sancho F, Alonso C, et al. Pigmented Paget's disease in a man previously treated with mammaplasty reduction for gynecomastia. J Am Acad Dermatol. 2006; 55(2 Suppl):S62–S63.

11. Fujisawa Y, Yamamoto A, Machida H, Yamazaki N. Cytokeratin 7 staining was useful in a case of pigmented mammary Paget's disease resembling malignant melanoma. Int J Dermatol. 2006; 45:1257–1258.

12. Bernardo MM, Mascarenhas MJ, Lopes DP. Primary malignant melanoma of the breast. Acta Med Port. 1980; 2:39–43.

13. Padmore RF, Lara JF, Ackerman DJ, Gales T, Sigurdson ER, Ehya H, et al. Primary combined malignant melanoma and ductal carcinoma of the breast. A report of two cases. Cancer. 1996; 78:2515–2525.

14. Bonetti F, Colombari R, Manfrin E, Zamboni G, Martignoni G, Mombello A, et al. Breast carcinoma with positive results for melanoma marker (HMB-45). HMB-45 immunoreactivity in normal and neoplastic breast. Am J Clin Pathol. 1989; 92:491–495.

15. Smith KJ, Tuur S, Corvette D, Lupton GP, Skelton HG. Cytokeratin 7 staining in mammary and extramammary Paget's disease. Mod Pathol. 1997; 10:1069–1074.

16. Konomi K, Imayama S, Nagae S, Terasaka R, Chijiiwa K, Yashima Y. Melanocyte chemotactic factor produced by skin metastases of a breast carcinoma. J Surg Oncol. 1992; 50:62–66.

17. Chumas JC, Lorelle CA. Melanotic adenocarcinoma of the anorectum. Am J Surg Pathol. 1981; 5:711–717.