Immunohistochemical Analysis for the Origin of Mammary Paget's DiseaseSang

Lee, Yoon; Park, Woo Chan; Seo, Young Jin; Choi, Seung Hye; Jung, Sang Seol

Abstract

James Paget issued the first report that nipple symptoms were related to breast carcinoma; however, the histogenesis of mammary Paget cells is still controversial. Toker presented evidence for epidermotropic migration of Paget cells. An other main theory hypothesizes that the Paget cell originates in the intraepidermis and is to be considered an independent in situ carcinoma, possibly as a multicentric breast cancer. The authors examined fifteen cases of Paget's disease in the breast for the immunohistochemical epithelial membrane antigen, glandular low-molecular-weight cytokeratin, epidermal high- molecular-weight cytokeratin, and carcinoembryonic antigen in order to determine the origin of the histogenesis of the Paget cell. All specimens revealed Paget cells strongly reactive with the epithelial membrane antigen. Thirteen out of the fifteen cases showed a strong reaction with the glandular cytokeratin. Four out of the fifteen cases showed a moderate reaction with the carcinoembryonic antigen. All specimens showed a negative reaction with the epidermal cytokeratin. With the above results, the authors conclud that mammary Paget cells may originate from the underlying breast tissue and suggest a radical mastectomy for Paget's disease with the underlying invasive cancer and conservative surgery for the disease with intraductal cancer in the breast.