Yeungnam Univ J Med.  2018 Jun;35(1):99-103. 10.12701/yujm.2018.35.1.99.

Mammary Paget's disease without underlying malignancy of the breast

• Jang N
• Kang S
• Bae YK

• KMID: 2415741
• DOI: http://doi.org/10.12701/yujm.2018.35.1.99

Abstract

Mammary Paget's disease (MPD) is usually accompanied by underlying breast malignancy; however, a few cases have been reported as only skin lesions without any evidence of malignancy of the breast on imaging tests and microscopic examination of surgical specimen. Here, we describe a 47-year-old woman who visited our hospital who had an eczematous lesion on right nipple and areola for over 10 years. The lesion was diagnosed as Paget's disease by punch biopsy; however, imaging studies demonstrated no breast malignancy or lymph node metastasis. The patient underwent surgery of on the nipple and areola including underlying breast tissue. No underlying malignancy was found upon microscopic examination, except for Paget's disease. Immunohistochemical stains revealed that the tumor cells were positive for cytokeratin 7, and negativity for p63, cytokeratin 5/6, estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2. We report a case of MPD without underlying malignancy. To the best of our knowledge, this is the third case reported in Korea.

Keyword

Paget's disease; Breast; Immunohistochemistry

MeSH Terms

Biopsy
Breast*
Coloring Agents
Estrogens
Female
Humans
Immunohistochemistry
Keratin-7
Keratins
Korea
Lymph Nodes
Middle Aged
Neoplasm Metastasis
Nipples
Paget's Disease, Mammary*
Receptor, Epidermal Growth Factor
Receptors, Progesterone
Skin
Coloring Agents
Estrogens
Keratin-7
Keratins
Receptor, Epidermal Growth Factor
Receptors, Progesterone

Figure

• 

  Fig. 1. Gross finding of right nipple and areola. The areolar skin is erythematous and the nipple has no ulcer.

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  Fig. 2. Radiologic findings of the breast. (A) Mammography showed unremarkable finding. (B) Ultrasonography demonstrated a 0.4-cm-sized hypoechoic lesion suggesting benign.

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  Fig. 3. Gross findings of the resected specimen. (A) The skin showed slightly light red discoloration. (B) On section, there was no definite mass-like lesion.

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  Fig. 4. Microscopic findings of the nipple and areola. (A) The tumor cells formed nests or showed glandular differentiation within the epidermis. Some of single tumor cells are spreading to the striata (H&E stain, ×200). (B, C) The tumor cells were positive for CK7 and MUC1 (B, ×200; C, ×200). (D-F) The tumor cells were negative for ER, PR, and HER2 (D, ×100; E, ×100; F, ×100). CK7, cytokeratin 7, MUC1, mucin 1, ER, estrogen receptor, PR, progesterone receptor, HER2, human epidermal growth factor receptor 2.

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