Materiały źródłowe

• #1 Paget’s disease of the breast – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pagets-disease-of-the-breast/symptoms-causes/syc-20351079

  Paget’s disease of the breast is a rare form of breast cancer. Paget’s disease of the breast starts on the nipple and extends to the dark circle of skin (areola) around the nipple. Paget’s disease of the breast occurs most often after age 50. Most people with this diagnosis also have underlying ductal breast cancer, either in situ meaning in its original place or, less commonly, invasive breast cancer. Only rarely is Paget’s disease of the breast confined to the nipple itself. […] Signs and symptoms usually occur in one breast only. The disease typically starts in the nipple and may spread to the areola and other areas of the breast. […] On average, signs and symptoms occur for several months before a diagnosis is made. […] If you feel a lump in your breast, or if you experience itching or skin irritation that persists for more than a month, make an appointment with your doctor.

• #2 Paget’s disease of the breast: Causes, symptoms, treatment, and more

  https://www.medicalnewstoday.com/articles/192362

  Pagets disease of the breast or nipple involves dry skin, flaking, or changes in the color or shape of the nipple. It may look like eczema or psoriasis, but it can be a sign of breast cancer. […] Pagets disease of the breast typically occurs as a manifestation of a type of precancerous lesion known as ductal carcinoma in situ (DCIS) or an underlying invasive cancer. […] The symptoms of Pagets disease of the breast can resemble those of a skin condition, such as eczema or psoriasis. This sometimes delays diagnosis, increasing the risk of the condition advancing. […] Pagets disease of the breast causes skin symptoms on the breasts or nipples because of underlying breast cancer. In 80% to 90% of people with Pagets disease of the breast, the underlying cancer is either ductal carcinoma in situ (DCIS) or invasive breast cancer.

• #3 Paget’s disease of the breast – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pagets-disease-of-the-breast/symptoms-causes/syc-20351079

  Paget’s disease of the breast is a rare form of breast cancer. Paget’s disease of the breast starts on the nipple and extends to the dark circle of skin (areola) around the nipple. Paget’s disease of the breast occurs most often after age 50. Most people with this diagnosis also have underlying ductal breast cancer, either in situ meaning in its original place or, less commonly, invasive breast cancer. Only rarely is Paget’s disease of the breast confined to the nipple itself. […] Signs and symptoms usually occur in one breast only. The disease typically starts in the nipple and may spread to the areola and other areas of the breast. […] On average, signs and symptoms occur for several months before a diagnosis is made. […] If you feel a lump in your breast, or if you experience itching or skin irritation that persists for more than a month, make an appointment with your doctor.

• #4 Paget’s disease of the breast: Causes, symptoms, treatment, and more

  https://www.medicalnewstoday.com/articles/192362

  Pagets disease of the breast or nipple involves dry skin, flaking, or changes in the color or shape of the nipple. It may look like eczema or psoriasis, but it can be a sign of breast cancer. […] Pagets disease of the breast typically occurs as a manifestation of a type of precancerous lesion known as ductal carcinoma in situ (DCIS) or an underlying invasive cancer. […] The symptoms of Pagets disease of the breast can resemble those of a skin condition, such as eczema or psoriasis. This sometimes delays diagnosis, increasing the risk of the condition advancing. […] Pagets disease of the breast causes skin symptoms on the breasts or nipples because of underlying breast cancer. In 80% to 90% of people with Pagets disease of the breast, the underlying cancer is either ductal carcinoma in situ (DCIS) or invasive breast cancer.

• #5 Paget’s disease of the breast – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pagets-disease-of-the-breast/diagnosis-treatment/drc-20351084

  Tests and procedures used to diagnose Paget’s disease of the breast include: […] Your doctor will check both of your breasts and the lymph nodes in your armpit, feeling for any lumps or other abnormalities. […] A mammogram is an X-ray of the breast. Mammograms are commonly used to screen for breast cancer. If an abnormality is detected on a screening mammogram, your doctor may recommend a diagnostic mammogram to further evaluate that abnormality. […] Ultrasound uses sound waves to produce images of structures deep within the body. Ultrasound may be used to determine whether a new breast lump is a solid mass or a fluid-filled cyst. […] An Magnetic resonance imaging (MRI) machine uses a magnet and radio waves to create pictures of the interior of your breast. Before a breast MRI, you receive an injection of dye.

• #6 What You Should Know About Paget’s Disease of the Breast – Iowa Radiology

  https://www.iowaradiology.com/what-you-should-know-about-pagets-disease-of-the-breast/

  Pagets disease of the breast, also called Pagets disease of the nipple or mammary Pagets disease, is a rare type of breast cancer that causes changes to the skin of the nipple. It is estimated to be present in 14% of breast cancer cases. More than 90% of patients with mammary Pagets disease also have invasive or noninvasive carcinoma, most often either DCIS or invasive ductal carcinoma. The prevailing theory is that Pagets disease results cells from an underlying ductal cancer travel through the milk ducts to the surface of the nipple; however, since additional cancer is not always found, it is possible that these cells can become cancerous on their own. […] If Pagets disease is suspected, the doctor will likely perform a physical exam to check for palpable tumors, which are found in approximately 50% of Pagets patients. A mammogram, with the possible addition of breast ultrasound and/or MRI is typically performed to look at other areas of the breast for signs of cancer. A biopsy of the nipple and areola is performed to either confirm or rule out the presence of Pagets disease. A biopsy of the sentinel lymph nodes under the arm may also be performed to assess possible spread of cancer cells.

• #7 Mammary Paget disease. Paget disease of the nipple

  https://dermnetnz.org/topics/mammary-paget-disease

  Mammary Paget disease should be suspected clinically when a longstanding, slowly progressive, unilateral nipple change is seen. […] A skin biopsy will show the typical foamy Paget cells in the epidermis. In pigmented mammary Paget disease, special stains (eg, CK-7, S-100, Melan A, HMB-45) are required to distinguish Paget cells from malignant melanocytes. […] A wedge biopsy of the nipple extends more deeply into the breast tissue and aids diagnosis of the underlying cancer. Immunohistochemistry is used to determine hormone receptor status (oestrogen receptor, progesterone receptor) and human epidermal growth receptor 2 (HER2) that can influence treatment. […] Investigations to determine the extent of the associated breast cancer may include ultrasound, mammogram, or MRI.

• #8 Paget’s disease of the breast – Wikipedia

  https://en.wikipedia.org/wiki/Paget%27s_disease_of_the_breast

  Paget’s disease of the breast (also known as mammary Paget’s disease) is a rare skin change at the nipple nearly always associated with underlying breast cancer. 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. Mammogram and biopsy with cytopathology are common confirmatory tests. 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). […] Less commonly, samples of nipple discharge may also be examined under the microscope to determine whether Paget cells are present. In addition, ultrasound of the breast may be performed in the absence of positive findings on mammography.

• #9 Mammary Paget’s Disease: An Update

  https://www.mdpi.com/2072-6694/14/10/2422

  Mammary Paget’s disease of the breast is an uncommon and often misdiagnosed breast malignancy. The review discusses the diagnosis, work-up, treatment, and prognosis of mammary Paget’s disease. […] This review article discusses Paget’s disease etiology, clinical presentation, differential diagnosis, diagnostic work-up, natural history and prognosis. […] MDP is diagnosed initially based on clinical presentation, physical examination, and breast imaging. Both benign and malignant processes can produce visible symptoms in the skin of the nipple. However, if apparently benign skin changes do not improve after a two-week course of topical corticosteroids, a diagnostic imaging work-up and biopsy should be performed. […] Efficient work-up includes high-quality diagnostic imaging to rule out malignancy due to the high probability of breast carcinoma associated with MPD.

• #10 Paget’s disease of the breast | Breast Cancer Now

  https://breastcancernow.org/about-breast-cancer/diagnosis/types-of-breast-cancer/pagets-disease-of-the-breast/

  Pagets disease of the breast is an uncommon type of breast cancer. […] As Pagets disease is uncommon and can look like other skin conditions, its not always diagnosed straight away. […] Once your GP has referred you to a specialist, you may have several tests including: A mammogram, An ultrasound scan, A biopsy. […] You will usually have a biopsy to confirm the diagnosis. […] The type of biopsy you have will depend on your symptoms. […] If your mammogram or ultrasound results show an area of concern within your breast, you may have another biopsy called an image-guided biopsy. […] The samples of tissue or cells are sent to a laboratory where they are examined under a microscope.

• #11 Paget Disease of the Breast | Details, Diagnosis and Signs | American Cancer Society

  https://www.cancer.org/cancer/types/breast-cancer/about/types-of-breast-cancer/paget-disease-of-the-nipple.html

  Paget disease of the breast is diagnosed by a biopsy, removing a small piece of the breast tissue and looking at it closely in the lab. […] Most people with Paget disease of the breast also have tumors in the same breast. One or more of the following imaging tests may be done to check for other breast changes: Diagnostic mammogram, Breast ultrasound, Breast MRI (magnetic resonance imaging) scan. […] Only a biopsy can show for sure that it is cancer.

• #12 Paget’s Disease | Breast Cancer 101 | Breastlink

  http://breastlink.com/breast-cancer-101/rare-breast-cancer-types/pagets-disease

  The first step in evaluating a patient with a change in the skin of the nipple is to obtain a detailed history and conduct a careful breast examination, followed by a diagnostic mammogram. If Paget’s disease is diagnosed, the next step is to identify the location of the underlying breast cancer. […] More than 50 percent of patients with Paget’s disease will have an abnormality on their mammogram. When performing a diagnostic mammogram, the mammogram technologist is informed about the possibility of a Paget’s disease diagnosis. Special films are used to look for fine calcifications behind the nipple. […] If the mammogram is negative and our clinical suspicion is low, we usually suggest that the patient use a cortisone cream on the nipple for two weeks. If the symptoms persist or there is a clinical concern, additional imaging techniques such as breast ultrasound and/or MRI may be ordered. Careful follow-up is always necessary with a potential diagnosis of Paget’s disease.

• #13 Spectrum of Imaging Findings in Paget’s Disease of the Breast—A Pictorial Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4519816/

  We aimed to demonstrate imaging features of Pagets disease of breast, which is an extremely uncommon malignancy that presents with changes in the nipple-areolar region that may or may not be associated with an underlying in situ component or invasive cancer. […] Mammography is the initial investigation of choice, having a high sensitivity especially in cases where a palpable mass is present. The addition of ultrasound improves the accuracy of mammography. When both mammography and ultrasound are negative, MRI may detect an underlying mass or ductal carcinoma in situ (DCIS). […] The surgical management of Pagets disease includes mastectomy with or without axillary dissection, though breast conservation surgery in the form of wide local excision can also be done in a selected group of patients. Management should be based on both clinical and imaging findings, including mammography and ultrasound, with MRI playing a crucial role in defining the extent of involvement.

• #14 Paget disease (breast) | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/paget-disease-breast?lang=us

  Paget disease of the breast, which is also known as Paget disease of the nipple, has traditionally been described as a form of breast malignancy characterized by infiltration of the nipple epidermis by malignant cells. […] The average age at diagnosis is around the 6th decade (53-59 years). […] Mammary Paget disease can be classified into four clinical stages: stage 0: lesion is confined to the epidermis, without underlying ductal carcinoma in situ (DCIS) of the breast; stage 1: associated with DCIS just beneath the nipple; stage 2: associated with extensive DCIS; stage 3: associated with invasive ductal carcinoma. […] In most cases of Paget of the breast, there are malignant ductal cells that extend to the nipple surface through the terminal lactiferous ducts. […] Mammary Paget disease can be undetectable on mammography in ~50% of cases.

• #15 Can a Mammogram Detect Paget’s Disease? ¡ Check Now !

  https://atlanticendomd.com/can-a-mammogram-detect-pagets-disease/

  But can this common screening tool effectively detect Pagets Disease of the breast? […] While mammograms are the gold standard for detecting breast cancer, their effectiveness in identifying Pagets Disease is not as clear-cut. […] Mammograms primarily focus on detecting changes in breast tissue density. Pagets Disease primarily affects the skin of the nipple and areola, which may not show significant changes on a mammogram. […] In conclusion, mammograms can sometimes provide clues that suggest Pagets Disease, but they are not a definitive diagnostic tool for this condition. […] A biopsy involves taking a small tissue sample from the affected area for microscopic examination. This is the most definitive way to diagnose Pagets Disease. […] Mammography remains a vital tool in detecting breast cancer and other breast abnormalities. However, for Pagets Disease, a comprehensive diagnostic approach is necessary.

• #16 Paget’s disease of the breast – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pagets-disease-of-the-breast/diagnosis-treatment/drc-20351084

  Tests and procedures used to diagnose Paget’s disease of the breast include: […] Your doctor will check both of your breasts and the lymph nodes in your armpit, feeling for any lumps or other abnormalities. […] A mammogram is an X-ray of the breast. Mammograms are commonly used to screen for breast cancer. If an abnormality is detected on a screening mammogram, your doctor may recommend a diagnostic mammogram to further evaluate that abnormality. […] Ultrasound uses sound waves to produce images of structures deep within the body. Ultrasound may be used to determine whether a new breast lump is a solid mass or a fluid-filled cyst. […] An Magnetic resonance imaging (MRI) machine uses a magnet and radio waves to create pictures of the interior of your breast. Before a breast MRI, you receive an injection of dye.

• #17 Spectrum of Imaging Findings in Paget’s Disease of the Breast—A Pictorial Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4519816/

  A biopsy from the nipple areolar region is necessary to confirm the diagnosis. […] Mammography plays an important role in the diagnosis and management of Pagets disease; however, it has its own limitations and may be normal in some cases. […] MRI accurately depicted underlying DCIS in a patient without a palpable mass or any positive mammography findings. […] Though Pagets disease is predominantly a clinical diagnosis, negative mammography cannot reliably exclude underlying malignancy. Both clinical and imaging findings are complementary to each in order to make a diagnosis.

• #18 Diagnosis and treatment of Paget’s disease of the breast: an analysis of 72 cases

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4694522/

  Among the cases presenting with lymph node metastases, those negative for ER/PR accounted for 78%; Her-2-positive cases accounted for 56%. […] The diagnosis is generally based on the presence of Paget cells using postoperative pathological examination. […] The accurate diagnosis rate can be improved by skin biopsy. […] Imaging examination is mainly intended to identify intraductal lesions and to evaluate axillary lymph node metastases, so as to optimize the surgical treatment. […] The prognostic factors of Pagets disease of the breast include concurrent ductal carcinoma and the histological type and lymph node metastasis. […] ER, PR and Her-2 testing can aid the choice of therapy and help predict the prognosis. […] Surgical treatment is the preferred choice for Pagets disease of the breast.

• #19 Accuracy of mammography and magnetic resonance imaging to diagnose underlying malignancy in Paget’s disease of the nipple: a systematic review and meta-analysis – Madsen – Annals of Breast Surgery

  https://abs.amegroups.org/article/view/7229/html

  Pagets disease (PD) of the nipple is a less common type of breast cancer. Often it is accompanied by underlying malignancy and identification of this prior to surgery plays an important role in the surgical assessment. Until now no agreement about a standard diagnostic program exists. A few smaller studies of the accuracy of mammography (MMG) and magnetic resonance imaging (MRI) to determine presence and extent of underlying malignancy in patients with PD have been published. The aim of this study was to pool the published evidence with a systematic review and meta-analysis. […] The total sensitivity (95% CI) of MMG and MRI was 39% (95% CI: 2751%) and 68% (95% CI: 5281%), respectively. The difference was significant (P=0.0025). The total specificity (95% CI) of MMG and MRI was 100% (95% CI: 54100%) and 100% (95% CI: 29100%), respectively.

• #20 Breast MRI as a Problem Solving Tool in Paget’s Disease of the Nipple | Peters | Journal of Current Surgery

  https://www.currentsurgery.org/index.php/jcs/article/view/80/66

  Pagets disease of the nipple is a rare breast malignancy. It is usually, but not always, associated with an underlying ductal carcinoma in situ or invasive ductal carcinoma. Conventional breast imaging studies often fail to detect underlying breast malignancy when present. […] If Pagets disease is suspected, a skin punch biopsy is performed to obtain a diagnosis. Often, but not always, Pagets disease of the nipple is associated with underlying ductal carcinoma in situ (DCIS) or an invasive ductal carcinoma and the underlying malignancy is in the majority of cases contiguous with Pagets disease of the nipple. […] More recently, breast MRI has been identified as a modality which may improve detection of clinically and mammographically occult breast malignancies associated with Pagets disease.

• #21 Accuracy of mammography and magnetic resonance imaging to diagnose underlying malignancy in Paget’s disease of the nipple: a systematic review and meta-analysis – Madsen – Annals of Breast Surgery

  https://abs.amegroups.org/article/view/7229/html

  This study demonstrated that MRI is a significantly more accurate tool to diagnose underlying malignancy in patients with PD compared to MMG. […] Identification of underlying malignancy was found to be significantly more accurate when MRI was used in addition to MMG. Adding MRI seems therefore to improve surgical treatment of patients with PD and a negative MMG.

• #22 Pathological and imaging features of Paget’s disease and nipple adenoma: a comparative study – Liu – Gland Surgery

  https://gs.amegroups.org/article/view/87760/html

  Breast MRI can clearly show the areola lesions of nipple PD and NA, accurately evaluate the degree and size of breast lesions, and help clinicians choose appropriate and personalized diagnosis and treatment methods. […] The combination of multiple breast imaging examinations (including X-ray, ultrasound, and MRI) can improve the diagnosis of PD and NA and play a guiding role in the options for clinical treatment. […] Pagets disease (PD) of the nipple is a rare breast malignant disease caused by the infiltration of epidermoid carcinoma cells into the nipple and/or areola. […] Both PD and NA occurred in the nipple and share some similarities in clinical manifestations, such as enlargement, rupture, and repeated scab of the nipple. […] However, PD and NA have different pathological manifestations and imaging findings.

• #23 Paget disease (breast) | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/paget-disease-breast?lang=us

  MR imaging may play an important role in the selection of patients with Paget disease for breast-conserving therapy if there is no clinical or mammographic evidence of breast carcinoma. […] Traditionally, treatment has been a mastectomy with nodal dissection. However, with MRI, breast-conserving therapy is more frequently being used.

• #24 Paget Disease of the Breast | Details, Diagnosis and Signs | American Cancer Society

  https://www.cancer.org/cancer/types/breast-cancer/about/types-of-breast-cancer/paget-disease-of-the-nipple.html

  Paget disease of the breast is diagnosed by a biopsy, removing a small piece of the breast tissue and looking at it closely in the lab. […] Most people with Paget disease of the breast also have tumors in the same breast. One or more of the following imaging tests may be done to check for other breast changes: Diagnostic mammogram, Breast ultrasound, Breast MRI (magnetic resonance imaging) scan. […] Only a biopsy can show for sure that it is cancer.

• #25 Paget’s Disease of the Breast: Stages, Symptoms & Prognosis

  https://my.clevelandclinic.org/health/diseases/17913-pagets-disease-of-the-breast

  Paget’s disease of the breast is a rare type of breast cancer that develops in the skin of the nipple. Most people who have Paget’s disease of the breast also have underlying cancer in the milk ducts of the breast (ductal carcinoma). The primary treatment is surgery. […] Paget’s disease of the breast resembles eczema on your nipple and may be mistaken for an ordinary rash at first. […] Your healthcare provider may attempt to treat your condition as eczema at first. When that fails, or when they suspect Paget’s disease of the breast, they’ll need to take a sample of the nipple tissue to examine under a microscope. Paget’s cells are easily recognizable this way. […] After identifying Paget’s disease of the breast, your healthcare provider will need to find out if you have underlying ductal carcinoma, and if so, how advanced it is.

• #26 Paget’s disease of the breast biopsy – wikidoc

  https://www.wikidoc.org/index.php/Paget%27s_disease_of_the_breast_biopsy

  A full-thickness biopsy of the nipple and areola is important for establishing the diagnosis of Paget’s disease of the breast. Findings on biopsy diagnostic of Paget’s disease of the breast include presence of Paget cells, which are arranged in solid groups. […] The diagnosis of Paget’s disease can be made from a wedge biopsy, a superficial shave biopsy of epidermis or from a punch biopsy. […] Wedge biopsy is the most useful method to make the diagnosis because the biopsy is likely to include the epidermis and a part of lactiferous duct. […] It is essential that the sample contains part of the lactiferous duct and if the areola is affected, it also needs to be represented in the sample to confirm the diagnosis. […] A shave biopsy is less likely to contain sufficient number of Paget’s cells, especially when the surface of the lesion is ulcerated.

• #27

  https://biomedres.us/fulltexts/BJSTR.MS.ID.005717.php

  Pagets breast disease (PBD) is a rare disease with an unusual presentation, so early diagnosis is quite difficult. Only histopathology can give the definitive diagnosis, and the treatments depend upon the presence or absence of associated breast lump. […] A biopsy is mandatory to confirm the diagnosis, particularly in cases without an associated lump. […] A nipple biopsy is essential for the diagnosis of PBD. Wedge biopsy is ideal (a blade is used to remove a small wedge of the nipple and eczematous skin). This is most informative as a good amount of tissue is available. […] The immunohistochemistry is essential to distinguish Paget cells from other cell types like Toker cells which are normally present and can be difficult to distinguish from Pagets disease. […] Our case highlights the importance of histologic examination via incisional or deep punch biopsy to confirm PDB diagnosis, regardless of a prior normal mammogram or breast ultrasound.

• #28

  https://www.nhs.uk/conditions/pagets-disease-nipple/diagnosis/

  As Paget’s disease of the nipple is usually a sign of breast cancer, it’s very important you see your GP if you notice changes to the tissue or skin of your breast. […] Therefore, you should visit your GP for a diagnosis rather than assuming you have eczema. Paget’s disease is a form of breast cancer and the sooner it’s diagnosed, the better the outcome is likely to be. […] If your GP thinks you may have breast cancer, they’ll refer you to a specialist breast clinic for tests. […] At the breast clinic you’ll have tests to find out whether you have breast cancer and, if you have, what type of breast cancer. […] A skin biopsy is often used to confirm a diagnosis of Paget’s disease of the nipple. A small tissue sample will be taken from your nipple or the skin around it. The sample will be examined under a microscope and tested to see if it’s cancerous.

• #29 Paget’s disease of the breast biopsy – wikidoc

  https://www.wikidoc.org/index.php/Paget%27s_disease_of_the_breast_biopsy

  A full-thickness biopsy of the nipple and areola is important for establishing the diagnosis of Paget’s disease of the breast. Findings on biopsy diagnostic of Paget’s disease of the breast include presence of Paget cells, which are arranged in solid groups. […] The diagnosis of Paget’s disease can be made from a wedge biopsy, a superficial shave biopsy of epidermis or from a punch biopsy. […] Wedge biopsy is the most useful method to make the diagnosis because the biopsy is likely to include the epidermis and a part of lactiferous duct. […] It is essential that the sample contains part of the lactiferous duct and if the areola is affected, it also needs to be represented in the sample to confirm the diagnosis. […] A shave biopsy is less likely to contain sufficient number of Paget’s cells, especially when the surface of the lesion is ulcerated.

• #30 Paget’s disease of the breast biopsy – wikidoc

  https://www.wikidoc.org/index.php/Paget%27s_disease_of_the_breast_biopsy

  A full-thickness biopsy of the nipple and areola is important for establishing the diagnosis of Paget’s disease of the breast. Findings on biopsy diagnostic of Paget’s disease of the breast include presence of Paget cells, which are arranged in solid groups. […] The diagnosis of Paget’s disease can be made from a wedge biopsy, a superficial shave biopsy of epidermis or from a punch biopsy. […] Wedge biopsy is the most useful method to make the diagnosis because the biopsy is likely to include the epidermis and a part of lactiferous duct. […] It is essential that the sample contains part of the lactiferous duct and if the areola is affected, it also needs to be represented in the sample to confirm the diagnosis. […] A shave biopsy is less likely to contain sufficient number of Paget’s cells, especially when the surface of the lesion is ulcerated.

• #31 Paget’s disease of the breast biopsy – wikidoc

  https://www.wikidoc.org/index.php/Paget%27s_disease_of_the_breast_biopsy

  A punch biopsy will include the underlying stroma and possibly part of a duct. It frequently provides less epidermis to examine. […] Many times a full-thickness biopsy of the nipple and areola is important for establishing the diagnosis of Paget’s disease of the breast. […] Biopsy is not always successful, therefore, it is at times necessary to take a second biopsy or to excise the nipple. […] Often histological exams are inconclusive and more biopsies, or even surgical removal of the entire nipple may be required. […] The main histological characteristic is the presence of Paget cells, which are arranged in solid groups. […] On occasion, they form glandular arrangements outlining the basal epidermis and exhibit migration to the granular layer, similarly to melanocytes.

• #32 Pathology Outlines – Paget disease

  https://www.pathologyoutlines.com/topic/breastmalignantpaget.html

  Mammary Paget disease (MPD) is a proliferation of malignant glandular epithelial cells (in situ carcinoma) in the nipple areolar epidermis (Histopathology 2020;77:181) […] In symptomatic cases, the diagnosis is primarily clinical and confirmed by histologic examination […] Most commonly used techniques include skin punch or shave biopsy and less often, core needle biopsy; samples are usually small due to concern about the cosmetic appearance of the nipple (Breast J 2019;25:1328, Radiol Med 2021;126:936) […] Nipple scrape cytology can detect tumor cells on the surface of the epidermis or in the scale crust but it may be painful for the patients and is rarely used (Diagn Cytopathol 2019;47:249) […] In addition to nipple biopsy, any underlying masses or mammographic abnormalities must be biopsied, usually by core needle; in patients with a palpable lump, alternatively by fine needle aspiration cytology

• #33 Paget’s disease of the breast | Breast Cancer Now

  https://breastcancernow.org/about-breast-cancer/diagnosis/types-of-breast-cancer/pagets-disease-of-the-breast/

  Pagets disease of the breast is an uncommon type of breast cancer. […] As Pagets disease is uncommon and can look like other skin conditions, its not always diagnosed straight away. […] Once your GP has referred you to a specialist, you may have several tests including: A mammogram, An ultrasound scan, A biopsy. […] You will usually have a biopsy to confirm the diagnosis. […] The type of biopsy you have will depend on your symptoms. […] If your mammogram or ultrasound results show an area of concern within your breast, you may have another biopsy called an image-guided biopsy. […] The samples of tissue or cells are sent to a laboratory where they are examined under a microscope.

• #34 Paget’s disease of the breast | Breast Cancer Now

  https://breastcancernow.org/about-breast-cancer/diagnosis/types-of-breast-cancer/pagets-disease-of-the-breast/

  Pagets disease of the breast is an uncommon type of breast cancer. […] As Pagets disease is uncommon and can look like other skin conditions, its not always diagnosed straight away. […] Once your GP has referred you to a specialist, you may have several tests including: A mammogram, An ultrasound scan, A biopsy. […] You will usually have a biopsy to confirm the diagnosis. […] The type of biopsy you have will depend on your symptoms. […] If your mammogram or ultrasound results show an area of concern within your breast, you may have another biopsy called an image-guided biopsy. […] The samples of tissue or cells are sent to a laboratory where they are examined under a microscope.

• #35 Paget’s Disease of the Breast: Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/breast-cancer/guide/paget-disease/

  Breast magnetic resonance imaging (MRI), which uses an MRI machine with a large magnet and radio waves to create pictures of the breast tissue and screen for breast cancer. […] Breast biopsy, in which a small sample of breast tissue is removed and sent to a lab for analysis. […] Sentinel lymph node biopsy, which may be done if imaging tests show invasive breast cancer. In this case, your doctor will want to see if the cancer has spread to the lymph nodes under your arms. If no cancer is found in a tissue sample from the sentinel node, it is unlikely the cancer has spread to any other nodes.

• #36 What You Should Know About Paget’s Disease of the Breast – Iowa Radiology

  https://www.iowaradiology.com/what-you-should-know-about-pagets-disease-of-the-breast/

  Pagets disease of the breast, also called Pagets disease of the nipple or mammary Pagets disease, is a rare type of breast cancer that causes changes to the skin of the nipple. It is estimated to be present in 14% of breast cancer cases. More than 90% of patients with mammary Pagets disease also have invasive or noninvasive carcinoma, most often either DCIS or invasive ductal carcinoma. The prevailing theory is that Pagets disease results cells from an underlying ductal cancer travel through the milk ducts to the surface of the nipple; however, since additional cancer is not always found, it is possible that these cells can become cancerous on their own. […] If Pagets disease is suspected, the doctor will likely perform a physical exam to check for palpable tumors, which are found in approximately 50% of Pagets patients. A mammogram, with the possible addition of breast ultrasound and/or MRI is typically performed to look at other areas of the breast for signs of cancer. A biopsy of the nipple and areola is performed to either confirm or rule out the presence of Pagets disease. A biopsy of the sentinel lymph nodes under the arm may also be performed to assess possible spread of cancer cells.

• #37 Paget’s Disease of the Breast: Stages, Symptoms & Prognosis

  https://my.clevelandclinic.org/health/diseases/17913-pagets-disease-of-the-breast

  Treatment involves surgery and sometimes additional cancer therapies. […] Breast cancer survival is based on the stage of the cancer when it’s detected. If you only have Paget’s disease of the nipple or ductal carcinoma in situ (stage 0) that hasn’t spread beyond the milk ducts, your prognosis is excellent. […] Always see your healthcare provider if you notice any changes in your breast, including skin conditions and changes under the skin. […] Paget’s disease of the breast is characterized by distinctive cancer cells on the skin of the nipple that can be seen under a microscope. Because Paget originally described them, they’re known as Paget cells. […] Paget’s disease of the breast is early-stage breast cancer of the milk ducts that occurs in the nipple. It’s sometimes accompanied by more invasive breast cancer. You may notice nipple changes such as crusting, flaking of the skin, discharge or a raw area that doesn’t heal. The earlier you identify and treat it, the better your outcome will be. Many people make a full recovery, but it will require surgery to remove it.

• #38 Paget’s disease of the breast biopsy – wikidoc

  https://www.wikidoc.org/index.php/Paget%27s_disease_of_the_breast_biopsy

  A full-thickness biopsy of the nipple and areola is important for establishing the diagnosis of Paget’s disease of the breast. Findings on biopsy diagnostic of Paget’s disease of the breast include presence of Paget cells, which are arranged in solid groups. […] The diagnosis of Paget’s disease can be made from a wedge biopsy, a superficial shave biopsy of epidermis or from a punch biopsy. […] Wedge biopsy is the most useful method to make the diagnosis because the biopsy is likely to include the epidermis and a part of lactiferous duct. […] It is essential that the sample contains part of the lactiferous duct and if the areola is affected, it also needs to be represented in the sample to confirm the diagnosis. […] A shave biopsy is less likely to contain sufficient number of Paget’s cells, especially when the surface of the lesion is ulcerated.

• #39 Paget`s disease of the Breast. Differential diagnosis using additional IHC-panel. Literature review and own observations. – Unified Citation Journals

  https://ucjournals.com/pagets-disease-of-the-breast-differential-diagnosis-using-additional-ihc-panel-literature-review-and-own-observations/

  The erythematous spot is usually sharply demarcated. Nipple retraction or palpable nodules indicate underlying breast carcinoma. […] Pagets cells often compress the basal keratinocytes that lie between Pagets cells and the papillary dermis. Paget cells are located singly or in the nests. […] Pagets cells almost always express molecules such as low molecular weight keratins, EMA, c-erb B-2, and polyclonal pCEA. Increased expression of HER-2 family proteins, and variable expression of ER, PR receptors are also often detected. […] The main differential diagnostic differences between Paget cells in and Toker cells are presented in Table 2. […] The main differential diagnostic criteria for Melanoma and Paget`s breast disease are Below (Table 3.) […] The main differential diagnostic criteria for Bowen Disease and Pagets breast disease are given below (Table 4.). […] Key differential diagnostic criteria between Paget`s breast disease and Weisner`s nevus are shown in the table below (Table 5).

• #40

  https://biomedres.us/fulltexts/BJSTR.MS.ID.005717.php

  Pagets breast disease (PBD) is a rare disease with an unusual presentation, so early diagnosis is quite difficult. Only histopathology can give the definitive diagnosis, and the treatments depend upon the presence or absence of associated breast lump. […] A biopsy is mandatory to confirm the diagnosis, particularly in cases without an associated lump. […] A nipple biopsy is essential for the diagnosis of PBD. Wedge biopsy is ideal (a blade is used to remove a small wedge of the nipple and eczematous skin). This is most informative as a good amount of tissue is available. […] The immunohistochemistry is essential to distinguish Paget cells from other cell types like Toker cells which are normally present and can be difficult to distinguish from Pagets disease. […] Our case highlights the importance of histologic examination via incisional or deep punch biopsy to confirm PDB diagnosis, regardless of a prior normal mammogram or breast ultrasound.

• #41 Paget`s disease of the Breast. Differential diagnosis using additional IHC-panel. Literature review and own observations. – Unified Citation Journals

  https://ucjournals.com/pagets-disease-of-the-breast-differential-diagnosis-using-additional-ihc-panel-literature-review-and-own-observations/

  In 1874, Sir James Paget described a tumor that was later called Pagets disease of the breast. Currently, Pagets disease of the breast is a rare type of cancer that affects the skin of the nipple and usually the areola. Moreover, it should be noted that, as a rule, this cancer is associated with other breast carcinomas, such as: ductal carcinoma in situ or invasive cancer. […] We have developed a wide differential diagnostic IHC panel that simplifies the diagnosis of Pagets disease of the breast. We recommend using such stains as: CD138, P53, CK8, Ck7, HER2 / Neu, EMA / MUC1, HMB-45, Melan A, S-100, P-63, P16 and BAP1. […] Pagets mammary disease is characterized by scaly, erythematous, thickened, crusty plaques located on the nipple, with a tendency to spread to surrounding areas. In this case, the spread of the tumor occurs not only in the nearest (for example, the areola) but also in relatively distant areas, so axillary Paget arcinoma can arise from the axillary auxiliary tissue of the mammary gland.

• #42 Diagnosis and treatment of Paget’s disease of the breast: an analysis of 72 cases

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4694522/

  Among the cases presenting with lymph node metastases, those negative for ER/PR accounted for 78%; Her-2-positive cases accounted for 56%. […] The diagnosis is generally based on the presence of Paget cells using postoperative pathological examination. […] The accurate diagnosis rate can be improved by skin biopsy. […] Imaging examination is mainly intended to identify intraductal lesions and to evaluate axillary lymph node metastases, so as to optimize the surgical treatment. […] The prognostic factors of Pagets disease of the breast include concurrent ductal carcinoma and the histological type and lymph node metastasis. […] ER, PR and Her-2 testing can aid the choice of therapy and help predict the prognosis. […] Surgical treatment is the preferred choice for Pagets disease of the breast.

• #43 Paget’s disease of the breast | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/breast-cancer/pagets-disease-of-the-breast

  The samples are looked at under a microscope to check for cancer cells. This is to find out whether there are any DCIS or invasive breast cancer cells. […] If invasive breast cancer cells are found, your doctor will arrange other tests. This is to find out whether the cancer cells have receptors (proteins) for hormones or for HER2.

• #44 Paget’s Disease of the Breast | CancerIndex

  http://www.cancerindex.org/clink3pb.htm

  Paget’s disease (PD) is an uncommon intraepithelial adenocarcinoma with unknown pathogenesis. […] There are two anatomic subtypes: mammary (MPD) and extramammary (EMPD). […] Paget’s disease of the breast is characterized by eczematous changes of the nipple-areolar complex and is associated with an underlying in situ or invasive breast carcinoma in most cases. […] Paget’s disease must be differentiated from other conditions including eczema, Bowen’s disease, squamous cell carcinoma, and melanoma. […] Recognition of Paget’s disease clinically and pathologically is critical as the superficial lesion may be the only sign of an underlying ductal carcinoma and its presence may be of prognostic significance. […] Paget disease is characterized by an intense lymphocytic response, devoid of the immune-suppressive impact of the PD-L1 pathway, but with occasional CTLA-4 expression.

• #45 Paget’s Disease of the Breast

  http://www.aboutcancer.com/pagets_harris.htm

  Paget’s disease initially presents with errythema and mild eczematous scaling and flaking of the nipple skin. Without treatment, the condition advances to crusting, skin erosion, and ulceration, with exudation or frank discharge. The clinical differential diagnosis of scaling skin and erythema of the nipple-areolar complex includes eczema, contact dermatitis, postradiation dermatitis, and Paget’s disease. The diagnosis can be obtained by scrape cytology, a superficial epidermal shave biopsy, a 2-mm punch biopsy, a wedge incisional biopsy, or nipple excision. In 807 patients with clinical Paget’s disease from 12 series, 371 (46%) presented with a breast mass, and 436 (54%) presented without a mass. In patients with clinical Paget’s disease without a palpable breast mass, mammography has been reported as normal in 2.5% to 100% of patients. The histologic differential diagnosis of Paget’s disease includes superficial spreading melanoma, squamous cell carcinoma in situ (Bowen’s disease), and clear cell changes of squamous cells of the epidermis (Toker cells). The diagnosis of Paget’s disease is confirmed by nipple scrape cytology or biopsy. Patients with clinical and mammographic disease limited to the retroareolar area can be considered candidates for breast conservation.

• #46 Paget disease (breast) | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/paget-disease-breast?lang=us

  Paget disease of the breast, which is also known as Paget disease of the nipple, has traditionally been described as a form of breast malignancy characterized by infiltration of the nipple epidermis by malignant cells. […] The average age at diagnosis is around the 6th decade (53-59 years). […] Mammary Paget disease can be classified into four clinical stages: stage 0: lesion is confined to the epidermis, without underlying ductal carcinoma in situ (DCIS) of the breast; stage 1: associated with DCIS just beneath the nipple; stage 2: associated with extensive DCIS; stage 3: associated with invasive ductal carcinoma. […] In most cases of Paget of the breast, there are malignant ductal cells that extend to the nipple surface through the terminal lactiferous ducts. […] Mammary Paget disease can be undetectable on mammography in ~50% of cases.

• #47 Paget’s Disease of the Breast: Symptoms, Treatment, Survival

  https://www.verywellhealth.com/pagets-disease-of-the-breast-430628

  Paget’s disease of the breast is a rare cancer of the nipple and areola (the darkened skin around the nipple) closely associated with ductal carcinoma in situ (a cancer of milk ducts). […] The diagnosis of Paget’s disease of the breast involves the same steps and procedures used for other forms of breast cancer, including: […] If you have Pagets disease of the breast, a mammogram may show nipple and skin changes that are linked to underlying breast cancer. Your healthcare provider may follow up with magnetic resonance imaging (MRI). […] During a breast biopsy, a small sample of tissue is taken from a lump or the skin of the nipple or areola to view under the microscope. If there is nipple discharge, it will also be collected and examined. […] If cancer is diagnosed, it will be staged based on the TNM classification system. Staging tells you how advanced the cancer is and helps direct the appropriate course of treatment.

• #48 Mammary Paget’s Disease: An Update

  https://www.mdpi.com/2072-6694/14/10/2422

  Mammary Paget’s disease of the breast is an uncommon and often misdiagnosed breast malignancy. The review discusses the diagnosis, work-up, treatment, and prognosis of mammary Paget’s disease. […] This review article discusses Paget’s disease etiology, clinical presentation, differential diagnosis, diagnostic work-up, natural history and prognosis. […] MDP is diagnosed initially based on clinical presentation, physical examination, and breast imaging. Both benign and malignant processes can produce visible symptoms in the skin of the nipple. However, if apparently benign skin changes do not improve after a two-week course of topical corticosteroids, a diagnostic imaging work-up and biopsy should be performed. […] Efficient work-up includes high-quality diagnostic imaging to rule out malignancy due to the high probability of breast carcinoma associated with MPD.

• #49 Mammary Paget’s Disease: An Update

  https://www.mdpi.com/2072-6694/14/10/2422

  Mammography should be used as the primary diagnostic imaging modality for detecting underlying carcinoma, followed by breast ultrasound if the mammogram is negative. […] Whether or not underlying malignancy is identified, patients presenting with a persistent nipple-areolar rash and suspected MPD should undergo a full-thickness biopsy of the nipple or areolar using a 2–4 mm diameter punch biopsy tool or a full-thickness incisional biopsy.

• #50 Paget’s disease of the breast | Breast cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/breast-cancer/types/pagets-disease-breast

  Paget’s disease is a sign that there might be breast cancer in the tissues behind the nipple. […] To diagnose Pagets disease, you usually have a sample of tissue taken from the skin around the nipple. This is a biopsy. Other tests you may have include: a mammogram (an x ray of the breast), an ultrasound scan of the breast, a biopsy of the breast lump (if there is a lump). […] You may also have an MRI of the breast if the doctors need more information to help confirm whether there is breast cancer or not.

• #51 Paget’s Disease | Breast Cancer 101 | Breastlink

  http://breastlink.com/breast-cancer-101/rare-breast-cancer-types/pagets-disease

  Paget’s disease of the breast is a rare form of breast cancer named after the 19th-century British doctor Sir James Paget. Although Paget’s disease can affect other parts of the human body, Paget’s disease of the breast is typically clinically observed with scaling of the nipple skin, nipple redness, or nipple burning. Paget’s disease of the breast accounts for 1-4 percent of breast cancer cases. The median age of diagnosis is 57, but cases have been found in patients as young as their early 20s and as old as their late 80s. […] The diagnosis of Paget’s disease is relatively straightforward. At Breastlink, our breast-dedicated physicians utilize a simple skin punch biopsy technique to remove a small piece of tissue from the area of the nipple affected by abnormal changes. This procedure is painless, performed under local anesthesia, and takes only a few minutes. A small amount of skin and underlying tissue is removed and sent to a pathologist. In our experience, with hundreds of cases, this method has proven to be highly accurate.

• #52 Diagnosis and treatment of Paget’s disease of the breast: an analysis of 72 cases

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4694522/

  The commonly used treatments include modified radical mastectomy, simple mastectomy and breast-conserving surgery, depending on whether Pagets disease of the breast is associated with ductal carcinoma, the histological type of ductal carcinoma and axillary lymph node metastases. […] For cases who were not found to have breast lumps and enlarged axillary lymph nodes preoperatively, the major ducts behind the nipple-areolar complex and the low axillary lymph nodes were resected and subject to intraoperative frozen section examination. […] It is now recognized that breast carcinoma is a systemic disease. […] Local treatment for early breast carcinomas will help lower the probability of local recurrence and distant metastasis and thus prolong the survival. […] Therefore, it is crucial to determine whether Pagets disease of the breast is associated with breast lump.

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