Materiały źródłowe

• #1 Paget Disease of the Breast – NCI

  https://www.cancer.gov/types/breast/paget-breast-fact-sheet

  How is Paget disease of the breast diagnosed? […] A nipple biopsy allows doctors to correctly diagnose Paget disease of the breast. […] Most people who have Paget disease of the breast also have one or more tumors inside the same breast. In addition to ordering a nipple biopsy, the doctor should perform a clinical breast exam to check for lumps or other breast changes. […] The doctor may order additional diagnostic tests, such as a diagnostic mammogram, an ultrasound exam, or a magnetic resonance imaging scan to look for possible tumors.

• #2 Paget’s Disease of the Breast: Symptoms, Treatment & Prognosis

  https://www.cancercenter.com/cancer-types/breast-cancer/types/rare-breast-cancer-types/pagets-disease-of-the-breast

  How is Pagets disease diagnosed? […] If Pagets disease is suspected, doctors may recommend a breast biopsy, in which a small sample of tissue is removed for testing. Under a microscope, these cancer cells appear large and round, and may either be grouped together or alone as single cells. In some circumstances, doctors may have to remove the entire nipple for the biopsy. […] Because Pagets disease may also coexist with other cancer cells within the breast, additional breast cancer screenings may be necessary, such as a mammogram, ultrasound or MRI (magnetic resonance imaging) of the breast or a combination of these. […] As many as half of Pagets disease patients also have a palpable breast lump, according to the NCI, so a physical breast exam may be a part of the diagnosis process.

• #3 Paget Disease of the Breast | MD Anderson Cancer Center

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

  Paget disease is a rare form of breast cancer, making up 1-4% of all breast cancer cases, according to the National Cancer Institute. […] If a doctor suspects a patient has Paget disease of the breast, the breast should be imaged. This can be done by a mammogram or possibly an ultrasound. […] If the images and biopsy comes back clear, though, the patient may still have cancer. At this point, the nipple and/or areola must be biopsied directly. […] Because Paget disease is a rare breast cancer, finding a team with the expertise to properly diagnose and treat this cancer is essential.

• #4 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 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. […] Doctors don’t know what causes Paget’s disease of the breast. The most widely accepted theory is that the disease results from an underlying ductal breast cancer. The cancer cells from the original tumor then travel through milk ducts to the nipple and its surrounding skin. […] If your doctor has determined that you have an increased risk of breast cancer, you may discuss options to reduce your risk, such as preventive medications (chemoprevention). Estrogen-blocking medications reduce the risk of breast cancer if you have a high risk of the disease.

• #5 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. […] 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. […] According to the American Cancer Society, Pagets disease usually appears in one breast or nipple. […] If a person has any nipple or skin changes on the breast, they should tell a doctor right away, even if they think Pagets is unlikely.

• #6 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.

• #7 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

  Pagets disease of the breast is a condition that causes a scaly rash on the skin of the nipple. […] Pagets disease usually affects the nipple first. After a few weeks, it spreads to the areola. Other skin conditions usually affect the areola first and then the nipple. […] It may be possible to confuse Pagets disease with other skin conditions such as eczema, dermatitis and psoriasis. This is because they look similar. Pagets disease can be difficult to diagnose just by looking at it. […] Your first test will usually be to check the skin changes on your nipple. Your specialist breast cancer doctor may do the following tests: A skin or punch biopsy. The doctor removes a small sample of skin from the affected nipple and tissue from under the skin. They inject some local anaesthetic into the skin to numb the area first. The sample is looked at under a microscope for cancer cells.

• #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 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.

• #9 Paget’s Disease of the Breast: Symptoms, Treatment & Prognosis

  https://www.cancercenter.com/cancer-types/breast-cancer/types/rare-breast-cancer-types/pagets-disease-of-the-breast

  How is Pagets disease diagnosed? […] If Pagets disease is suspected, doctors may recommend a breast biopsy, in which a small sample of tissue is removed for testing. Under a microscope, these cancer cells appear large and round, and may either be grouped together or alone as single cells. In some circumstances, doctors may have to remove the entire nipple for the biopsy. […] Because Pagets disease may also coexist with other cancer cells within the breast, additional breast cancer screenings may be necessary, such as a mammogram, ultrasound or MRI (magnetic resonance imaging) of the breast or a combination of these. […] As many as half of Pagets disease patients also have a palpable breast lump, according to the NCI, so a physical breast exam may be a part of the diagnosis process.

• #10 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: […] Up to 50% of people with Paget’s disease of the nipple have a breast lump or an area of thickening that is felt upon clinical exam. […] If you have Pagets disease of the breast, a mammogram may show nipple and skin changes that are linked to underlying breast cancer. […] 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 cancer is diagnosed, it will be staged based on the TNM classification system.

• #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: […] Only a biopsy can show for sure that it is cancer.

• #12 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.

• #13 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. […] Its sometimes called Pagets disease of the nipple. […] 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. […] A biopsy is the removal of tissue to be looked at under a microscope. […] 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.

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

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

  Mammary Paget disease can be undetectable on mammography in ~50% of cases. […] 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.

• #15

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

  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. […] Most patients with PBD without a palpable mass will have a normal mammogram as in our case. […] However, negative radiological studies alone cannot rule out PDB in a patient presenting with cutaneous nipple changes.

• #16

  https://www.nursingcenter.com/journalarticle?Article_ID=5555113&Journal_ID=849729&Issue_ID=5555089

  ABSTRACT: Paget’s disease of the breast (PDB) is a rare disorder of the nipple-areola complex that may present clinically as a unilateral, eczematous, or ulcerated papule or plaque. This case highlights the importance of either punch or incisional wedge biopsy to establish a diagnosis of PDB for patients who present with chronic cutaneous changes of the nipple, areola, or skin of the breast, regardless of any previous normal mammogram or breast ultrasound. Mammography alone cannot rule out a diagnosis of PDB in a patient with cutaneous changes of the breast. […] This case study highlights the importance of histologic examination via incisional or deep punch biopsy to confirm a diagnosis of PDB, regardless of prior normal mammogram or breast ultrasound. […] Despite high prevalence of underlying breast cancer among patients with PDB, only approximately 35%-65% of patients with biopsy-proven PDB exhibit findings on mammography that are concerning for underlying breast carcinoma. […] Mammography has low sensitivity to detect PDB and should be used as a complimentary diagnostic tool to surgical wedge or punch biopsy when PDB is suspected.

• #17 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.

• #18 Paget’s disease of the breast | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/pagets-disease-of-the-breast?content_id=CON-20155351

  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 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.

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

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

  Pagets disease is usually associated with ductal carcinoma in situ (DCIS), limited to the nipple and areola area of the breast. […] Paget disease of the breast is the most common cutaneous presentation of intraductal carcinoma of the breast, but is often initially misdiagnosed as nipple eczema. […] The diagnosis is histological and prognosis and treatment depend on the type of underlying breast cancer. […] Paget’s disease must be differentiated from other conditions including eczema, Bowen’s disease, squamous cell carcinoma, and melanoma. […] Sonography can recognize the echoic abnormalities of nipple and lesions of breast. […] The visualization of increased nipple blood flow using Doppler sonography is a simple and low-cost method that provides useful data for identifying Paget disease during routine medical care.

• #20 Practical consensus recommendatons for Paget’s disease in breast cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5909301/

  Because mammography have limitations in the evaluation of patients with Paget’s disease, in the setting of clinically and mammographically occult disease, additional evaluation with MRI can help detect underlying invasive cancer and DCIS. […] As a result, both clinical and imaging findings are complementary and should be correlated to confirm or exclude a diagnosis of Paget’s disease.

• #21 Paget’s disease of the nipple diagnosed by MRI – PubMed

  https://pubmed.ncbi.nlm.nih.gov/16622685/

  Paget’s disease of the breast is a rare manifestation of breast carcinoma. […] Magnetic resonance imaging (MRI) correctly depicted Paget’s disease of the nipple. […] MRI was very useful and accurate to diagnose Paget’s disease of the breast without palpable mass, ultrasonographic and mammographic findings.

• #22 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.

• #23 Pathological and radiological assessments of Paget’s disease – Nakai – Annals of Breast Surgery

  https://abs.amegroups.org/article/view/5150/html

  Sensitivity and specificity of intra-breast disease detection were 62% and 100%, respectively, in 14 patients who had both MMG and MRI findings of PD. […] Our data confirm that breast conserving surgery is difficult in patients with PD. […] The surgical procedure might have to be determined in consideration of a balance between curability and cosmesis. […] A guideline published by the National Comprehensive Cancer Network is available with an algorithm for diagnostic and surgical strategies for PD patients. […] However, there is an annotation stating that, Mastectomy is always an option with any manifestation of PD, reflecting the difficulty of surgically managing this disease. […] The very low incidence rate of PD (0.62%) might be a major factor impeding the basic and clinical studies needed to resolve problems with managing PD, including selection of the optimal surgical procedure.

• #24 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

  Recently, breast MRI has emerged as a staging tool that can detect otherwise occult malignancy in these patients. […] Although breast MRI is known to have very high sensitivity in this clinical setting, false positive findings can also occur resulting in a lower specificity. […] In patients with newly diagnosed breast malignancy, including Pagets disease of the nipple, any asymmetric enhancement should be considered suspicious for further disease, and an MR-guided biopsy should be performed to obtain a tissue diagnosis if not seen on a second-look ultrasound. […] Breast MRI is useful as an additional staging tool in this setting, to detect otherwise occult associated ductal carcinoma in situ or invasive malignancy. Breast MRI is also able to exclude underlying malignancy in Pagets disease, so that breast conservation surgery can be considered as a treatment option.

• #25

  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. […] 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. […] The nipple changes should be correlated with biopsy and clinical findings to establish a PDB diagnosis. A punch or wedge biopsy of the nipple should be performed to take a full thickness of the nipple and areola to ascertain the diagnosis.

• #26 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

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

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

  Pagets disease of the breast is diagnosed with a biopsy, in which a small area of the nipple is removed to be examined in a lab. Most likely, your doctor will use a circular cutting tool, called a punch, to remove a disk-shaped area of tissue. Sometimes, the entire nipple is removed. […] If a biopsy identifies Pagets disease of the breast, your doctor will also want to test for other breast cancers, including DCIS, using some of the following tests: […] Breast exam, in which a doctor will check your breasts and lymph nodes for lumps or other abnormalities. About 50 percent of people with Pagets disease of the breast have a breast lump that can be felt during a breast exam. […] Mammogram, an X-ray of the breast tissue that is used to screen for breast cancer. […] Breast ultrasound, a test that uses sound waves to create an image of the breast to screen for breast cancer.

• #28 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. […] Many times a full-thickness biopsy of the nipple and areola is important for establishing the diagnosis of Paget’s disease of the breast.

• #29

  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. […] 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. […] The nipple changes should be correlated with biopsy and clinical findings to establish a PDB diagnosis. A punch or wedge biopsy of the nipple should be performed to take a full thickness of the nipple and areola to ascertain the diagnosis.

• #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. […] Many times a full-thickness biopsy of the nipple and areola is important for establishing the diagnosis of Paget’s disease of the breast.

• #31 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

• #32 Diagnosis and Treatment of Paget’s disease of the breast

  https://www.medindia.net/health/conditions/pagets-disease-diagnosis.htm

  Magnetic Resonance Imaging (MRI): This diagnostic tool creates multidimensional detailed pictures of areas inside the breast. […] Biopsy (skin punch biopsy technique): This is the main test for confirming cancer cells below the skin surface. A small piece of tissue from the area of the nipple with the abnormal changes and a small amount of skin and underlying tissues is removed and sent to the pathologist. This procedure takes a few minutes to perform under local anesthesia and is painless. It is 100% accurate. Variations to this procedure include stereotactic core needle biopsy. Based on the biopsy report it will be very useful in the staging of the disease and thereby facilitate the treatment process. […] Imprint or scrape cytology: It is a non-invasive, reliable, rapid diagnostic screening method for Paget’s disease of the breast. Cells from the affected area and discharge from the nipple can be scraped or pressed on to a slide and examined under a microscope.

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

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

  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.

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

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

  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.

• #35 Paget’s Disease of the Breast – The Operative Review Of Surgery

  https://operativereview.com/pagets-disease-of-the-breast/

  Should Undergo a Bilateral Diagnostic Mammogram to Evaluate Underlying Lesion 8,9 […] May Also Consider an MRI to Evaluate for More Occult Lesions that May Be Missed on Mammogram 11 […] Definitive Diagnosis: Full Thickness (Punch) Skin Biopsy of the Nipple 9 […] May Also require Core Needle Biopsy (CNB) to Diagnose the Primary Lesion […] Pathology: Paget Cells are Malignant Adenocarcinoma Cells within the Epidermis of the Nipple […] Does Not Invade Through the Dermal Basement Membrane 12 […] Pagets Disease of the Breast Does Not Change the Stage of an Underlying Malignancy 13

• #36 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/

  Pagets cells are able to completely (or almost completely) replace normal keratinocytes in ulcerated areas. […] 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. […] Paget cells can be localized in any layer epidermis, but no dermal invasion. Although they may pseudo-immersion into the dermis along the excretory ducts of the sebaceous and sweat glands. […] Paget cells may be localized in any layers of the epidermis, but do not have any dermal invasion. Although they can pseudo-immersed in the dermis along the excretory ducts of the sebaceous and sweat glands. […] A characteristic and necessary criterion for the diagnosis is negative BAP1 expression.

• #37 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.

• #38

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

  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. […] Most patients with PBD without a palpable mass will have a normal mammogram as in our case. […] However, negative radiological studies alone cannot rule out PDB in a patient presenting with cutaneous nipple changes.

• #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/

  Pagets cells are able to completely (or almost completely) replace normal keratinocytes in ulcerated areas. […] 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. […] Paget cells can be localized in any layer epidermis, but no dermal invasion. Although they may pseudo-immersion into the dermis along the excretory ducts of the sebaceous and sweat glands. […] Paget cells may be localized in any layers of the epidermis, but do not have any dermal invasion. Although they can pseudo-immersed in the dermis along the excretory ducts of the sebaceous and sweat glands. […] A characteristic and necessary criterion for the diagnosis is negative BAP1 expression.

• #40 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/

  Pagets cells are able to completely (or almost completely) replace normal keratinocytes in ulcerated areas. […] 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. […] Paget cells can be localized in any layer epidermis, but no dermal invasion. Although they may pseudo-immersion into the dermis along the excretory ducts of the sebaceous and sweat glands. […] Paget cells may be localized in any layers of the epidermis, but do not have any dermal invasion. Although they can pseudo-immersed in the dermis along the excretory ducts of the sebaceous and sweat glands. […] A characteristic and necessary criterion for the diagnosis is negative BAP1 expression.

• #41 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 cancer that develops in the skin of your nipple, and sometimes the areola (the darker skin surrounding the nipple). […] 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. They’ll start by examining your breast tissue with imaging tests, such as a mammogram or breast ultrasound. […] 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. Most people who discover and treat these conditions early will make a full recovery.

• #42 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

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

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

  With the TNM system, the stages are determined based on the size and extent of the tumor (T), the number of nearby lymph nodes with cancer cells in them (N), and whether or not the cancer has spread, or metastasized, to distant organs (M). […] The treatment of Paget’s disease of the breast varies by the cancer stage, the type of cancer cells you have, and other factors (like the absence or presence of estrogen receptors). […] Surgery is the primary treatment option. […] A lumpectomy is usually followed by radiation therapy to kill any remaining cancer cells. […] After mastectomy, your oncologist may recommend additional treatments to prevent breast cancer recurrence. […] If Paget’s disease of the breast is diagnosed and treated early, the prognosis (expected outcome) is excellent. […] The five-year survival rate for Paget’s disease also varies by the stage of cancer.

• #44 Paget’s Disease of the Breast: Causes, Symptoms, and Treatments | SELF

  https://www.self.com/story/pagets-disease-of-the-breast

  A mammogram—an X-ray exam of your breast tissue—may indicate whether the nipple and skin changes are linked to an underlying breast cancer, as is usually the case in Paget’s disease of the breast. […] During a biopsy, your doctor obtains a small sample of tissue from the skin of your nipple for examination under a microscope. […] If cancer cells are detected in the samples collected, you may be referred to a breast surgeon to discuss treatment options. […] If you have invasive breast cancer, the lymph nodes under your arm (axillary lymph nodes) need to be checked to see if the cancer has spread to this area. This can be done in a procedure known as a sentinel lymph node biopsy.

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

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

  Pagets disease is usually associated with ductal carcinoma in situ (DCIS), limited to the nipple and areola area of the breast. […] Paget disease of the breast is the most common cutaneous presentation of intraductal carcinoma of the breast, but is often initially misdiagnosed as nipple eczema. […] The diagnosis is histological and prognosis and treatment depend on the type of underlying breast cancer. […] Paget’s disease must be differentiated from other conditions including eczema, Bowen’s disease, squamous cell carcinoma, and melanoma. […] Sonography can recognize the echoic abnormalities of nipple and lesions of breast. […] The visualization of increased nipple blood flow using Doppler sonography is a simple and low-cost method that provides useful data for identifying Paget disease during routine medical care.

• #46 Final Diagnosis — Case 331

  https://path.upmc.edu/cases/case331/dx.html

  FINAL DIAGNOSIS: PAGET’S DISEASE OF THE BREAST […] Paget’s disease (PD) of the breast is rare, with a reported incidence of 0.5-2% of all patients with breast cancer. However, this disorder should be considered in the differential diagnosis of all the patients presenting with lesions of the nipple. […] Exfoliative cytology with demonstration of Paget’s cells may be useful, but a negative finding does not exclude PD. Surgical biopsy is the diagnostic standard. […] The histogenesis of PD continues to be debated. […] Fifty to sixty percent of patients have a palpable tumor in the breast. An invasive carcinoma was detected in 75-90% of women who had PD accompanied by a tumor. […] Histologic differential diagnosis includes inflammatory conditions of the skin, clear cell change in epidermal cells, Toker cells, florid papillomatosis of nipple ducts or nipple adenoma. The most common differential diagnoses are malignant melanoma and squamous or basal cell carcinoma.

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

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

  Paget’s disease of the breast 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.

• #48 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

  Pagets disease of the breast is a condition that causes a scaly rash on the skin of the nipple. […] Pagets disease usually affects the nipple first. After a few weeks, it spreads to the areola. Other skin conditions usually affect the areola first and then the nipple. […] It may be possible to confuse Pagets disease with other skin conditions such as eczema, dermatitis and psoriasis. This is because they look similar. Pagets disease can be difficult to diagnose just by looking at it. […] Your first test will usually be to check the skin changes on your nipple. Your specialist breast cancer doctor may do the following tests: A skin or punch biopsy. The doctor removes a small sample of skin from the affected nipple and tissue from under the skin. They inject some local anaesthetic into the skin to numb the area first. The sample is looked at under a microscope for cancer cells.

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

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

  Pagets disease is usually associated with ductal carcinoma in situ (DCIS), limited to the nipple and areola area of the breast. […] Paget disease of the breast is the most common cutaneous presentation of intraductal carcinoma of the breast, but is often initially misdiagnosed as nipple eczema. […] The diagnosis is histological and prognosis and treatment depend on the type of underlying breast cancer. […] Paget’s disease must be differentiated from other conditions including eczema, Bowen’s disease, squamous cell carcinoma, and melanoma. […] Sonography can recognize the echoic abnormalities of nipple and lesions of breast. […] The visualization of increased nipple blood flow using Doppler sonography is a simple and low-cost method that provides useful data for identifying Paget disease during routine medical care.

• #50 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.

• #51 Paget Disease of the Breast – Dermatologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/dermatologic-disorders/cancers-of-the-skin/paget-disease-of-the-breast

  Paget disease is a rare type of carcinoma that appears as a unilateral eczematous to psoriasiform plaque of the nipple and areola. Diagnosis is by biopsy. […] In Paget disease of the breast, metastatic disease is often present at the time of the diagnosis. […] The redness, oozing, and crusting closely resemble dermatitis, but physicians should suspect carcinoma because the lesion is sharply marginated, unilateral, and unresponsive to topical therapy. Biopsy shows typical histologic changes. […] Because this tumor is associated with underlying cancer, systemic evaluation (eg, history and physical examination, age-appropriate cancer screening, imaging) is required.

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

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

  With the TNM system, the stages are determined based on the size and extent of the tumor (T), the number of nearby lymph nodes with cancer cells in them (N), and whether or not the cancer has spread, or metastasized, to distant organs (M). […] The treatment of Paget’s disease of the breast varies by the cancer stage, the type of cancer cells you have, and other factors (like the absence or presence of estrogen receptors). […] Surgery is the primary treatment option. […] A lumpectomy is usually followed by radiation therapy to kill any remaining cancer cells. […] After mastectomy, your oncologist may recommend additional treatments to prevent breast cancer recurrence. […] If Paget’s disease of the breast is diagnosed and treated early, the prognosis (expected outcome) is excellent. […] The five-year survival rate for Paget’s disease also varies by the stage of cancer.

• #53 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). […] Eczematous appearing changes of the nipple include reddening, scaling, hyperkeratosis, and crusting of the nipple surface. […] 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.

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

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

  With the TNM system, the stages are determined based on the size and extent of the tumor (T), the number of nearby lymph nodes with cancer cells in them (N), and whether or not the cancer has spread, or metastasized, to distant organs (M). […] The treatment of Paget’s disease of the breast varies by the cancer stage, the type of cancer cells you have, and other factors (like the absence or presence of estrogen receptors). […] Surgery is the primary treatment option. […] A lumpectomy is usually followed by radiation therapy to kill any remaining cancer cells. […] After mastectomy, your oncologist may recommend additional treatments to prevent breast cancer recurrence. […] If Paget’s disease of the breast is diagnosed and treated early, the prognosis (expected outcome) is excellent. […] The five-year survival rate for Paget’s disease also varies by the stage of cancer.

• #55 Paget’s Disease of Breast: Symptoms and Treatment | Doctor

  https://patient.info/doctor/pagets-disease-of-breast

  Pagets disease of the breast, or mammary Pagets disease, was first described by Sir James Paget in 1874 as an eczematous lesion of the nipple associated with underlying breast cancer. […] Mammary Paget’s disease is nearly always associated with an underlying intraductal breast cancer located near the areola. […] Mammary Pagets disease is reported in 13% of all primary breast cancers. […] Diagnosis is made 12 months after onset in women and 8-9 months in men. […] Biopsy with immunohistochemistry and special stains. […] Investigation of a breast lump, if palpable. […] Investigations looking for underlying malignancy if there is no lump palpable – eg, mammography or MRI (may be more useful). […] Paget’s disease of the nipple with no associated tumour is staged as carcinoma in situ.

• #56 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. […] 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. […] According to the American Cancer Society, Pagets disease usually appears in one breast or nipple. […] If a person has any nipple or skin changes on the breast, they should tell a doctor right away, even if they think Pagets is unlikely.

• #57 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

  Pagets disease of the breast is a condition that causes a scaly rash on the skin of the nipple. […] Pagets disease usually affects the nipple first. After a few weeks, it spreads to the areola. Other skin conditions usually affect the areola first and then the nipple. […] It may be possible to confuse Pagets disease with other skin conditions such as eczema, dermatitis and psoriasis. This is because they look similar. Pagets disease can be difficult to diagnose just by looking at it. […] Your first test will usually be to check the skin changes on your nipple. Your specialist breast cancer doctor may do the following tests: A skin or punch biopsy. The doctor removes a small sample of skin from the affected nipple and tissue from under the skin. They inject some local anaesthetic into the skin to numb the area first. The sample is looked at under a microscope for cancer cells.

• #58 Paget Disease of the Breast | MD Anderson Cancer Center

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

  Paget disease is a rare form of breast cancer, making up 1-4% of all breast cancer cases, according to the National Cancer Institute. […] If a doctor suspects a patient has Paget disease of the breast, the breast should be imaged. This can be done by a mammogram or possibly an ultrasound. […] If the images and biopsy comes back clear, though, the patient may still have cancer. At this point, the nipple and/or areola must be biopsied directly. […] Because Paget disease is a rare breast cancer, finding a team with the expertise to properly diagnose and treat this cancer is essential.

• #59 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. […] 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. […] According to the American Cancer Society, Pagets disease usually appears in one breast or nipple. […] If a person has any nipple or skin changes on the breast, they should tell a doctor right away, even if they think Pagets is unlikely.

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

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

  Mammary Paget disease can be undetectable on mammography in ~50% of cases. […] 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.

• #61

  https://www.nursingcenter.com/journalarticle?Article_ID=5555113&Journal_ID=849729&Issue_ID=5555089

  ABSTRACT: Paget’s disease of the breast (PDB) is a rare disorder of the nipple-areola complex that may present clinically as a unilateral, eczematous, or ulcerated papule or plaque. This case highlights the importance of either punch or incisional wedge biopsy to establish a diagnosis of PDB for patients who present with chronic cutaneous changes of the nipple, areola, or skin of the breast, regardless of any previous normal mammogram or breast ultrasound. Mammography alone cannot rule out a diagnosis of PDB in a patient with cutaneous changes of the breast. […] This case study highlights the importance of histologic examination via incisional or deep punch biopsy to confirm a diagnosis of PDB, regardless of prior normal mammogram or breast ultrasound. […] Despite high prevalence of underlying breast cancer among patients with PDB, only approximately 35%-65% of patients with biopsy-proven PDB exhibit findings on mammography that are concerning for underlying breast carcinoma. […] Mammography has low sensitivity to detect PDB and should be used as a complimentary diagnostic tool to surgical wedge or punch biopsy when PDB is suspected.

• #62 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/

  Pagets cells are able to completely (or almost completely) replace normal keratinocytes in ulcerated areas. […] 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. […] Paget cells can be localized in any layer epidermis, but no dermal invasion. Although they may pseudo-immersion into the dermis along the excretory ducts of the sebaceous and sweat glands. […] Paget cells may be localized in any layers of the epidermis, but do not have any dermal invasion. Although they can pseudo-immersed in the dermis along the excretory ducts of the sebaceous and sweat glands. […] A characteristic and necessary criterion for the diagnosis is negative BAP1 expression.

• #63 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 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. […] Doctors don’t know what causes Paget’s disease of the breast. The most widely accepted theory is that the disease results from an underlying ductal breast cancer. The cancer cells from the original tumor then travel through milk ducts to the nipple and its surrounding skin. […] If your doctor has determined that you have an increased risk of breast cancer, you may discuss options to reduce your risk, such as preventive medications (chemoprevention). Estrogen-blocking medications reduce the risk of breast cancer if you have a high risk of the disease.

• #64 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. […] 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. […] According to the American Cancer Society, Pagets disease usually appears in one breast or nipple. […] If a person has any nipple or skin changes on the breast, they should tell a doctor right away, even if they think Pagets is unlikely.

• #65 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 cancer that develops in the skin of your nipple, and sometimes the areola (the darker skin surrounding the nipple). […] 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. They’ll start by examining your breast tissue with imaging tests, such as a mammogram or breast ultrasound. […] 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. Most people who discover and treat these conditions early will make a full recovery.

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

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

  A doctor will examine any unusual areas of the breast, especially the skin on and around the nipples, and feel for any lumps or areas of thickening. […] To confirm the diagnosis, a doctor may recommend: a mammogram, an ultrasound, or both; MRI scan, if mammography or ultrasound do not detect any underlying disease; a biopsy of the affected skin. […] Pagets disease of the breast is not usually an aggressive breast cancer. However, it can spread if a person does not seek prompt treatment. […] With early diagnosis and treatment, Pagets disease of the breast is typically curable.

• #67 Paget’s Disease of the Nipple | Magee-Women’s Hospital

  https://www.upmc.com/locations/hospitals/magee/services/magee-womens-cancers/breast-cancer-program/types-of-breast-cancer/pagets-disease

  The five-year survival rate for people with Pagets disease of the nipple is more than 80%. […] The goal of treatment for Pagets disease is to remove as much of the cancer as possible and to prevent cancer cells from spreading. […] Doctors treat Pagets disease with surgery. […] Surgery is almost always used to treat Pagets disease. […] Doctors often treat Paget’s disease with radiation therapy, which uses high-energy rays to destroy cancer cells.

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

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

  With the TNM system, the stages are determined based on the size and extent of the tumor (T), the number of nearby lymph nodes with cancer cells in them (N), and whether or not the cancer has spread, or metastasized, to distant organs (M). […] The treatment of Paget’s disease of the breast varies by the cancer stage, the type of cancer cells you have, and other factors (like the absence or presence of estrogen receptors). […] Surgery is the primary treatment option. […] A lumpectomy is usually followed by radiation therapy to kill any remaining cancer cells. […] After mastectomy, your oncologist may recommend additional treatments to prevent breast cancer recurrence. […] If Paget’s disease of the breast is diagnosed and treated early, the prognosis (expected outcome) is excellent. […] The five-year survival rate for Paget’s disease also varies by the stage of cancer.

• #69

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

  Paget’s disease of the nipple, also known as Paget’s disease of the breast, is a rare condition associated with breast cancer. […] You should see your GP if you notice any changes in the skin of your nipple or areola. […] As Paget’s disease of the nipple is associated with breast cancer, the sooner it’s diagnosed, the better the outcome is likely to be. […] A biopsy is used to confirm a suspected diagnosis of Paget’s disease of the nipple. […] If the results of the biopsy indicate Paget’s disease, you’ll have a mammogram (a low-dose breast X-ray) to investigate further.

• #70

  https://111.wales.nhs.uk/encyclopaedia/p/article/pagetsdiseaseofthenipple/

  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. […] You should see your GP if you notice any changes in the skin of your nipple or areola. […] As Paget’s disease of the nipple is associated with breast cancer, the sooner it’s diagnosed, the better the outcome is likely to be. […] A biopsy is used to confirm a suspected diagnosis of Paget’s disease of the nipple. A small tissue sample (punch biopsy of the skin) will be taken from your nipple and examined under a microscope to see if it’s cancerous. […] If the results of the biopsy indicate Paget’s disease, you’ll have a mammogram (a low-dose breast X-ray) to investigate further. […] Paget’s disease of the nipple can sometimes be confused with eczema, a skin condition that also causes red, itchy and dry skin. […] 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.

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