Share This Article:

Extramammary Paget’s Disease Covered the Left Nipple and Areola

Abstract Full-Text HTML XML Download Download as PDF (Size:231KB) PP. 65-68
DOI: 10.4236/ijcm.2012.31015    4,116 Downloads   6,444 Views   Citations

ABSTRACT

We present a case of a 71-year-old woman suffering from mammary Paget,s disease and having a 10-years history of an irregular, widespread erosion accompanied by itching and burning on the skin of her left chest, extending to the breast. The erosion had steadily enlarged and had become increasingly tender. The nipple and areola of the left breast disappeared and could not be recognized. No abnormality of the right nipple, areola, and covering skin and no supernumerary nipple were seen. Mammography and ultrasonography could not be performed because of severe pain and erosive wetness. Histopathology of a surgical biopsy specimen showed epidermal infiltration by large, round, clear atypical cells scattered individually or in small clusters and distributed horizontally throughout the epidermis. The cytoplasm of these large cells was pale and vacuolated and was equivalent to that in nipple cells in Paget,s disease, and a diagnosis of mammary Paget,s disease was made. We performed total mastectomy of the left breast with wide excision of the Paget lesion of the left chest and axillary lymph node sampling. Histological examination of the specimen showed typical distribution of Paget,s cells; however no ductal carcinoma in situ was found in the mammary ducts and invasive growth was not recognized beyond the basal membrane of the lesion. From this evidences, we established a diagnosis of large, irregulaly shaped unusual mammary Paget,s disease, not of breast cancer origin, covering the left breast, areola, and nipple.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

I. Abe, K. Sugiyama, M. Suda, F. Igari, K. Senuma, A. Arakawa, M. Saitoh and F. Kasumi, "Extramammary Paget’s Disease Covered the Left Nipple and Areola," International Journal of Clinical Medicine, Vol. 3 No. 1, 2012, pp. 65-68. doi: 10.4236/ijcm.2012.31015.

References

[1] R. M. Mackie, “Paget’s Disease of the Nipple. Extramammary Paget’s Disease,” In: R. H. Champion, J. L. Burton, D. A. Burns and S. M. Breathnach, Eds., Textbook of Dermatology (Rook, Wilkinson, Ebling), 6th Edition, Blackwell Scientific Publications, Oxford, 2005. pp. 1677-1679.
[2] S. M. Connolly, “Mammary and Extramammary Paget’s Disease,” In: I. M. Freedberg, A. Z. Eisen, K. Wolff, K. F. Austen, Eds., Dermatology in General Medicine, 6th Edition, McGraw-Hill, New York,2003. pp. 813-817.
[3] M. A. Cohen, A. Hanly, E. Poulos and G. D. Goldstein, “Extramammary Paget’s Disease Presenting on the Face,” Dermatologic Surgery, Vol. 30, No. 10, 2004, pp. 1361-1363. doi:10.1111/j.1524-4725.2004.30412.x
[4] S. Chilukuri, R. Page, J. A. Reed, J. Friedman and I. Orengo, “Ectopic Extramammary Paget’s Disease Arising on the Cheek,” Dermatologic Surgery, Vol. 28, No. 5, 2002, pp. 430-433. doi:10.1046/j.1524-4725.2002.01199.x
[5] Y. Onishi and K. Ohara, “Ectopic Extramammary Paget’s Disease Affecting the Upper Abdomen,” British Journal of Dermatology, Vol. 134, No. 5, 1996, pp. 958-961. doi:10.1111/j.1365-2133.1996.tb06336.x
[6] Y. Nagai, H. Ishibuchi, M. Takahashi, A. Shimizu, Y. Matushima, A. Tamura, et al., “Extramammary Paget’s Disease with Bowenoid Histologic Features Accompanied by an Ectopic Lesion on the Upper Abdomen,” Journal of Dermatology, Vol. 32, No. 8, 2005, pp. 670-673.
[7] T. Saida and M. Iwata, “‘Ectopic’ Extramammary Paget’s Disease Affecting the Lower Anterior Aspect of the Chest,” Journal of the American Academy of Dermatology, Vol. 17, No. 5, 1987, pp. 910-913. doi:10.1016/S0190-9622(87)70279-5
[8] M. H. Yeh and S. L. Hu, “Treatment of Double Ectopic Extramammary Paget’s Disease of Bilateral Chest with Imiquimod 5% Cream,” Journal of the European Academy of Dermatology and Venereology, Vol. 21, No. 7, 2007, pp. 997-999. doi:10.1111/j.1468-3083.2006.02070.x
[9] O. H. Iwenofu, F. H. Samie, J. Ralston, R. T. Cheney and N. C. Zeitouni, “Extramammary Paget’s Disease Presenting as Alopecia Neoplastica,” Journal of Cutaneous Pathology, Vol. 35, No. , 2008, pp. 761-764. doi:10.1111/j.1600-0560.2007.00897.x
[10] H. Kakinuma, U. Iwasawa, N. Kurakata and H. Suzuki, “A Case of Extramammary Paget’s Disease with Depigmented Macules as the Sole Manifestation,” British Journal of Dermatology, Vol. 130, No. 1, 1994, pp. 102-105. doi:10.1111/j.1365-2133.1994.tb06892.x
[11] R. E. Jones Jr., C. Austin and A. B. Ackerman, “Extramammary Paget’s Disease. A Critical Reexamination,” The American Journal of Dermatopathology, Vol. 1, No. 2, 1997, pp. 101-132. doi:10.1097/00000372-197900120-00002
[12] T. S Saunders, “Extramammary Paget’s Disease and the Milk Line” Journal of the American Academy of Dermatology, Vol. 19, No. 1, 1988, p. 139. doi:10.1016/S0190-9622(88)80231-7
[13] T. Takeuchi, M. Komatsuzaki, Y. Minesaki, K. Yokoi, R. Kamide, M. Niimura, et al., “Paget’s Disease Arising near a Male Areola without an Underlying Carcinoma,” Journal of Dermatology, Vol. 26, No. 4, 1999, pp. 248-252.
[14] S. Ito, K. Arai, M. Saitoh, Y. Kato, T. Ohi and M. Koga, “A Case of Extramammary Paget’s Disease Affecting the Left Lateral Chest,” Nishinihonhifuka, Vol. 65, No. 4, 2003, pp. 343-346. doi:10.2336/nishinihonhifu.65.343
[15] H. Miyaguni, S. Sakaki, M. Kurokawa, K. Ogata and S. Inoue, “A Case of Mammary Paget’s Disease without an Underlying Carcinoma,” Hifukanorinsho, Vol. 42, No. 8, 2000, pp. 1187-1190.
[16] K. E. Taylor, H. M. Ormsby, J. M. Havercroft and A. Rodger, “An Unusually Exten-sive Case of Paget’s Disease of the Nipple,” The Breast, Vol. 10, No. 5, 2001, pp. 442-446. doi:10.1054/brst.2000.0268
[17] F. Kasumi, “Kasumi’s Color Atlas of Breast Cancer,” Igakushoin, 2009, pp. 259-272.
[18] G. H. Sakorafas, K. Blanchard, M. G. Sarr and D. R. Farley, “Paget’s Disease of the Breast,” Cancer Treatment Reviews, Vol. 27, No. 1, 2001, pp. 9-18. doi:10.1053/ctrv.2000.0203
[19] P. P. Rosen, “Paget’s Disease of the Nipple,” In: P. P. Rosen, Ed., Rosen’s Breast Pathology, Lippincott Williams & Wilkins, Philadelphia, 2001, pp. 565-759.
[20] R. Horii, F. Akiyama, F. Kasumi, M. Koike and G. Sakamoto, “Spontaneous ‘Healing’ of Breast Cancer,” Breast Cancer, Vol. 12, No. 2, 2005, pp. 140-144. doi:10.2325/jbcs.12.140
[21] Y. Kawabata, “Mammary Paget’s Disease and Extramammary Paget’s Disease,” In: K. Tamaki, H. Iizuka, H. Shimizu, et al., Eds., Handbook of Dermatology, Vol. 12. Nakayama Shoten, Tokyo, 2002. pp. 216-229. doi:10.1016/j.breast.2003.11.005
[22] G. Nicoletti, S. Scevola, R. Ruggiero, A. M. Coghi and G. S. Toussoun, “Gigantic Paget Disease of the Breast,” The Breast, Vol. 13, No. 5, 2004, pp. 425-427.
[23] A. J. Kanwar, D. De, K. Vaiphei, A. Bhatia, R. K. Sharma and G. Singh, “Extensive Mammary Paget’s Disease,” Clinical and Experimental Dermatology, Vol. 32, No. 3, 2007, pp. 326-327. doi:10.1111/j.1365-2230.2006.02326.x
[24] O. Mori, H. Hachisuka and Y. Sasai, “Immunohistochemical Demonstration of Epithelial Membrane Antigen(EMA), Carcinoembryonic Antigen(CEA), and Keratin on Mammary and Extramammary Paget’s Disease,” Acta Histochemitry, Vol. 85, No. 1, 1989, pp. 93-100.
[25] T. Tazawa, M. Ito, H. Fujiwara, N. Shimizu and Y. Sato, “Immunologic Characteristics of Keratins in Extramammary Paget’s Disease,” Archives of Dermatology, Vol. 124, No. 7, 1988, pp. 1063-1068. doi:10.1001/archderm.1988.01670070051018
[26] M. A. Nowak, P. Guerriere-Kovach, A. Pathan, T. E. Campbell and L. M. Deppisch, “Perianal Paget’s Disease: Distinguishing Primary and Secondary Lesions Using Immunohistochemical Studies Including Gross Cystic Disease fluid Protein-15 and Cytokeratin 20 Expression,” Archives of Pathology Laboratory Medicine, Vol. 122, No. 12, 2000, pp. 1077-1081.
[27] N. Kirkham, “Paget’s Disease. Extramammary Paget’s Disease,” In: D. Elder, Ed., Lever’s Histopathology of the Skin, 9th Edition, New York Lippincott-Raven, Philadelphia, 2005, pp. 852-855.
[28] J. C. Noel, I. Fayt and F. Buxant, “Proliferating Activity in Paget Disease of the Nipple,” Pathology and Oncology Research, Vol. 16, No. 1, 2010, pp. 7-10. doi:10.1007/s12253-009-9179-4

  
comments powered by Disqus

Copyright © 2018 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.