Paget disease of the breast

Question 1

Paget disease of the nipple occurs ____ (rarely/commonly)

Answer 1

Rarely (1% to 4% of cases)

Question 2

PE finding in Paget disease and its mechanism

Answer 2

Erythematous eruption with a scaly crust

Malignant cells extend from ductal DCIS into nipple skin without crossing the basement membrane

↓

Cells disrupt the epithelial barrier and allow extracellular fluid to seep out

↓

Creation of an erythematous eruption with a scaly crust

Question 3

Paget disease underlying cause

• With palpable mass
• Without palpable mass

Answer 3

• With palpable mass
  
  • Most have invasive carcinoma
• Without palpable mass
  
  • Underlying DCIS
• Summary:*
• It is usually associated with the two

Question 4

Pathognomonic histologic finding in Paget disease

Answer 4

Large, pale, vacuolated cells in the rete pegs of epithelium

Question 5

A partially blind 65-year-old mother presents with a slight change in color of the areola of her left breast. An eczematous rash of the left areola has persisted for the last 3 months. Biopsy of the nipple reveals Paget’s disease. In Paget’s disease of the nipple which of the following is TRUE?

1. Carcinoma of the breast is rarely found
2. Surgical therapy often fails to cure Paget’s disease
3. The diagnosis should be made by nipple biopsy when suspected
4. The underlying carcinoma when present is very large
5. Paget’s disease of the bone is commonly encountered

Answer 5

Answer: 3

• The diagnosis should be made by nipple biopsy when suspected

Rationale:

• The diagnosis should be made by nipple biopsy when suspected
• 1 – Paget’s disease represents a ductal carcinoma that has grown along the ducts into the nipple/areolar region
• 3 – Many cases involve small breast cancers, which are missed on clinical examination and mammogram
• 2 – Surgical therapy is often curative
• 5 – This is unrelated to Paget’s disease of the bone