Mammary Paget’s Disease: a Rare Case of Early Dermal Invasion

Richard Deane, Bradley Gluck, Alan Heimann, Jun Fan and Edna Kapenhas

Department of Surgery, Stony Brook Southampton Hospital, USA
Department of Radiology, Stony Brook Southampton Hospital, USA
Department of Pathology, Stony Brook University Hospital, USA

^*Correspondance to: Edna Kapenhas 

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Abstract:

Introduction: Mammary Paget’s Disease (MPD) is a rare cancer that typically involves an eczematous lesion of the nipple with underlying intra epidermal cancer. Mammary Paget’s disease with dermal invasion is an unusual and poorly documented disorder, characterized as Paget disease that invades through the basement membrane into the dermis.Presentation: We present a 64 years old female with a 6 months history of left nipple rash. Her physical exam and subsequent workup was suspicious for Paget’s disease of the left nipple with Ductal Carcinoma In Situ (DCIS). Punch biopsy confirmed MPD with early dermal invasion, ER/ PR negative, and HER2 positive. A left breast MRI guided biopsy revealed a single duct profile suspicious for DCIS. She underwent a left central partial mastectomy and subsequently a sentinel lymph node biopsy.Discussion: Mammary Paget’s disease is a rare cancer that represents 1% to 3% of breast cancers. The surgical treatment for Paget’s disease is debatable. Most common form of MPD is intraepidermal the rare case of dermal invasion has minimal documented cases. Thus, further clinical investigation and research is required for the surgical treatment for MPD with dermal invasion. The few cases, including our case with documented Paget’s disease with dermal invasion have been treated with breast conserving therapy.
Conclusion: We conclude that the management of MPD with dermal invasion requires further clinical investigation. Our case and the few others explored here reveal that a diagnosis of MPD with dermal invasion-based on histopathological criteria-can favor conservative operative management with radiation.

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Cite the Article:

Deane R, Gluck B, Heimann A, Fan J, Kapenhas E. Mammary Paget’s Disease: a Rare Case of Early Dermal Invasion. Clin Oncol. 2018; 3: 1510.