Background
* Corresponds to a cancer involving the nipple areolar complex. * Described by James Paget in 1871 as an itchy erythema associated with underlying cancer in the mammary gland. * Defined by an invasion of the nipple epidermis by malignant cells. * Skin changes of the nipple areolar complex. * When suspected, should be performed: punch biopsy to confirm the diagnosis; bilateral mammograms and ultrasound (US).
Educational Goals / Teaching Points
1. Present and discuss Paget disease 2. Review the spectrum of clinical, pathological, and imaging findings. 3. Describe technical challenges and propose management tips.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
MPD is a proliferation of malignant glandular epithelial cells (in situ carcinoma) in the nipple areolar complex. It is defined pathologically by the presence of Paget cells within the epidermis of the nipple by Paget cells. This is the hallmark of the disease. Paget cells are of glandular nature. In case of clinical suspicion of PD, bilateral diagnostic mammograms and ultrasound are recommended to assess an underlying breast carcinoma. Image-guided biopsy should be considered any time there is a positive imaging finding. US-guided biopsy is to be preferred when there is a target. Punch biopsy has been proposed but must include epidermis.
Conclusion
PD is a rare breast carcinoma. However, its clinical features are specific, characterized by involvement of the nipple-areolar complex. Any clinical should be aware of this diagnosis and look for an underlying breast carcinoma. Imaging workup includes bilateral mammograms and US. In case of negative imaging finding, surgical wedge biopsy of nipple epidermis is recommended when there is no imaging target.
