Difference between revisions of "Paget's disease of the breast"
(change) |
|||
(8 intermediate revisions by 2 users not shown) | |||
Line 9: | Line 9: | ||
| LMDDx = benign Toker cell hyperplasia, [[malignant melanoma]], [[Bowen's disease]], [[apocrine carcinoma of the skin]] | | LMDDx = benign Toker cell hyperplasia, [[malignant melanoma]], [[Bowen's disease]], [[apocrine carcinoma of the skin]] | ||
| Stains = | | Stains = | ||
| IHC = CK7 +ve, CEA +ve, S-100 -ve, CK5/6 -ve, HER2 +ve | | IHC = CK7 +ve, CEA +ve, S-100 -ve, [[CK5/6]] -ve, HER2 +ve | ||
| EM = | | EM = | ||
| Molecular = | | Molecular = | ||
Line 30: | Line 30: | ||
| Tx = | | Tx = | ||
}} | }} | ||
'''Paget disease of the breast''', also ''' | '''[[Paget's disease]] of the breast''', also '''Paget disease of the breast''' and '''Paget's disease of the nipple''', is a lesion of the [[breast]]. It is abbreviated '''PDB'''.<ref name=pmid19919588>{{Cite journal | last1 = Ellis | first1 = PE. | last2 = Maclean | first2 = AB. | last3 = Crow | first3 = JC. | last4 = Wong Te Fong | first4 = LF. | last5 = Rolfe | first5 = KJ. | last6 = Perrett | first6 = CW. | title = Expression of cyclin D1 and retinoblastoma protein in Paget's disease of the vulva and breast: an immunohistochemical study of 108 cases. | journal = Histopathology | volume = 55 | issue = 6 | pages = 709-15 | month = Dec | year = 2009 | doi = 10.1111/j.1365-2559.2009.03434.x | PMID = 19919588 }}</ref> | ||
There is also a ''[[Paget disease of the bone]]'' - just to make things confusing. This is dealt with in | There is also a ''[[Paget's disease of the bone]]'' - just to make things confusing. This is dealt with in [[Paget's disease of the bone|its own article]] and has nothing (from a pathologic perspective) to do with the Paget's disease discussed in this article; these two things just happened to be discovered by the same guy. | ||
Non-bone Paget disease is subdivided into: | Non-bone Paget's disease is subdivided into: | ||
#Mammary Paget disease - dealt with in this article. | #Mammary Paget's disease - dealt with in this article. | ||
#[[Extramammary Paget disease]]. | #[[Extramammary Paget's disease]]. | ||
Histologically, i.e. under the [[microscope]], the above are essentially identically; however, the associations (and prognosis) are quite different! | Histologically, i.e. under the [[microscope]], the above are essentially identically; however, the associations (and prognosis) are quite different! | ||
Line 82: | Line 82: | ||
Image:Extramammary_Paget_disease_-_low_mag.jpg | Paget disease - low mag. (WC/Nephron) | Image:Extramammary_Paget_disease_-_low_mag.jpg | Paget disease - low mag. (WC/Nephron) | ||
Image:Extramammary_Paget_disease_-_high_mag.jpg | Paget disease - high mag. (WC/Nephron) | Image:Extramammary_Paget_disease_-_high_mag.jpg | Paget disease - high mag. (WC/Nephron) | ||
Image:Breast PagetDisease HP SNP.jpg|thumb|Breast Paget Disease - high power - (SKB) | |||
Image:Breast PagetsDisease InvasiveDuctalCarcinoma PA.JPG|thumb|Breast Paget Disease - underlying invasive carcinoma - medium power - (SKB) | |||
Image:Breast PagetsDisease HP PA.JPG|thumb|Breast Paget Disease - high power - (SKB) | |||
Image:Breast PagetsDisease PA.JPG|thumb|Breast Paget Disease - high power - (SKB) | |||
Image:Breast PagetDisease LP SNP.jpg|thumb|Breast Paget Disease - medium power - (SKB) | |||
</gallery> | </gallery> | ||
www: | www: | ||
Line 96: | Line 101: | ||
Additional: | Additional: | ||
*HER2/neu - usually +ve. | *HER2/neu - usually +ve. | ||
*CK5/6 -ve.<ref>RS. May 2010.</ref> | *[[CK5/6]] -ve.<ref>RS. May 2010.</ref> | ||
**Usu. +ve in squamous cell carcinoma.<ref name=pmid19170169>{{Cite journal | last1 = Khayyata | first1 = S. | last2 = Yun | first2 = S. | last3 = Pasha | first3 = T. | last4 = Jian | first4 = B. | last5 = McGrath | first5 = C. | last6 = Yu | first6 = G. | last7 = Gupta | first7 = P. | last8 = Baloch | first8 = Z. | title = Value of P63 and CK5/6 in distinguishing squamous cell carcinoma from adenocarcinoma in lung fine-needle aspiration specimens. | journal = Diagn Cytopathol | volume = 37 | issue = 3 | pages = 178-83 | month = Mar | year = 2009 | doi = 10.1002/dc.20975 | PMID = 19170169 }}</ref> | **Usu. +ve in squamous cell carcinoma.<ref name=pmid19170169>{{Cite journal | last1 = Khayyata | first1 = S. | last2 = Yun | first2 = S. | last3 = Pasha | first3 = T. | last4 = Jian | first4 = B. | last5 = McGrath | first5 = C. | last6 = Yu | first6 = G. | last7 = Gupta | first7 = P. | last8 = Baloch | first8 = Z. | title = Value of P63 and CK5/6 in distinguishing squamous cell carcinoma from adenocarcinoma in lung fine-needle aspiration specimens. | journal = Diagn Cytopathol | volume = 37 | issue = 3 | pages = 178-83 | month = Mar | year = 2009 | doi = 10.1002/dc.20975 | PMID = 19170169 }}</ref> | ||
===Tabular comparison=== | ===Tabular comparison=== | ||
IHC features of Paget disease and its DDx:<ref>URL: [http://www.histopathology-india.net/EPD.htm http://www.histopathology-india.net/EPD.htm]. Accessed on: 4 December 2011.</ref> | IHC features of Paget disease and its DDx:<ref>URL: [http://www.histopathology-india.net/EPD.htm http://www.histopathology-india.net/EPD.htm]. Accessed on: 4 December 2011.</ref><ref name=pmid12189500>{{Cite journal | last1 = Marucci | first1 = G. | last2 = Betts | first2 = CM. | last3 = Golouh | first3 = R. | last4 = Peterse | first4 = JL. | last5 = Foschini | first5 = MP. | last6 = Eusebi | first6 = V. | title = Toker cells are probably precursors of Paget cell carcinoma: a morphological and ultrastructural description. | journal = Virchows Arch | volume = 441 | issue = 2 | pages = 117-23 | month = Aug | year = 2002 | doi = 10.1007/s00428-001-0581-x | PMID = 12189500 }}</ref> | ||
{| class="wikitable sortable" | {| class="wikitable sortable" | ||
!Entity | !Entity | ||
Line 136: | Line 141: | ||
|CK7 '''+ve''' | |CK7 '''+ve''' | ||
|CAM5.2 ? | |CAM5.2 ? | ||
|EMA | |EMA +ve/-ve<ref name=pmid12680957>{{Cite journal | last1 = Willman | first1 = JH. | last2 = Golitz | first2 = LE. | last3 = Fitzpatrick | first3 = JE. | title = Clear cells of Toker in accessory nipples. | journal = J Cutan Pathol | volume = 30 | issue = 4 | pages = 256-60 | month = Apr | year = 2003 | doi = | PMID = 12680957 }}</ref> | ||
|CEA '''-ve''' | |CEA '''-ve'''<ref name=pmid18758638/> | ||
|HER2 | |HER2 -ve<ref name=pmid19601945>{{Cite journal | last1 = Nofech-Mozes | first1 = S. | last2 = Hanna | first2 = W. | title = Toker cells revisited. | journal = Breast J | volume = 15 | issue = 4 | pages = 394-8 | month = | year = | doi = 10.1111/j.1524-4741.2009.00743.x | PMID = 19601945 }}</ref> | ||
|S100 | |S100 -ve<ref name=pmid18758638>{{Cite journal | last1 = Fernandez-Flores | first1 = A. | title = Toker cell related to the folliculo-sebaceous-apocrine unit: a study of horizontal sections of the nipple. | journal = Rom J Morphol Embryol | volume = 49 | issue = 3 | pages = 339-43 | month = | year = 2008 | doi = | PMID = 18758638 }}</ref> | ||
|HMB-45 ? | |HMB-45 ? | ||
|- | |- | ||
Line 177: | Line 182: | ||
|- | |- | ||
|} | |} | ||
==Sign out== | |||
<pre> | |||
Right Nipple, Biopsy: | |||
- Paget's disease. | |||
Comment: | |||
The Paget-like cells stain as follows: | |||
POSITIVE: CK7 (moderate, diffuse), HER2 (complete membranous, moderate/strong). | |||
NEGATIVE: S-100, HMB-45, CK5, CEA-mono. | |||
The morphologic and immunohistochemical findings are in keeping with Paget's disease of the breast. | |||
The breast imaging findings are noted. | |||
</pre> | |||
==See also== | ==See also== |
Latest revision as of 15:49, 23 February 2023
Paget's disease of the breast | |
---|---|
Diagnosis in short | |
![]() Paget's disease. H&E stain. | |
| |
LM | large epithelioid cells - nested or single - in the epidermis, clear/pale cytoplasm (occasionally eosinophilic), large nucleoli |
LM DDx | benign Toker cell hyperplasia, malignant melanoma, Bowen's disease, apocrine carcinoma of the skin |
IHC | CK7 +ve, CEA +ve, S-100 -ve, CK5/6 -ve, HER2 +ve |
Gross | erythema, +/-weeping, +/-crusted |
Site | breast |
| |
Prognosis | usu. associated with invasive breast carcinoma |
Clin. DDx | nipple adenoma, contact dermatitis |
Paget's disease of the breast, also Paget disease of the breast and Paget's disease of the nipple, is a lesion of the breast. It is abbreviated PDB.[1]
There is also a Paget's disease of the bone - just to make things confusing. This is dealt with in its own article and has nothing (from a pathologic perspective) to do with the Paget's disease discussed in this article; these two things just happened to be discovered by the same guy.
Non-bone Paget's disease is subdivided into:
- Mammary Paget's disease - dealt with in this article.
- Extramammary Paget's disease.
Histologically, i.e. under the microscope, the above are essentially identically; however, the associations (and prognosis) are quite different!
General
- Cells in the epithelium, i.e. skin, that look like they don't belong.
- Associated with underlying invasive breast carcinoma.[2]
Note:
- Extramammary Paget's disease is not usually associated with malignancy.
Gross
Features:[3]
- Erythematous, i.e. red.
- +/-Crusted.
- +/-Weeping (wet).
DDx - clinical:
Images:
Microscopic
Features:[2]
- Epitheliod morphology (round/ovoid).
- Cells nested or single.
- Clear/pale cytoplasm key feature - may also be eosinophilic.
- Large nucleoli.
Note:
- The neoplastic cells of Paget's disease may contain melanin.[7]
DDx
- Benign Toker cell hyperplasia.
- Malignant melanoma.
- Bowen disease.
- Nipple (duct) adenoma (clinical DDx).
- Apocrine carcinoma of the skin.[8]
Images
www:
- Paget disease of the breast - several good pictures (upmc.edu).
- Paget disease of the nipple (webpathology.com).
IHC
Panel:[2]
- S-100 -ve, HMB-45 -ve (both typically +ve in melanoma).
- CK7 +ve. (???)
- Toker cells CK7 +ve.[9]
- CEA +ve (-ve in Bowen's disease, -ve in Toker cells).
Additional:
Tabular comparison
IHC features of Paget disease and its DDx:[12][13]
Entity | CK5/6 | CK7 | CAM5.2 | EMA | CEA | HER2 | S100 | HMB-45 |
---|---|---|---|---|---|---|---|---|
Paget disease | CK5/6 -ve | CK7 +ve (?) | CAM5.2 +ve | EMA +ve | CEA +ve | HER2 +ve | S100 -ve | HMB-45 -ve |
Bowen disease | CK5/6 +ve | CK7 -ve | CAM5.2 -ve | EMA -ve | CEA -ve | HER2 -ve (?) | S100 -ve | HMB-45 -ve |
Toker cell hyperplasia | CK5/6 ? | CK7 +ve | CAM5.2 ? | EMA +ve/-ve[14] | CEA -ve[15] | HER2 -ve[9] | S100 -ve[15] | HMB-45 ? |
Melanoma | CK5/6 -ve | CK7 -ve | CAM5.2 -ve | EMA -ve | CEA -ve | HER2 -ve | S100 +ve | HMB-45 +ve |
Mini-table comparison
Entity | CK7 | CEA | HER2 |
---|---|---|---|
Paget disease | CK7 +ve | CEA +ve | HER2 +ve |
Toker cell hyperplasia | CK7 +ve | CEA -ve | HER2 -ve |
Bowen disease | CK7 -ve | CEA -ve | HER2 -ve |
Sign out
Right Nipple, Biopsy: - Paget's disease. Comment: The Paget-like cells stain as follows: POSITIVE: CK7 (moderate, diffuse), HER2 (complete membranous, moderate/strong). NEGATIVE: S-100, HMB-45, CK5, CEA-mono. The morphologic and immunohistochemical findings are in keeping with Paget's disease of the breast. The breast imaging findings are noted.
See also
References
- ↑ Ellis, PE.; Maclean, AB.; Crow, JC.; Wong Te Fong, LF.; Rolfe, KJ.; Perrett, CW. (Dec 2009). "Expression of cyclin D1 and retinoblastoma protein in Paget's disease of the vulva and breast: an immunohistochemical study of 108 cases.". Histopathology 55 (6): 709-15. doi:10.1111/j.1365-2559.2009.03434.x. PMID 19919588.
- ↑ 2.0 2.1 2.2 URL: http://emedicine.medscape.com/article/1101235-diagnosis
- ↑ Lefkowitch, Jay H. (2006). Anatomic Pathology Board Review (1st ed.). Saunders. pp. 294 & 306 Q15. ISBN 978-1416025887.
- ↑ URL: http://www.danderm-pdv.is.kkh.dk/atlas/2-38.html. Accessed on: 30 May 2012.
- ↑ Feroze, K.; Manoj, J.; Venkitakrishnan, S. (2008). "Allergic contact dermatitis mimicking mammary paget's disease.". Indian J Dermatol 53 (3): 154-5. doi:10.4103/0019-5154.43210. PMID 19882019.
- ↑ URL: http://www.gfmer.ch/selected_images_v2/search_result_list.php?offset=15¶m1=Paget%20disease%20of%20breast¶m2=and. Accessed on: 30 May 2012.
- ↑ Lefkowitch, Jay H. (2006). Anatomic Pathology Board Review (1st ed.). Saunders. pp. 306-7 Q15. ISBN 978-1416025887.
- ↑ URL: http://derm101.com/searchResults.aspx?searchStr=apocrine+carcinoma&rootTerm=apocrine+carcinoma&searchType=2&rootID=12687. Accessed on: 9 September 2011.
- ↑ 9.0 9.1 Nofech-Mozes, S.; Hanna, W.. "Toker cells revisited.". Breast J 15 (4): 394-8. doi:10.1111/j.1524-4741.2009.00743.x. PMID 19601945.
- ↑ RS. May 2010.
- ↑ Khayyata, S.; Yun, S.; Pasha, T.; Jian, B.; McGrath, C.; Yu, G.; Gupta, P.; Baloch, Z. (Mar 2009). "Value of P63 and CK5/6 in distinguishing squamous cell carcinoma from adenocarcinoma in lung fine-needle aspiration specimens.". Diagn Cytopathol 37 (3): 178-83. doi:10.1002/dc.20975. PMID 19170169.
- ↑ URL: http://www.histopathology-india.net/EPD.htm. Accessed on: 4 December 2011.
- ↑ Marucci, G.; Betts, CM.; Golouh, R.; Peterse, JL.; Foschini, MP.; Eusebi, V. (Aug 2002). "Toker cells are probably precursors of Paget cell carcinoma: a morphological and ultrastructural description.". Virchows Arch 441 (2): 117-23. doi:10.1007/s00428-001-0581-x. PMID 12189500.
- ↑ Willman, JH.; Golitz, LE.; Fitzpatrick, JE. (Apr 2003). "Clear cells of Toker in accessory nipples.". J Cutan Pathol 30 (4): 256-60. PMID 12680957.
- ↑ 15.0 15.1 Fernandez-Flores, A. (2008). "Toker cell related to the folliculo-sebaceous-apocrine unit: a study of horizontal sections of the nipple.". Rom J Morphol Embryol 49 (3): 339-43. PMID 18758638.