Difference between revisions of "Paget disease of the breast"

From Libre Pathology
Jump to navigation Jump to search
(Redirected page to Paget's disease of the breast)
 
(One intermediate revision by the same user not shown)
Line 1: Line 1:
 
#redirect [[Paget's disease of the breast]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Extramammary_Paget_disease_-_high_mag.jpg
| Width      =
| Caption    = Paget's disease. [[H&E stain]].
| Synonyms  =
| Micro      = large epithelioid cells - nested or single - in the epidermis, clear/pale cytoplasm (occasionally eosinophilic), large nucleoli
| Subtypes  =
| LMDDx      = benign Toker cell hyperplasia, [[malignant melanoma]], [[Bowen's disease]], [[apocrine carcinoma of the skin]]
| Stains    =
| IHC        = CK7 +ve, CEA +ve, S-100 -ve, CK5/6 -ve, HER2 +ve
| EM        =
| Molecular  =
| IF        =
| Gross      = erythema, +/-weeping, +/-crusted
| Grossing  =
| Site      = [[breast]]
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence =
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = usu. associated with invasive breast carcinoma
| Other      =
| ClinDDx    = [[nipple adenoma]], contact dermatitis
| Tx        =
}}
'''Paget disease of the breast''', also '''[[Paget's disease]] of the breast''' and '''Paget disease of the nipple''', is a thingy seen in 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 the ''[[bone]]'' article and has nothing (from a pathologic perspective) to do with the Paget disease discussed in this article; these two things just happened to be discovered by the same guy.
 
Non-bone Paget disease is subdivided into:
#Mammary Paget disease - dealt with in this article.
#[[Extramammary Paget 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 [[invasive breast cancer|breast carcinoma]].<ref name=emed_pagets>URL: [http://emedicine.medscape.com/article/1101235-diagnosis http://emedicine.medscape.com/article/1101235-diagnosis]</ref>
 
Note:
*[[Extramammary Paget's disease]] is '''not''' usually associated with malignancy.
 
==Gross==
Features:<ref>{{Ref APBR|294 & 306 Q15}}</ref>
*Erythematous, i.e. red.
*+/-Crusted.
*+/-Weeping (wet).
 
DDx - clinical:
*[[Contact dermatitis]].<ref>URL: [http://www.danderm-pdv.is.kkh.dk/atlas/2-38.html http://www.danderm-pdv.is.kkh.dk/atlas/2-38.html]. Accessed on: 30 May 2012.</ref><ref name=pmid19882019>{{Cite journal  | last1 = Feroze | first1 = K. | last2 = Manoj | first2 = J. | last3 = Venkitakrishnan | first3 = S. | title = Allergic contact dermatitis mimicking mammary paget's disease. | journal = Indian J Dermatol | volume = 53 | issue = 3 | pages = 154-5 | month =  | year = 2008 | doi = 10.4103/0019-5154.43210 | PMID = 19882019 }}</ref>
 
Images:
*[http://www.sciencephoto.com/media/252126/enlarge Paget disease of the breast (sciencephoto.com)].
*[http://img.medscape.com/pi/emed/ckb/dermatology/1048885-1101235-864.jpg Paget disease of breast (medscape.com)].<ref>URL: [http://www.gfmer.ch/selected_images_v2/search_result_list.php?offset=15&param1=Paget%20disease%20of%20breast&param2=and http://www.gfmer.ch/selected_images_v2/search_result_list.php?offset=15&param1=Paget%20disease%20of%20breast&param2=and]. Accessed on: 30 May 2012.</ref>
 
==Microscopic==
Features:<ref name=emed_pagets/>
*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.<ref name=Ref_APBR306-7>{{Ref APBR|306-7 Q15}}</ref>
 
===DDx===
*Benign Toker cell hyperplasia.
*[[Malignant melanoma]].
*[[Bowen disease]].
*[[Nipple adenoma|Nipple (duct) adenoma]] (clinical DDx).
*[[Apocrine carcinoma of the skin]].<ref>URL: [http://derm101.com/searchResults.aspx?searchStr=apocrine+carcinoma&rootTerm=apocrine+carcinoma&searchType=2&rootID=12687 http://derm101.com/searchResults.aspx?searchStr=apocrine+carcinoma&rootTerm=apocrine+carcinoma&searchType=2&rootID=12687]. Accessed on: 9 September 2011.</ref>
**Images: [http://commons.wikimedia.org/wiki/File:Apocrine_carcinoma_-_intermed_mag.jpg apocrine carcinoma - intermed. mag. (WC)], [http://commons.wikimedia.org/wiki/File:Apocrine_carcinoma_-_high_mag.jpg apocrine carcinoma - high mag. (WC)].
 
===Images===
<gallery>
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)
</gallery>
www:
*[http://path.upmc.edu/cases/case331.html Paget disease of the breast - several good pictures (upmc.edu)].
*[http://www.webpathology.com/image.asp?case=303&n=3 Paget disease of the nipple (webpathology.com)].
 
==IHC==
Panel:<ref name=emed_pagets/>
*S-100 -ve, HMB-45 -ve (both typically +ve in melanoma).
*CK7 +ve. (???)
**Toker cells CK7 +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>
*CEA +ve (-ve in Bowen's disease, -ve in Toker cells).
 
Additional:
*HER2/neu - usually +ve.
*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>
 
===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>
{| class="wikitable sortable"
!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 ?
|CEA '''-ve'''
|HER2 ?
|S100 ?
|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====
{| class="wikitable sortable"
!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
|-
|}
 
==See also==
*[[Breast]].
*[[Invasive breast cancer]].
*[[Paget disease]].
*[[Extramammary Paget disease]].
 
==References==
{{Reflist|2}}
 
[[Category:Breast pathology]]
[[Category:Diagnosis]]

Latest revision as of 02:11, 11 September 2014

Redirect to:

Retrieved from "https://librepathology.org/w/index.php?title=Paget_disease_of_the_breast&oldid=33423"