Difference between revisions of "Paget disease of the breast"

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'''Paget disease of the breast''', also '''[[Paget's disease]] of the breast''', is a thingy seen in the [[breast]]... and elsewhere - except bone.  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>
#redirect [[Paget's disease of the breast]]
 
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.
#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.
 
==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.
 
Images:
*[http://commons.wikimedia.org/wiki/File:Extramammary_Paget_disease_-_low_mag.jpg Paget disease - low mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Extramammary_Paget_disease_-_high_mag.jpg Paget disease - high mag. (WC)].
 
===DDx===
*Benign Toker cell hyperplasia.
*[[Malignant melanoma]].
*[[Bowen disease]].
*[[Nipple adenoma|Nipple (duct) adenoma]] (clinical DDx).
*[[Eccrine carcinoma]].
 
==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.
 
==See also==
*[[Breast]].
*[[Invasive breast cancer]].
*[[Paget disease]].
*[[Extramammary Paget disease]].
 
==References==
{{Reflist|2}}
 
[[Category:Breast pathology]]

Latest revision as of 02:11, 11 September 2014

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