Difference between revisions of "Paget disease of the breast"

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Note:
Note:
*[[Extramammary Paget's disease]] is '''not''' usually associated with malignancy.
*[[Extramammary Paget's disease]] is '''not''' usually associated with malignancy.
==Gross==
Features:
*Erythematous.
*Crusted.
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>
Image:
*[http://www.sciencephoto.com/media/252126/enlarge Paget disease of the breast (sciencephoto.com)].


==Microscopic==
==Microscopic==

Revision as of 15:40, 30 May 2012

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.[1]

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:

  1. Mammary Paget disease - dealt with in this article.
  2. 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 breast carcinoma.[2]

Note:

Gross

Features:

  • Erythematous.
  • Crusted.

DDx - clinical:

Image:

Microscopic

Features:[2]

  • Epitheliod morphology (round/ovoid).
  • Cells nested or single.
  • Clear/pale cytoplasm key feature - may also be eosinophilic.
  • Large nucleoli.

Images:

DDx

IHC

Panel:[2]

  • S-100 -ve, HMB-45 -ve (both typically +ve in melanoma).
  • CK7 +ve. (???)
    • Toker cells CK7 +ve.[6]
  • CEA +ve (-ve in Bowen's disease, -ve in Toker cells).

Additional:

  • HER2/neu - usually +ve.
  • CK5/6 -ve.[7]
    • Usu. +ve in squamous cell carcinoma.[8]

Tabular comparison

IHC features of Paget disease and its DDx:[9]

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

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

References

  1. ↑ 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. ↑ 2.0 2.1 2.2 URL: http://emedicine.medscape.com/article/1101235-diagnosis
  3. ↑ URL: http://www.danderm-pdv.is.kkh.dk/atlas/2-38.html. Accessed on: 30 May 2012.
  4. ↑ 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.
  5. ↑ URL: http://derm101.com/searchResults.aspx?searchStr=apocrine+carcinoma&rootTerm=apocrine+carcinoma&searchType=2&rootID=12687. Accessed on: 9 September 2011.
  6. ↑ 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.
  7. ↑ RS. May 2010.
  8. ↑ 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.
  9. ↑ URL: http://www.histopathology-india.net/EPD.htm. Accessed on: 4 December 2011.
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