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.
'''Paget disease of the breast''', also '''Paget's disease of the breast''', is a thingy seen in the [[breast]]... and elsewhere - except bone.


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.
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.


It is subdivided into:
Non-bone Paget disease is subdivided into:
*Mammary Paget disease.
#Mammary Paget disease.
*Extramammary Paget disease.
#Extramammary Paget disease.
 
Histologically, i.e. under the [[microscope]], the above are essentially identically; however, the association (and prognosis) are quite different!


==Mammary Paget disease==
==Mammary Paget disease==

Revision as of 17:54, 22 January 2011

Paget disease of the breast, also Paget's disease of the breast, is a thingy seen in the breast... and elsewhere - except bone.

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.
  2. Extramammary Paget disease.

Histologically, i.e. under the microscope, the above are essentially identically; however, the association (and prognosis) are quite different!

Mammary Paget disease

General

  • Cells in the epithelium, i.e. skin, that look like they don't belong.
  • Associated with underlying breast carcinoma.[1]

Note:

  • Extra-mammary Paget's disease is not assoc. with malignancy.

Microscopic

Features:[1]

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

Images:

DDx

  • Benign Toker cell hyperplasia.
  • Malignant melanoma.
  • Bowen disease.
  • Nipple duct adenoma (clinical DDx).

IHC

Panel:[1]

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

Additional:

  • HER2/neu - usually +ve.
  • CK5/6 -ve.[2]
    • Usu. +ve in squamous cell carcinoma.

Extramammary Paget disease

General

  • Usually not associated with malignancy.

Microscopic

Features:

  • Indistinguishable from mammary paget's disease.
    • See Microscopic section in mammary Paget's disease.

See also

References

  1. ↑ 1.0 1.1 1.2 URL: http://emedicine.medscape.com/article/1101235-diagnosis
  2. ↑ RS. May 2010.
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