Paget disease of the breast

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

It is subdivided into:

  • Mammary Paget disease.
  • Extramammary Paget disease.

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