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🌱 來自: Clinical manifestations of breast cancer

Paget disease

• Definition: a rare type of breast cancer that affects the lactiferous ducts and the skin of the nipple and areola
• Pathogenesis
  • Not fully understood
• The following two hypotheses have been postulated: [14]
• Migratory/epidermotropic theory: neoplastic ductal epithelial cells from an underlying DCIS or IDC move through the lactiferous ducts and invade the surrounding epidermis of the nipple.
• In situ malignant transformation of existing cells into Paget cells, meaning that the condition is a carcinoma in situ, without preexisting DCIS/IDC.

Clinical features-of-Paget disease

• Erythematous, scaly, or vesicular rash affecting the nipple and areola
• Pruritus; burning sensation
• Nipple retraction
• Ulceration that causes blood-tinged nipple discharge

Diagnostics

• Punch/wedge or surface biopsy of nipple tissue: Paget cells confirm disease.

• Imaging to look for underlying DCIS/IDC (see “Diagnostics” below)

• Differential diagnosis: mamillary eczema

• Treatment

• Breast-conserving surgery with subsequent adjuvant whole-breast radiation (see “Treatment” below)

• Mastectomy