Paget Disease of Breast
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n engl j med 353;3 w ww.n ej m. or g j ul y 21, 2005
The
new england journal of
medicine
e
3
images in clinical medicine
Paget’s Disease of the Breast
Lindy Peta Fox, M.D.
Yale University School of MedicineNew Haven, CT 06520
Marc E. Grossman, M.D.
Columbia University Medical CenterNew York, NY 10032
70-year-old woman presented with an erythematous, scaly
plaque with a hyperpigmented border that had replaced the areola and com-pletely effaced the nipple of the left breast. No breast mass or lymphadenop-
athy was detected. A skin biopsy demonstrated large round cells, with sizable nuclei
and abundant, pale-staining cytoplasm, permeating singly and in groups throughout the epidermis (inset, arrow). Immunohistochemical staining identified carcinoembry-onic antigen, confirming the diagnosis of Paget’s disease. Mammography and ultraso-nography demonstrated no underlying abnormality in the left breast. A needle-core bi-opsy of a hypoechoic, ill-defined nodule at the areolar margin of the right breast showed benign, nonproliferative fibrocystic changes without atypia. The patient de-clined further treatment and was lost to follow-up. Paget’s disease is often associated with underlying in situ or invasive carcinoma of the breast. Careful physical examinationfor a palpable breast mass or lymphadenopathy is an essential part of the evaluation.
Copyright © 2005 Massachusetts Medical Society.
a
The New England Journal of MedicineDownloaded from nejm.org on April 5, 2016. For personal use only. No other uses without permission.
Copyright © 2005 Massachusetts Medical Society. All rights reserved.