Paget's Disease of the Breast

Bilateral

Step 1: View clinicals

A 50-year-old woman presents with eczema and itching of both nipples for four months. She is otherwise asymptomatic. Her medical, surgical, and family histories are unremarkable, and she is not on any medications. Her menarche was at 12 years of age, and menopause was at 44 years. She has never been pregnant. She has never smoked, and only drinks socially.


Step 2: Order all relevant investigations

Nipple scrape cytology

Cytological analysis of scrapings from both nipples reveals the presence of numerous Paget cells.

Mammography B/L breasts

The mammograms of both breasts appear normal, with no evidence of masses or microcalcifications. Follow-up ultrasonography only reveals nonspecific skin thickening in the nipple-areolar regions of both breasts. There is no evidence of axillary lymphadenopathy.

Contrast MRI B/L breasts

Contrast enhanced MRI demonstrates linear clumped enhancement of both nipples extending into the subareolar space, indicative of ductal carcinoma in situ (DCIS) of both breasts.

Core biopsy B/L breasts

Microscopic examination of the biopsy specimens shows infiltration of the epidermis with numerous Paget cells. Underlying low-grade ductal carcinoma in situ (DCIS) is seen in specimens from both breasts.


Step 3: Select appropriate management

Bilateral central lumpectomy
Antituberculous therapy
Topical corticosteroids
Neoadjuvant chemotherapy


Score: ★★☆