Pagets disease – Breast

PAGETS DISEASE OF THE BREAST

• Named after the observations of Sir James Paget.

• Characterized by presence of malignant glandular epithelial cells within the squamous epithelium of the nipple

• Associated with invasive and insitu carcinoma breast

• Pathogenesis – Two hypothesis

  • Mostly accepted hypothesis: Local migration of underlying carcinoma cells into lactiferous ducts

  • Alternately, it is a form of carcinoma insitu of epidermis of nipple

• Gross appearance of nipple

  • Normal appearance

  • Erythematous 

  • Eczematous with weeping (Discharging serosanguinous fluid) – most common presentation

  • Crusting 

• Microscopy

  • Squamous epithelium of nipple shows paget cells

  • Pagets cells: Adenocarcinoma type cells with pleomorphic nuclei, prominent nucleoli and abundant clear cytoplasm containing PAS positive mucin vacuoles

  • Underlying lactiferous ducts often contain Duct cell carcinoma – in situ (DCIS)

  • Lesion is associated with high grade invasive carcinoma subtypes

  • Overlying epithelium of nipple shows varying degrees of hyperplasia, hyperkeratosis, inflammation and ulceration

  •  Diagnosis is by cytological examination of the exudates or nipple biopsy

  • It is associated with HER2/neu protein overexpression – Hence poor prognosis 

 

Microphotographs

References :

1. Robbins and Cotrans: Pathologic basis of diseases.8th edition

2. Robin Reid, Fiona Roberts, Elaine Mac Duff. Pathology illustrated.7th edition.2011

By
Dr.B.Chaitanya (Consultant Pathologist, RDT hospital, Anantapur) (bchaitanya.med@gmail.com)
Edited by Dr.V.Shanthi (Professor of Pathology, Narayana Medical College, Nellore)