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Anaplastic Paget's disease.
1Department of Pathology, St. John's Mercy Medical Center, St. Louis, Missouri 63141-8221.
The American Journal of Surgical Pathology
|November 1, 1992
Summary
Anaplastic Paget's disease, a rare nipple lesion mimicking Bowen's disease, is often associated with invasive ductal carcinoma. Distinguishing features include acantholysis and lack of dyskeratotic cells.
Area of Science:
- Dermatopathology
- Oncology
Background:
- Mammary Paget's disease (MPD) typically presents as nipple lesions.
- A distinct anaplastic variant of MPD, histologically resembling Bowen's disease, has been identified.
Purpose of the Study:
- To describe the clinicopathologic features of anaplastic Paget's disease.
- To identify distinguishing histologic features between anaplastic Paget's disease and Bowen's disease.
- To assess the association of anaplastic Paget's disease with invasive ductal carcinoma.
Main Methods:
- Retrospective analysis of six cases of anaplastic Paget's disease.
- Histologic examination including immunohistochemistry (CEA, EMA, AE1/AE3) and mucicarmine staining.
- Comparison of histologic features with Bowen's disease and conventional Paget's disease.
Main Results:
- All patients presented with scaling erythematous nipple lesions without palpable masses.
- Histology showed full-thickness epidermal atypia, loss of nuclear polarity, cytologic anaplasia, and intraepidermal acantholysis.
- Anaplastic Paget's disease was associated with invasive ductal carcinoma in 50% of cases, a significantly higher rate than previously reported.
Conclusions:
- Nipple lesions resembling Bowen's disease should be suspected as anaplastic Paget's disease.
- Key distinguishing features include cleft-like acantholysis and absence of dyskeratotic cells.
- The high rate of associated invasive ductal carcinoma underscores the importance of accurate diagnosis.