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Mammary Paget's Disease Presenting as an Annular Plaque
Chinatsu Matsumoto, Shiro Niiyama1, Takuya Nagata
1Shiro Niiyama, MD, PhD Department of Dermatology, Toho University Ohashi Medical Center Ohashi, Meguro-ku, Tokyo, Japan sniiyama@aol.com.
Acta Dermatovenerologica Croatica : ADC
|March 15, 2023
Summary
This case report details a rare presentation of Mammary Paget's disease (MPD) as an annular plaque. Early diagnosis through biopsy is crucial for effective treatment of this rare breast cancer subtype.
Area of Science:
- Dermatology
- Oncology
- Pathology
Background:
- Mammary Paget's disease (MPD) is a rare breast cancer subtype, typically presenting as nipple or areola epidermis adenocarcinoma.
- It is often associated with underlying ductal carcinoma, affecting 0.7-4.3% of breast cancer cases.
Observation:
- A 74-year-old Japanese woman presented with a 6-month history of an itchy, annular plaque on her left areola, unresponsive to topical steroids.
- Physical examination revealed a pink plaque encircling the nipple, with no palpable masses in either breast.
Findings:
- Histological examination of a punch biopsy confirmed MPD, showing atypical cells within the epidermis and dermal lymphocytic infiltration.
- Immunohistochemistry was positive for CK7 and negative for S-100 and HMB45.
- The patient underwent partial mastectomy and radiation therapy.
Implications:
- This case highlights an atypical clinical presentation of MPD as an annular plaque, emphasizing the need for biopsy in diagnosing persistent areolar lesions.
- Differential diagnoses include eczema, erosive adenomatosis, and other skin malignancies; sebaceous hyperplasia can mimic this presentation, especially in Asian populations.
- The possibility of pigmented MPD should be considered in cases with nipple pigmentation.
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