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Primary Invasive Paget's Disease in a Clinical Practice: A Case Report
Timia Raven-Gregg1, Sharat Chopra1, Prav Hamal2
1General Surgery, Aneurin Bevan University Health Board, Newport, GBR.
Cureus
|July 1, 2024
Summary
Invasive Paget's disease of the nipple (IPDN) is rare, often requiring histopathology for diagnosis. Dermal invasion by Paget cells may not impact prognosis, but deep invasion poses a risk for lymphatic spread.
Area of Science:
- Oncology
- Dermatology
- Pathology
Background:
- Paget's disease of the nipple (PDN) is a rare condition involving Paget cells invading the nipple epidermis.
- Invasive Paget's disease of the nipple (IPDN) is characterized by invasive carcinoma localized to the nipple.
- Clinical presentation of PDN can lack specificity, often necessitating histopathological confirmation.
Observation:
- An 82-year-old female presented with a tender, inflamed, and necrotic right nipple.
- Initial ultrasound indicated no underlying malignancy (U2).
- Microscopic examination revealed Paget's disease with ductal carcinoma in situ and minimal dermal invasion (0.4mm, 0.3mm).
Findings:
- Histopathology confirmed Paget's disease with underlying ductal carcinoma in situ and foci of dermal invasion, consistent with IPDN.
- Research indicates minimal impact of Paget cell dermal invasion on clinical outcome.
- Prognosis is primarily dependent on the associated underlying malignancy.
Implications:
- Deep dermal invasion or extensive Paget cell penetration carries potential for regional and distant lymphatic spread.
- Depth of invasion in extramammary Paget's disease correlates with poorer survival.
- Variability in PDN presentation necessitates careful clinical correlation with thorough histopathological evaluation.
