Paget disease of the breast: a pictorial essay

Paget disease of the breast accounts for approximately 2%-3% of breast cancers. It is characterized by infiltration of the nipple epidermis by adenocarcinoma cells, which cause an eczematous eruption on the nipple and areola. The clinical features are highly suggestive of the disease; awareness of these on the part of the clinician should lead to more prompt diagnosis and earlier initiation of appropriate treatment. Mammograms, although not always positive, should be obtained in all cases suggestive of Paget disease to search for the underlying tumor and direct further treatment. Findings that may be seen at mammography include skin thickening, nipple retraction, subareolar or more diffuse malignant microcalcifications, and a discrete mass or masses. However, a negative mammogram should not alter the course of treatment. Conversely, identification of subareolar mammographic findings should alert the clinician to search for physical signs in the nipple and areolar region suggestive of Paget disease.