Authors: Paola S. Young, MD, Ma. Celina C. Gonzales, MD, Felix Paolo J. Lizarondo, MD, Eileen A. Cubillan, MD, FPDS


Introduction:  Paget disease of the breast is considered to be a ductal carcinoma in situ from the lactiferous duct extending to the nipple epidermis, without invading the basement membrane in majority of cases. Only a few cases of the invasive type of mammary Paget disease have been documented in literature.

Case Summary:  We herein report a case of a Filipino woman presenting with an eight-month history of a pruritic unilateral solitary left nipple plaque, not associated with a palpable mass. Histopathology showed atypical ballooned cells diffusely infiltrating the epidermis. Intimately related to these areas of infiltrations were similar looking atypical cells invading some areas of the superficial and mid-dermis. The deep dermis was clear of these atypical cells. To determine the cellular origin, cytokeratin 7 immunostaining was done which turned out positive for a glandular origin, consistent with Paget Disease. While the association of mammary Paget disease and an underlying breast carcinoma has been well established, there have only been a few published cases of the invasive mammary Paget disease to establish its prognostic and treatment significance. Modified radical mastectomy with sentinel lymph node biopsy and formal lymph node dissection performed revealed a separate underlying invasive carcinoma in the breast parenchyma. The patient made a full recovery after the surgery and subsequently underwent radiotherapy and chemotherapy.

Conclusion:  This case describes the clinico-histopathologic features of an invasive variant of mammary Paget disease, its associated malignancy, and the surgical and medical interventions performed.





Paget, invasive, dermis, histopathologic, intervention

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