Difference between revisions of "Paget disease of the breast"

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(split-out EMPD)
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Histologically, i.e. under the [[microscope]], the above are essentially identically; however, the associations (and prognosis) are quite different!
Histologically, i.e. under the [[microscope]], the above are essentially identically; however, the associations (and prognosis) are quite different!


==Mammary Paget disease==
==General==
===General===
*Cells in the epithelium, i.e. skin, that look like they don't belong.
*Cells in the epithelium, i.e. skin, that look like they don't belong.
*Associated with underlying breast carcinoma.<ref name=emed_pagets>URL: [http://emedicine.medscape.com/article/1101235-diagnosis http://emedicine.medscape.com/article/1101235-diagnosis]</ref>
*Associated with underlying breast carcinoma.<ref name=emed_pagets>URL: [http://emedicine.medscape.com/article/1101235-diagnosis http://emedicine.medscape.com/article/1101235-diagnosis]</ref>
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*Extra-mammary Paget's disease is not assoc. with malignancy.
*Extra-mammary Paget's disease is not assoc. with malignancy.


===Microscopic===
==Microscopic==
Features:<ref name=emed_pagets/>
Features:<ref name=emed_pagets/>
*Epitheliod morphology (round/ovoid).
*Epitheliod morphology (round/ovoid).
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*[[Nipple adenoma|Nipple (duct) adenoma]] (clinical DDx).
*[[Nipple adenoma|Nipple (duct) adenoma]] (clinical DDx).


===IHC===
==IHC==
Panel:<ref name=emed_pagets/>
Panel:<ref name=emed_pagets/>
*S-100 -ve, HMB-45 -ve (both typically +ve in melanoma).
*S-100 -ve, HMB-45 -ve (both typically +ve in melanoma).
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*CK5/6 -ve.<ref>RS. May 2010.</ref>
*CK5/6 -ve.<ref>RS. May 2010.</ref>
**Usu. +ve in squamous cell carcinoma.
**Usu. +ve in squamous cell carcinoma.
==Extramammary Paget disease==
===General===
*Usually not associated with malignancy.
===Microscopic===
Features:
*Indistinguishable from mammary paget's disease.
**See ''Microscopic'' section in ''mammary Paget's disease''.


==See also==
==See also==
*[[Breast]].
*[[Breast]].
*[[Invasive breast cancer]].
*[[Invasive breast cancer]].
*[[Paget disease]].
*[[Extramammary Paget disease]].


==References==
==References==

Revision as of 05:26, 27 August 2011

Paget disease of the breast, also Paget's disease of the breast, is a thingy seen in the breast... and elsewhere - except bone.

There is also a Paget disease of the bone - just to make things confusing. This is dealt with in the bone article and has nothing (from a pathologic perspective) to do with the Paget disease discussed in this article; these two things just happened to be discovered by the same guy.

Non-bone Paget disease is subdivided into:

  1. Mammary Paget disease.
  2. Extramammary Paget disease.

Histologically, i.e. under the microscope, the above are essentially identically; however, the associations (and prognosis) are quite different!

General

  • Cells in the epithelium, i.e. skin, that look like they don't belong.
  • Associated with underlying breast carcinoma.[1]

Note:

  • Extra-mammary Paget's disease is not assoc. with malignancy.

Microscopic

Features:[1]

  • Epitheliod morphology (round/ovoid).
  • Cells nested or single.
  • Clear/pale cytoplasm key feature - may also be eosinophilic.
  • Large nucleoli.

Images:

DDx

IHC

Panel:[1]

  • S-100 -ve, HMB-45 -ve (both typically +ve in melanoma).
  • CK7 +ve
  • CEA +ve (-ve in Bowen's disease, -ve in Toker cells).

Additional:

  • HER2/neu - usually +ve.
  • CK5/6 -ve.[2]
    • Usu. +ve in squamous cell carcinoma.

See also

References

  1. ↑ 1.0 1.1 1.2 URL: http://emedicine.medscape.com/article/1101235-diagnosis
  2. ↑ RS. May 2010.
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