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Pagets Disease of the Breast

dr. Muamar "Ray" Amirullah

70-year-old woman presented with an erythematous, scaly Lindy Peta Fox, M.D.
plaque with a hyperpigmented border that had replaced the areola and comYale University School of Medicine
pletely effaced the nipple of the left breast. No breast mass or lymphadenop- New Haven, CT 06520
athy was detected. A skin biopsy demonstrated large round cells, with sizable nuclei
and abundant, pale-staining cytoplasm, permeating singly and in groups throughout Marc E. Grossman, M.D.
the epidermis (inset, arrow). Immunohistochemical staining identified carcinoembryUniversity Medical Center
onic antigen, confirming the diagnosis of Pagets disease. Mammography and ultraso- Columbia
New York, NY 10032
nography demonstrated no underlying abnormality in the left breast. A needle-core biopsy of a hypoechoic, ill-defined nodule at the areolar margin of the right breast
showed benign, nonproliferative fibrocystic changes without atypia. The patient declined further treatment and was lost to follow-up. Pagets disease is often associated
with underlying in situ or invasive carcinoma of the breast. Careful physical examination
for a palpable breast mass or lymphadenopathy is an essential part of the evaluation.

Copyright 2005 Massachusetts Medical Society.

n engl j med 353;3

www.nejm.org

july 21, 2005

The New England Journal of Medicine

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Copyright 2005 Massachusetts Medical Society. All rights reserved.

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