A peculiar case of Paget's disease of the breast.

Mammary Paget's disease is a disorder of the nipple-areola complex of the breast that, while rare, is often associated with an underlying carcinoma. The typical aspect is usually an eczematoid change of the nipple or a red and ulcerative nipple's lesion or erythematous and crusted lesion, with or without mass-like lesion and infiltration and inversion of the nipple. It was described at first by Sir James Paget in 1874, [1] who classified the disease in mammary and extramammary type. The mammary type (Paget' s Breast Cancer: PBC) has rare frequency. PBC occurs in 0.5-5% of all cases of breast cancer, it affects the mouth of the excretory ducts of the nipple, which is characterized by lesion of nipple's large ducts. PBC can be a superficial lesion or a nodule-tumor and it can be associated with underlying carcinoma in situ (DCIS) in more than 95% of cases, especially in postmenopausal women. In a small percentage of cases, PBC can also be associated with an invasive breast cancer. Accuracy in the diagnostic phase, in order to distinguish PBC from others diseases is paramount and histological examination of lesion's biopsy has a crucial role. Prognosis and treatment depend on the type of underlying breast cancer and are based on the stage of cancer, but more importantly, on the prompt of an adequate multidisciplinary diagnostic pathway. KEY WORDS: Histopathological Report, Oncological Outcomes Paget's Breast Cancer.

Gallstone obstruction at the proximal ileum in an elderly woman: CT findings.

We present the case of a 73 years old woman with intestinal obstruction caused by a rare cause of biliary ileus, who arrived at our emergency department with lower abdominal quadrants pain (since about 2 months), recently associated with nausea, vomiting and abdominal distension. After clinical and laboratory evaluations, a computed tomography (CT) scan without intravenous contrast medium administration was urgently requested. CT had shown the presence of a large gallstone (diameter of about 6 cms) at the proximal ileum (stopped in this tract after the passage through a biliary-enteric fistula), and another gallstone (diameter of about 2 cms) in the gallbladder, associated with concentric thickening of gallbladder's walls, gas in the biliary tree, obliteration of peri-gallbladder's fat density and fluid in the peri-subhepatic area. The patient had urgently a surgical treatment (videolaparoscopy). CT had a crucial role for the diagnosis of intestinal obstruction, for its high sensitivity and specificity. It is well able to provide the causes and the level of the obstruction, its extension and complications, thus orienting toward the best clinical management/outcome for the patient.