RESUMO
INTRODUCTION: Paget disease of the nipple in man is a very rare breast cancer, and there are not standard procedures or guidelines. In any cases, a Paget's disease could hide an invasive ductal breast cancer. CASE DESCRIPTION: We report the case of a 77-years old man affected by Alzheimer's disease, who presented to our attention because of an ulcerated palpable mass in the right nipple. A biopsy of the lesion showed "intra-epidermic proliferation of epitelioid cells, associated with linfo-plasmacellular infiltration of superficial dermis, compatible with Paget's disease (pTis)". We discussed the case in the multidisciplinary meeting and decided to subject the patient to surgery, so a right mastectomy plus sentinel lymph node biopsy (SLNB) were performed. Histo-pathological examination revealed "invasive ductal carcinoma of the breast, associated with a small component of in situ ductal carcinoma and Paget's disease of the nipple with superficial ulceration". Resection margins were free. Sentinel lymph node was negative. Biological features were as follows: ER 95%, PR 60%, Her-2/neu 1+, Ki-67 35%. The patient was discharged in the third post-operative day in good conditions. In the following weeks the patient's healing process was good and free of complications. CONCLUSIONS: Clinical recognition of Paget's disease is very important also in man, because it can be the alarm bell for an underlying invasive ductal breast cancer, often more aggressive than in woman.
Assuntos
Neoplasias da Mama Masculina/patologia , Estrogênios , Neoplasias Hormônio-Dependentes/patologia , Neoplasias Primárias Múltiplas/patologia , Mamilos/patologia , Doença de Paget Mamária/patologia , Progesterona , Idoso , Doença de Alzheimer/complicações , Antineoplásicos Hormonais/uso terapêutico , Neoplasias da Mama Masculina/complicações , Neoplasias da Mama Masculina/tratamento farmacológico , Neoplasias da Mama Masculina/cirurgia , Carcinoma Ductal de Mama/patologia , Carcinoma Ductal de Mama/cirurgia , Carcinoma Intraductal não Infiltrante/patologia , Carcinoma Intraductal não Infiltrante/cirurgia , Terapia Combinada , Humanos , Masculino , Mastectomia , Neoplasias Hormônio-Dependentes/complicações , Neoplasias Hormônio-Dependentes/tratamento farmacológico , Neoplasias Hormônio-Dependentes/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Doença de Paget Mamária/complicações , Doença de Paget Mamária/etiologia , Doença de Paget Mamária/cirurgia , Úlcera Cutânea/etiologia , Tamoxifeno/uso terapêuticoRESUMO
The relationships between diabetes mellitus and cognitive function were studied in patients aged over 50 years with good metabolic control and without chronic complications. The following tests were performed: CES-D, Rey's, Benton's, Span's, Corsi's, MMSE, Raven's. No differences were found in the comparison between groups (12 diabetics and 17 normals) contrary to other similar studies. This could be for the bad metabolic control of patients studied in previous studies or for the existence of minimal deficit not shown with the conventional tests.