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1.
Korean J Radiol ; 21(8): 955-966, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32677380

RESUMO

Ultrasound (US) is an attractive diagnostic approach to identify both common and uncommon nipple pathologies, such as duct ectasia, nipple abscess, nipple leiomyoma, nipple adenoma, fibroepithelial polyp, ductal carcinoma in situ (restricted to nipple), invasive carcinoma, and Paget's disease. US is the reliable first-line imaging technique to assess nipple pathologies. It is useful to identify and characterize nipple lesions. Additionally, we have presented the mammography and MRI outcomes correlated with histopathologic features for the relevant cases.


Assuntos
Adenoma/diagnóstico por imagem , Neoplasias da Mama/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Mamilos/diagnóstico por imagem , Doença de Paget Mamária/diagnóstico por imagem , Papiloma/diagnóstico por imagem , Ultrassonografia/métodos , Adenoma/patologia , Adulto , Idoso , Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/patologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Mamografia/métodos , Pessoa de Meia-Idade , Mamilos/patologia , Doença de Paget Mamária/diagnóstico , Doença de Paget Mamária/patologia , Papiloma/patologia
2.
J Eur Acad Dermatol Venereol ; 33(10): 1892-1898, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31270878

RESUMO

BACKGROUND: Mammary Paget's disease (MPD) is a rare intraepidermal adenocarcinoma of the nipple-areola complex, associated with an underlying breast cancer in approximately 90% of cases. Delayed diagnosis of MPD is common. Its dermoscopic features have been ill defined in the literature. OBJECTIVES: To determine the clinical and dermoscopic features of MPD versus other dermatologic entities that involve nipple and areola. METHODS: Members of the IDS were invited to submit any case of histologically confirmed MPD, as well as other benign and malignant dermatoses that involve the nipple and areola complex. A standardized evaluation of the dermoscopic images was performed and the results were statistically analyzed. RESULTS: Sixty-five lesions were included in the study, 22 (33.8%) of them MPD and 43 (66.2%) controls. The most frequent dermoscopic criteria of MPD were white scales (86.4%) and pink structureless areas (81.8%), followed by dotted vessels (72.7%), erosion/ulceration (68.2%) and white shiny lines (63.6%). The multivariate analysis showed that white scales and pink structureless areas were significant predictors of MPD, posing a 68-fold and a 31-fold probability of MPD, respectively. Split of the population into pigmented and non-pigmented lesions showed that in pigmented MPD, pink structureless areas, white lines and grey granules and dots are positive predictors of the disease. Among non-pigmented lesions, pink structureless areas, white lines, erosion/ulceration and white scales served as predictors of MPD. CONCLUSIONS: The most frequent profile of an individual with MPD is an elderly female with unilateral, asymptomatic, erythematous plaque of the nipple, dermoscopically displaying pink structureless areas, fine white scales, dotted and a few short linear vessels. In case of pigmentation we may also observe brown structureless areas and pigmented granules. LIMITATIONS: Small sample size, retrospective design.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Dermoscopia , Doença de Paget Mamária/diagnóstico por imagem , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mamilos , Estudos Retrospectivos
3.
J Eur Acad Dermatol Venereol ; 33(10): 1837-1846, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31166040

RESUMO

The differential diagnosis of nipple and areola complex (NAC) lesions encompasses a large spectrum of conditions from benign tumours to inflammatory diseases that could be challenging to recognize on clinical ground. While melanoma (MM) of the NAC is exceedingly rare, benign lesions are more frequent but could be difficult to distinguish from MM. Besides MM, other malignant tumours can affect this area and in particular Paget's disease (PD). For clinically doubtful lesions, biopsy is required, with possible functional and aesthetic consequences in this sensitive area. Dermoscopy and reflectance confocal microscopy (RCM) are widely used techniques for the diagnosis of many skin lesions, but their use for NAC lesions is not well established. The objective of this study was to evaluate current literature on these imaging techniques for NAC lesions. We searched in Medline, PubMed and Cochrane database all studies up to November 2018 dealing with dermoscopy, RCM and this special site. We found that the most described malignant tumour was PD and that only two primary MMs of the NAC have been reported with these imaging techniques. Although there are few data on diagnostic accuracy of non-invasive imaging techniques for NAC lesions, it seems that dermoscopy and RCM can add relevant information to be integrated with clinical examination for the diagnosis of NAC lesions and in particular for the differential diagnosis of PD and eczema.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Dermoscopia , Melanoma/diagnóstico por imagem , Mamilos/diagnóstico por imagem , Doença de Paget Mamária/diagnóstico por imagem , Transtornos da Pigmentação/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Carcinoma Basocelular/diagnóstico por imagem , Carcinoma de Células Escamosas/diagnóstico por imagem , Diagnóstico Diferencial , Eczema/diagnóstico por imagem , Humanos , Microscopia Confocal
6.
PLoS One ; 13(5): e0197156, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29768474

RESUMO

PURPOSE: Paget disease of the breast is a rare cancer that originates from the nipple-areolar complex. It is often overlooked and misdiagnosed as benign chronic eczema of the nipple. We aimed to retrospectively verify whether blood flow analysis using Doppler sonography was useful for detecting the presence of Paget disease. METHODS: In this retrospective study, 12 patients with pathologically proven unilateral nipple eczematous lesions (seven with Paget disease and five with simple dermatitis) were included. Nipple blood flow signal was observed using Doppler sonography, and the detected blood flow signals were quantified using digitally recorded images. Quantified blood flow ratio and pathologically examined capillary density were evaluated between affected and unaffected nipples. Findings of mammography, grayscale sonography, and contrast-enhanced magnetic resonance imaging (CE-MRI) were reviewed. RESULTS: In patients with Paget disease, Doppler effects in the affected nipple were more clearly visible than those in the unaffected nipple. These effects were sufficiently visible to identify Paget disease. No obvious effects were observed in the affected and unaffected nipples of simple dermatitis. The quantified blood flow ratio and pathologically examined capillary density were significantly higher for the Paget lesion than those for the non-Paget lesion. The sensitivity of CE-MRI and Doppler sonography was markedly correlated, revealing blood flow changes in the nipple lesions of Paget disease. CONCLUSION: Doppler sonography visualized the proliferation of blood vessels in Paget lesions. The visualization of increased nipple blood flow using Doppler sonography is a simple and low-cost method that provides useful data for identifying Paget disease during routine medical care.


Assuntos
Neoplasias da Mama , Ecocardiografia Doppler , Mamilos , Doença de Paget Mamária , Adulto , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Neoplasias da Mama/irrigação sanguínea , Neoplasias da Mama/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Mamilos/irrigação sanguínea , Mamilos/diagnóstico por imagem , Doença de Paget Mamária/irrigação sanguínea , Doença de Paget Mamária/diagnóstico por imagem , Estudos Retrospectivos
7.
Int J Surg Pathol ; 26(6): 573-577, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29580118

RESUMO

We report a case of invasive solid papillary carcinoma (SPC) of the nipple with Pagetoid extension to the skin and lymph node metastasis. SPC is an uncommon primary breast cancer accounting for less than 1% of all breast cancers. Only 2 cases occurring in the nipple have been reported. However, both cases were without Pagetoid extension or lymph node metastasis. The presently reported tumor consisted of irregularly shaped solid cell nests with delicate fibrovascular cores. The tumor cells had round nuclei with low-grade atypia and eosinophilic cytoplasm. Neuroendocrine differentiation was confirmed by immunohistochemical positivity for CD56, synaptophysin, and chromogranin A. Immunohistochemistry also confirmed the absence of myoepithelial cells around the tumor cell nests. Therefore, a diagnosis of invasive SPC was made. Additionally, tumor cell deposits in the intramammary and axillary lymph nodes were identified, and these deposits had the same histological characteristics as the invasive SPC of the nipple. The invasiveness of SPC can be difficult to determine. However, the tumor cell nests in the current case exhibited a retraction artifact, which is known to be associated with invasive carcinoma and a poor prognosis, as well as morphological patterns that have been previously identified as characteristic of invasive SPC. Although SPC is widely recognized as having a favorable outcome, the existence of exceptionally aggressive cases occurring in the nipple must be recognized. Additional cases of invasive SPC of the nipple are needed to analyze the clinicopathological correlation.


Assuntos
Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/patologia , Carcinoma Papilar/patologia , Mamilos/patologia , Doença de Paget Mamária/patologia , Idoso de 80 Anos ou mais , Axila , Biópsia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/cirurgia , Carcinoma Papilar/diagnóstico por imagem , Carcinoma Papilar/cirurgia , Feminino , Humanos , Excisão de Linfonodo , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática , Imagem por Ressonância Magnética , Mastectomia , Invasividade Neoplásica/patologia , Mamilos/diagnóstico por imagem , Mamilos/cirurgia , Doença de Paget Mamária/diagnóstico por imagem , Doença de Paget Mamária/cirurgia
8.
Gan To Kagaku Ryoho ; 45(13): 1842-1844, 2018 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-30692372

RESUMO

Paget's disease of the breast is usually localized in the nipple epidermis and lactiferous duct located near the nipple. Here, we report a rare case of synchronous breast carcinoma with Paget's disease and invasive ductal carcinoma. A 50-year-old woman was admitted to our hospital because of abnormalities in screening mammography findings. Ultrasonography(US) findings showed a 2.4×1.3×1.6 cm sized hypoechoic lesion in a region of the left mammary gland. Computed tomography (CT)findings did not reveal distant metastasis. Magnetic resonance imaging(MRI)revealed an approximately 2.2 cm sized irregular tumor. The pretreatment diagnosis was left non-invasive ductal carcinoma(cTisN0M0, Stage 0), and surgery was performed. The tumor was found in the range of 40.2×15.0 mm, many of which were breast ductal growth. An infiltrated image was confirmed at multiple sites, but the maximum size was 2.5×1.5 mm. Pathological findings of the main lesion revealed papillotubular carcinoma. Agglomeration of heterotypic cells with abundant cytoplasm was observed in the epidermis of the papilla. The final diagnosis was invasive breast cancer(pT1aN3M0, Stage Ⅲc, Luminal HER2)coexisting with Paget's disease.


Assuntos
Neoplasias da Mama , Carcinoma Ductal de Mama , Doença de Paget Mamária , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Ductal de Mama/cirurgia , Feminino , Humanos , Mamografia , Pessoa de Meia-Idade , Mamilos , Doença de Paget Mamária/diagnóstico por imagem , Doença de Paget Mamária/cirurgia
9.
Breast J ; 24(4): 637-641, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29265587

RESUMO

Solid papillary carcinoma (SPC) is a rare neoplasm of the breast showing a distinct morphology, neuroendocrine differentiation and should be divided into invasive and in situ subtype according to the current 2012 WHO classification of breast tumors. Here, we describe a case of a pure SPC, invasive-type, in a 31-years old female with an associated mammary Paget's disease (MPD) of the nipple showing a rare, CK7-negative immune phenotype, which has not been reported so far. This unusual differential diagnosis should be added to the rare condition of CK7-negative Paget's disease of the breast and complement a new feature to the characterization of SPC.


Assuntos
Neoplasias da Mama/patologia , Carcinoma Papilar/patologia , Doença de Paget Mamária/patologia , Adulto , Biópsia com Agulha de Grande Calibre , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Carcinoma Papilar/diagnóstico por imagem , Carcinoma Papilar/cirurgia , Feminino , Humanos , Queratina-7 , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/secundário , Mamilos/patologia , Doença de Paget Mamária/diagnóstico por imagem , Doença de Paget Mamária/cirurgia , Receptor ErbB-2
10.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 39(3): 396-400, 2017 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-28695812

RESUMO

Objective To summarize the clinical and sonographic features of mammary Paget's disease (MPD). Methods Totally 34 female patients with pathologically confirmed MPD were retrospectively recruited. According to diagnosis,the clinical data and sonographic findings were reviewed and analyzed. Results Among these 34 patients,7 patients had single MPD; in the remaining 27 patients,16 were accompanied by invasive ductal carcinoma (IDC),7 by ductal carcinoma in situ (DCIS),3 by both IDC and DCIS,and 1 by other pathologic types of carcinoma. Twenty-four patients presented with typical clinical features of MPD,whereas 10 patients had no typical features of MPD. Among the 24 patients with typical clinical features,ultrasound examinations showed that 11 had echoic abnormality in nipple-areolar complex,14 had lesions of breast,and 14 had microcalcifications. Among the 10 patients without typical clinical features,ultrasound examinations revealed echoic abnormality in nipple-areolar complex in 3 cases,breast lesions in 9 cases,and microcalcifications in 6 cases. Among the 14 patients with echoic abnormality in nipple-areolar complex,all of them presented as rich blood flow in nipple detected by color Doppler ultrasonography. Conclusions The main clinical feature of MPD is abnormalities in nipple-areolar complex. Sonography can recognize the echoic abnormalities of nipple and lesions of breast. Sonographer should be careful of the nipple-areolar complex when mass is found in breast.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Doença de Paget Mamária/diagnóstico por imagem , Feminino , Humanos , Mamilos/diagnóstico por imagem , Mamilos/patologia , Estudos Retrospectivos , Ultrassonografia
11.
Dermatol Clin ; 34(4): 443-458, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27692450

RESUMO

Solitary pink lesions can pose a particular challenge to dermatologists because they may be almost or completely featureless clinically and dermoscopically, previously requiring biopsy to exclude malignancy. However, these lesions usually are not particularly challenging histopathologically. Thus, the incorporation of in vivo reflectance confocal microscopy into the clinical practice, which allows for noninvasive examination of the skin at the cellular level revealing features previously seen only on histopathology, is particularly useful for this subset of clinically difficult lesions.


Assuntos
Acantoma/diagnóstico por imagem , Adenoma/diagnóstico por imagem , Carcinoma/diagnóstico por imagem , Hemangioma/diagnóstico por imagem , Histiocitoma Fibroso Benigno/diagnóstico por imagem , Melanoma Amelanótico/diagnóstico por imagem , Neoplasias das Glândulas Sebáceas/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Doença de Bowen/diagnóstico por imagem , Neoplasias da Mama/diagnóstico por imagem , Carcinoma in Situ/diagnóstico por imagem , Carcinoma de Células Escamosas/diagnóstico por imagem , Dermoscopia , Granuloma Piogênico/diagnóstico por imagem , Humanos , Microscopia Intravital , Ceratose Actínica/diagnóstico por imagem , Ceratose Seborreica/diagnóstico por imagem , Microscopia Confocal , Doença de Paget Extramamária/diagnóstico por imagem , Doença de Paget Mamária/diagnóstico por imagem , Dermatopatias/diagnóstico por imagem
14.
Gan To Kagaku Ryoho ; 37(7): 1329-32, 2010 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-20647720

RESUMO

A 66-year-old woman visited our hospital because of redness and erosion of her right breast, and was diagnosed with mammary Paget's disease by histological examination of erosive skin. The patient had a simple mastectomy. The pathological diagnosis was mammary Paget's disease (8x7.5 cm) showing intraductal spread. The resected skin margin was negative. Partially dermal microinvasion and lymphatic involvement were found. Immunohistochemical analysis of this tumor showed ER negative, PgR negative, and HER2 positive (3+). Eighteen months after the operation, she presented with redness of the chest wall with edema of the right arm. Incisional biopsy on the chest mass revealed a local recurrence of mammary Paget's disease. In addition, she had carcinomatous lymphangiosis in the bilateral lung, nodal metastases in the ipsilateral axillary and mediastinal space, and contralateral breast metastases on CT. She was treated with twelve courses of weekly paclitaxel in combination with trastuzumab. A complete response was obtained eleven months after initiation of chemotherapy. A rare case of early systemic recurrence of mammary Paget's disease after curative operation is reported with a review of the literature.


Assuntos
Neoplasias da Mama/patologia , Doença de Paget Mamária/patologia , Idoso , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/cirurgia , Feminino , Humanos , Paclitaxel/uso terapêutico , Doença de Paget Mamária/diagnóstico por imagem , Doença de Paget Mamária/tratamento farmacológico , Doença de Paget Mamária/cirurgia , Recidiva , Fatores de Tempo , Tomografia Computadorizada por Raios X , Trastuzumab
17.
G Chir ; 30(4): 153-5, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19419616

RESUMO

Paget breast disease is a kind of intraductal carcinoma that through an intracanalicular diffusion invades the basal epidermal layer, reaching the areola and nipple, producing a typical erythematous desquamative eczematous-like lesion. This neoplasia can remain undetected for a long time and inadequately treated as a dermatological affection. Synchronous or metachronous lesions are very uncommon. Surgical choice is conditioned by the presence of a tumor below the epidermal lesion, by its dimensions, and by the possible lymph node involvement. Surgical therapy can be radical or conservative. From our experience we think that lesion biopsy is always necessary to formulate a correct diagnosis and to schedule an appropriate therapeutic approach. In our case, a biopsy was performed first, then on the basis of the frozen section analysis a radical mastectomy with axillary third level lymph nodes dissection, because of the large dimensions of the lesion and the previous history of a methachronous lesion.


Assuntos
Neoplasias da Mama , Carcinoma Ductal de Mama , Segunda Neoplasia Primária , Doença de Paget Mamária , Idoso , Biópsia , Mama/patologia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/patologia , Feminino , Humanos , Excisão de Linfonodo , Mamografia , Mastectomia Radical , Estadiamento de Neoplasias , Segunda Neoplasia Primária/patologia , Segunda Neoplasia Primária/cirurgia , Doença de Paget Mamária/diagnóstico por imagem , Doença de Paget Mamária/patologia , Doença de Paget Mamária/cirurgia , Tomografia Computadorizada por Raios X
18.
J Am Coll Surg ; 206(2): 316-21, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18222386

RESUMO

INTRODUCTION: For patients with Paget disease (PD) of the nipple, preoperative imaging to detect and evaluate the extent of an underlying malignancy can facilitate appropriate treatment planning. The purpose of this study was to evaluate the role of breast MRI in this setting. STUDY DESIGN: Using ICD-9 codes for "breast symptoms," we identified 2,294 patients without a current cancer diagnosis seen at our institution (1995 to 2006). Sixty-nine patients (3%) had nipple changes suspicious for PD as the only physical finding. Skin/nipple biopsy confirmed PD in 39 of 69 (57%) patients. Thirty-four patients were eligible for review. RESULTS: Surgical pathology identified cancer in 32 of 34 (94%) patients (7 invasive ductal carcinoma, 25 ductal carcinoma in situ). Nineteen (59%) cancers were confined to the central quadrant of the breast (unifocal). Preoperative imaging (mammography 34 of 34, MRI 13 of 34) detected 15 of 32 (49%) cancers. Mammography detected 11 cancers, accurately demonstrating extent of disease in 9 of 11 patients. MRI detected seven cancers, accurately demonstrating extent of disease in six of seven patients. After positive mammography (n = 11), MRI (n = 5) did not change management. After negative mammography (n = 23), MRI (n = 8) detected otherwise occult disease in 4 of 8 patients, accurately demonstrating extent of disease in 4 of 4 patients and ruling out an underlying cancer in 1 of 1 patient. CONCLUSIONS: Ninety-four percent of patients with biopsy-proved PD as the only physical finding had an underlying cancer and 59% had unifocal disease. Negative preoperative imaging did not reliably exclude an underlying cancer, but the increased sensitivity of MRI detected otherwise occult disease. In the setting of negative mammography, MRI can facilitate treatment planning for patients with PD.


Assuntos
Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/patologia , Imagem por Ressonância Magnética , Mamilos , Doença de Paget Mamária/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/cirurgia , Feminino , Humanos , Mamografia , Pessoa de Meia-Idade , Doença de Paget Mamária/diagnóstico por imagem , Doença de Paget Mamária/cirurgia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos
19.
Breast ; 17(3): 317-8, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18171616

RESUMO

Bilateral breast carcinoma is reported to occur in 5-10% of all patients with breast cancer. Paget disease of the breast represents 1-3% of all breast malignancies [Ashikari R, Park K, Huvos AG, Urban JA. Paget's disease of the breast. Cancer 1970;26:680-5; Marshall JK, Griffith KA, Haffty BG, Solin LJ, Vicini FA, McCormick B, et al. Conservative management of Paget disease of the breast with radiotherapy. Cancer 2003;97:2142-9]. However, synchronous bilateral Paget disease of the nipple is extremely rare. We report synchronous bilateral Paget disease with infiltrative ductal carcinoma in a 74-year-old man who underwent bilateral mastectomy.


Assuntos
Neoplasias da Mama Masculina/patologia , Carcinoma Ductal de Mama/patologia , Neoplasias Primárias Múltiplas/patologia , Mamilos/patologia , Doença de Paget Mamária/patologia , Idoso , Neoplasias da Mama Masculina/diagnóstico por imagem , Neoplasias da Mama Masculina/cirurgia , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/cirurgia , Humanos , Masculino , Mamografia , Mastectomia , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/cirurgia , Doença de Paget Mamária/diagnóstico por imagem , Doença de Paget Mamária/cirurgia
20.
Eur J Radiol ; 60(2): 256-63, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16887314

RESUMO

PURPOSE: To determine and quantitate radiologic characteristics of Paget's disease of the breast and to report clinical and pathologic findings. MATERIALS AND METHODS: A retrospective review of records of 2872 women who received a diagnosis of breast carcinoma between January 1988 and January 2006 revealed 52 histologically proved Paget's disease of the breast. Analysis included history, findings at physical examination, mammography and sonography (US) and histologic type of Paget's disease. RESULTS: At physical examination, palpable mass (n=33, 63%), nipple erythema-eczema-ulceration (n=17, 33%) and blood-stained nipple discharge (n=5, 10%) were noted. Among 17 patients who had clinically evident Paget's disease, the mammographic findings were isolated microcalcifications in 3 (18%), mass associated with microcalcifications in 5 (29%), mass in 2 (12%) and negative in 7 (41%) patients. In the 35 patients with clinically inevident Paget's disease, these mammographic findings were 43% (n=15), 34% (n=12), 20% (n=7) and 3% (n=1), respectively. US depicted 43 masses in 35 patients, all of which were lobulated or irregularly contoured, mostly (n=41, 95%) without posterior acoustic shadowing. The cancer was clinically occult in 10% (n=5), mammographically occult in 15% (n=8) and radiologically occult in 13% (n=7) of the 52 patients. Histologically, the tumor was multifocal and/or multicentric in 11 (21%) patients. CONCLUSION: The clinical features of Paget's disease are characteristic and should alert the clinician to the likelihood of an underlying carcinoma, which should be evaluated radiologically. However, as Paget's disease is primarily a clinical diagnosis and mammograms may be negative, screening programs without clinical examination may result with delay in diagnosis. As a result, both clinical and imaging findings are complementary and should be correlated to confirm or exclude a diagnosis of Paget's disease.


Assuntos
Neoplasias da Mama/diagnóstico , Mamografia , Doença de Paget Mamária/diagnóstico , Ultrassonografia Mamária , Adulto , Idoso , Idoso de 80 Anos ou mais , Axila , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Calcinose/diagnóstico , Carcinoma in Situ/diagnóstico , Carcinoma Ductal de Mama/diagnóstico , Feminino , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Mamilos/diagnóstico por imagem , Mamilos/patologia , Doença de Paget Mamária/diagnóstico por imagem , Doença de Paget Mamária/patologia , Estudos Retrospectivos , Sensibilidade e Especificidade
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