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1.
Medicine (Baltimore) ; 99(51): e23443, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371071

RESUMO

BACKGOUND: This study aims to identify the expression of lipoma preferred partner (LPP) in Paget disease (PD) and to further understand the pathogenesis of PD. METHODS: Tissue microarray was used to evaluate the expression of LPP by immunohistochemistry in 40 PD patients. The results of LPP expression were combined with clinical and histopathological characteristics. Patient files were analyzed retrospectively. RESULTS: Twenty-one cases were mammary Paget disease (MPD) and 19 extramammary Paget disease (EMPD) involving the vulva, scrotum, and penis. LPP was expressed in PD and this expression was significantly greater in MPD versus EMPD (P = .031). The expression of LPP in MPD was significantly related with age (P = .009) and expression of Ki-67 (P = .011). No statistically significant differences were observed in LPP expression as related to sex, body location, and time of PD diagnosis. CONCLUSIONS: While LPP is expressed in both MPD and EMPD, the intensity of this expression is greater in MPD. LPP expression is positively correlated with Ki-67 and is more prevalent in middle-aged versus senior MPD patients. Further research is needed to determine its potential role in tumorigenesis and distribution.


Assuntos
Proteínas do Citoesqueleto/biossíntese , Proteínas com Domínio LIM/biossíntese , Neoplasias/patologia , Doença de Paget Extramamária/patologia , Doença de Paget Mamária/patologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Penianas/patologia , Estudos Retrospectivos , Neoplasias Testiculares/patologia , Análise Serial de Tecidos , Neoplasias Vulvares/patologia
2.
Oncol Res Treat ; 43(7-8): 346-353, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645702

RESUMO

INTRODUCTION: Mammary Paget's disease (MPD) is a rare cutaneous manifestation. Epidemiologically, more than half of the MPD patients concurrently have underlying invasive ductal carcinoma (MPD-IDC), and their prognosis remains poor despite multimodal treatments of breast cancer have markedly improved patients' survival. Accordingly, it is crucial to seek out novel therapeutic targets of MPD-IDC. As an emerging biological marker, the value of androgen receptor (AR) in MPD-IDC is inconsistent. Our objectives were to investigate the associations between AR and clinicopathological factors, and to explore its prognostic value in MPD-IDC. METHODS: We retrospectively analyzed data from 103 MPD-IDC patients, and immunohistochemical staining was used to determine their AR statuses. RESULTS: AR was expressed in 44 patients (42.7%), and AR expression was significantly correlated with body mass index (BMI) (p = 0.038) and axillary lymph node (ALN) status (p = 0.025). Kaplan-Meier curves showed that AR positivity was significantly associated with better overall survival (OS) in MPD-IDC patients (p = 0.019) and estrogen receptor-negative MPD-IDC patients (p = 0.039). Multivariate Cox regression analysis revealed that AR was not an independent prognostic indicator of disease-free survival (DFS) or OS in MPD-IDC patients (p = 0.395 and p = 0.073, respectively). CONCLUSIONS: In contrast to AR-negative tumors, patients with AR-positive ones were more likely to have lower BMI, no ALN metastasis, and better OS. AR-targeted treatments for MPD-IDC may add to existing therapeutic approaches to improve their effectiveness.


Assuntos
Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/patologia , Receptor alfa de Estrogênio/metabolismo , Linfonodos/patologia , Doença de Paget Mamária/patologia , Receptores Androgênicos/metabolismo , Adulto , Idoso , Axila , Neoplasias da Mama/metabolismo , Carcinoma Ductal de Mama/metabolismo , Feminino , Humanos , Linfonodos/metabolismo , Metástase Linfática , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Doença de Paget Mamária/metabolismo , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
3.
Dermatol Online J ; 26(3)2020 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-32609452

RESUMO

Paget disease of the nipple is a rare presentation of breast cancer. It is sometimes mistaken for a benign skin condition of the nipple and surrounding areola, which can significantly delay the diagnosis and treatment. In over 90% of cases there is an underlying carcinoma, either ductal carcinoma in situ (DCIS) or invasive breast cancer. We present a rare case of Paget disease of the nipple without the typical characteristics, detected by simple nipple scraping technique. A 62-year-old woman presented with a small fissure on the left nipple with scant clear nipple discharge. There were no other changes to the nipple-areola complex. The mammography and ultrasound were unremarkable. However, nipple scraping provided the immediate cytological diagnosis of Paget disease. Breast MRI with core biopsy showed high grade ductal carcinoma in situ with suggestion of microinvasion, confirmed histologically after mastectomy. Nipple scraping is a simple and inexpensive technique, which can be used in the office without anesthesia and with minimal discomfort to the patient. It could allow for significantly earlier cancer detection and treatment at the earliest stage of breast cancer. However, if the results are negative, full thickness biopsy may be needed if clinically indicated.


Assuntos
Neoplasias da Mama/patologia , Mamilos/patologia , Doença de Paget Mamária/patologia , Patologia Clínica/métodos , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mastectomia , Pessoa de Meia-Idade , Doença de Paget Mamária/cirurgia
4.
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
5.
Pathologe ; 41(4): 393-399, 2020 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-32405655

RESUMO

The classical Paget's disease of the nipple is histologically characterized by tumor cell infiltration originating in intraductal or invasive breast carcinoma, immunohistologically by a frequent overexpression of HER2 and clinically by eczema-like changes of the nipple and areola. Variants with different histological, immunohistological, and clinical features are observed in nonclassical forms of Paget's disease, such as isolated Paget's disease of the nipple, anaplastic Paget's disease, Paget's disease with invasion, and pigmented Paget's disease of the nipple. In the differential diagnosis of Paget's disease, benign changes have to be considered, including Toker cell hyperplasia, nipple eczema, and rare dermatoses.


Assuntos
Neoplasias da Mama , Doença de Paget Mamária , Neoplasias da Mama/patologia , Diagnóstico Diferencial , Humanos , Hiperplasia/patologia , Mamilos/patologia , Doença de Paget Mamária/diagnóstico , Doença de Paget Mamária/patologia
6.
Medicine (Baltimore) ; 99(15): e19728, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282731

RESUMO

BACKGROUND: The aim of this study was to present several cases of benign and malignant nipple lesions and contribute to diagnosis and differential diagnosis. METHODS: A retrospective study was conducted on 13 patients. All of the patients were evaluated by ultrasonography, and 11 of them had pathological results. We analyzed the clinical and sonographic features. RESULTS: There were 3 malignant lesions, 7 benign lesions, and 3 congenital nipple dysplasia, listed as follows:Malignant lesions (n = 3, 23%): Paget's disease (PD, n = 3, 23%). All of the patients with PD showed unilateral nipple erosion, discharge, and pain. The ultrasound showed abundant blood flow (n = 3, 23%); 2 patients (n = 2, 15%) had microcalcifications.Benign lesions (n = 7, 54%): Adenoma of the nipple (n = 2, 15%). One patient (n = 1, 8%) had nipple erosion and discharge. Two patients (n = 2, 15%) had a palpable nodule in the nipple. The ultrasound of both patients (n = 2, 15%) showed regular-shaped, clear border nodule with abundant blood flow (n = 2, 15%).Leiomyoma of the nipple (n = 1, 8%): This male patient was characterized by unilateral nipple enlargement and pain. The ultrasound showed a regular nodule with absent blood flow.Plasma cell mastitis (n = 2, 15%): Two patients showed unilateral nipple inversion and pain. One patient (n = 1, 8%) showed swollen and redness. The 2 patients showed a lesion in the gland around the nipple present as an irregular shape and unclear boundary hypoechoic mass.Nipple wart (n = 2, 15%): Two patients showed a unilateral soft exogenous neoplasm. Both of the patients showed a hypoechoic wart; the echo was similar to the nipple, the border was clear, and had no blood flow in the wart.Nipple Dysplasia (n = 3, 23%): Accessory nipple (n = 3, 23%). Two patients (n = 2, 15%) had accessory nipples in the subcoastal area, 1 patient (n = 1, 8%) in the areolar. All of the patients' sonographic features were the same as the nipple.The positive predict value (PPV) of the clinical symptoms: Erosion and discharge are both 75% (P < 0.05). The PPV of the US manifestations: irregular shape, indictinct margin, abundant blood flow, microcalcification, thicken skin in diagnosing malignant lesions are 60%,60%,60%,100%,100%, respectively (P < 0.05). CONCLUSIONS: The characteristic sonographic features together with clinical symptoms contribute to the diagnosis of nipple lesions.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Mamilos/irrigação sanguínea , Mamilos/diagnóstico por imagem , Ultrassonografia/métodos , Adenoma/patologia , Adulto , Neoplasias da Mama/patologia , Calcinose/patologia , Diagnóstico Diferencial , Feminino , Doença da Mama Fibrocística/patologia , Humanos , Leiomioma/patologia , Masculino , Mastite , Pessoa de Meia-Idade , Mamilos/patologia , Doença de Paget Mamária/patologia , Dor/diagnóstico , Plasmócitos/patologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Ultrassonografia/tendências , Verrugas
7.
Int J Surg Pathol ; 28(2): 210-215, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31514589

RESUMO

Mammary Paget's disease is rare and comprises about 0.62% of all breast cancer cases, only 1.65% of which occur in male patients. This case report involves a 76-year-old man who presented to his primary care physician with an itching, scaly, unilateral lesion involving the nipple skin. He underwent wide local excision of the lesion for a diagnosis of Bowen's disease (squamous cell carcinoma in situ). Histologic examination of the specimen revealed mammary Paget's disease with ductal carcinoma in situ in the underlying breast tissue. A panel of immunohistochemical stains revealed the Paget cells to be positive for cytokeratin 7, MUC1, GATA3, and androgen receptor and negative for cytokeratins 5/6, p63, SOX10, and MART-1/Melan-A. Paget cells were also negative for estrogen receptor and progesterone receptor, and positive for HER2/neu. However, the underlying ductal carcinoma in situ was positive for both estrogen receptor and progesterone receptor and negative for HER2/neu. This discordance, supported by the current literature, suggests an alternative etiology for Paget's disease in certain cases that cannot be explained by the well-established epidermotropic and transformative theories of Paget's disease evolution.


Assuntos
Neoplasias da Mama Masculina/patologia , Doença de Paget Mamária/patologia , Idoso , Biomarcadores Tumorais/análise , Neoplasias da Mama Masculina/metabolismo , Humanos , Imuno-Histoquímica , Masculino , Doença de Paget Mamária/metabolismo
8.
Breast Cancer Res Treat ; 179(3): 577-584, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31720992

RESUMO

PURPOSE: Paget's disease (PD) of the breast is an uncommon disease of the nipple usually accompanied by an underlying carcinoma, often HER2 + , and accounting for 0.5-5% of all breast cancer. To date, histogenesis of PD of the breast remains controversial, as two theories-transformation and epidermotropic-have been proposed to explain this disease. Currently, animal models recapitulating PD of the nipple have not been described. METHODS: HER2-enriched DT13 breast cancer cells were injected into the mammary fat pad of NOD scid gamma null (NSG) female mice. Immunohistochemical staining and pathological studies were performed on tumor samples, and diagnosis of PD of the nipple was confirmed by expression of proteins characteristic of Paget cells (epidermal growth factor 2 (HER2), androgen receptor (AR), cytokeratin 7 (CK7), cytokeratin 8/18 (CK8/18), and mucin 1 (MUC1)). In addition, DT13 cells grown in 2D culture and in soft agar assays were sensitive to in vitro treatment with pharmacological inhibitors targeting Her2, adenylyl cyclase, mTOR, and PI3K signaling pathways. RESULTS: Mice developed tumors and nipple lesions that were detected exclusively on the tumor-bearing mammary fat pad. Tumor cells were positive for proteins characteristic of Paget cells. In vitro, DT13 cells were sensitive to inhibition of Her2, adenylyl cyclase, mTOR, and PI3K signaling pathways. CONCLUSIONS: Our results suggest that injection of HER2 + DT13 cells into the mammary fat pad of NSG mice recapitulates critical aspects of the pathophysiology of PD of the nipple, supporting the epidermotropic theory as the more likely to explain the histogenesis of this disease.


Assuntos
Neoplasias da Mama/patologia , Glândulas Mamárias Animais/patologia , Mamilos/patologia , Doença de Paget Mamária/patologia , Receptor ErbB-2/metabolismo , Idoso , Animais , Carcinoma Ductal de Mama/patologia , Linhagem Celular Tumoral , Feminino , Humanos , Queratina-18/metabolismo , Queratina-7/metabolismo , Queratina-8/metabolismo , Camundongos , Camundongos Endogâmicos NOD , Camundongos SCID , Mucina-1/metabolismo , Transplante de Neoplasias , Fosfatidilinositol 3-Quinases/metabolismo , Receptores Androgênicos/metabolismo , Transplante Heterólogo
9.
Rev Colomb Obstet Ginecol ; 70(1): 58-67, 2019 03.
Artigo em Espanhol | MEDLINE | ID: mdl-31613071

RESUMO

OBJECTIVE: To present one case of Paget's disease (PD) of the breast without associated ductal carcinoma, and to conduct a review of the literature on its diagnosis and treatment. METHODS: 59-year-old woman with a two-year history of a chronic erythematous, ulcerated, itchy lesion in the left nipple, initially treated dermatologically with topical steroids with no improvement, finally visits a primary healthcare institution in the city of Tunja, Colombia for diagnosis. A biopsy and histochemical testing were performed to make the diagnosis and the lesion was then treated with central quadrantectomy. The post-operative pathology testing was negative for malignancy, without recurrence at one-year follow-up. A search was conducted in the PubMed, SciELO, ProQuest, ScienceDirect and Google Scholar databases using the terms "Paget´s Disease," "Breast Neoplasms," "Mammography," "Ultrasonography," Mammary," "Biopsy," and "Mastectomy," tracking bibliographic review articles, editorials, reports and clinical case series in English and Spanish, without time limitation. RESULTS: Overall, 11 publications were included consisting of 5 case reports, 3 case series, 1 review of the literature based on a clinical case, and 2 letters to the editor describing cases related to Paget's disease of the nipple with no associated carcinoma. The diagnosis was based on the clinical suspicion of the disease and a biopsy of the lesion. Histochemistry was useful for the differential diagnosis: treatment options ranged from mastectomy to nipple-areolar complex resection. Radiotherapy has also been used. CONCLUSIONS: The diagnosis of Paget's disease with no associated ductal carcinoma is based on early clinical suspicion and histopathology of the nipple- areolar complex. There is no consensus regarding surgical management of this lesion. Follow-up studies of this subgroup of patients treated with radiotherapy or conservative surgery are required.


Assuntos
Neoplasias da Mama/diagnóstico , Mastectomia Segmentar/métodos , Doença de Paget Mamária/diagnóstico , Biópsia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Colômbia , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Doença de Paget Mamária/patologia , Doença de Paget Mamária/cirurgia
10.
Breast J ; 25(4): 706-708, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31172621

RESUMO

Invasive ductal carcinoma of the nipple-areolar complex is exceedingly rare. Patients who present with bloody nipple discharge with or without the presence of Paget's disease constitute one-third of all symptomatic in situ patients. Only rarely does an invasive cancer cause nipple discharge in the absence of a clinical mass. Even more obscure is the case of the invasive cancer involving solely the nipple-areolar complex. Sir James Paget first described 'an eczematous change in the skin of the nipple preceding an underlying mammary cancer' in 1874, which is now known as Paget's disease, considered to be ductal carcinoma in situ of the nipple-areolar region. There are two competing theories as to the pathogenesis of Paget's disease of the breast-one suggests that Pagetoid cells are keratinocytes that have undergone malignant transformation. According to this theory, Paget's disease of the breast represents an in situ carcinoma of the skin-and that overlying skin changes and underlying malignancy are discontinuous. The second theory suggests that cells migrate along basement membranes and enter the epidermis and dermis of the nipple-areola complex. Pagetoid cells and underlying carcinomas demonstrate similar immunohistochemical staining patterns.


Assuntos
Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/patologia , Mamilos/patologia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/cirurgia , Feminino , Humanos , Mastectomia , Pessoa de Meia-Idade , Doença de Paget Mamária/patologia , Ultrassonografia Mamária
11.
Cancer Med ; 8(8): 4043-4054, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31134761

RESUMO

BACKGROUND: Most mammary Paget disease (MPD) is associated with underlying in situ or invasive breast cancer. The objective of this study was to compare the clinicopathological characteristics and survival outcomes between breast cancer with Paget disease (PD) and breast cancer alone. METHODS: From the Surveillance, Epidemiology, and End Results (SEER) database, 2000-2015, of the US National Cancer Institute, we identified 1569 women who had PD with invasive ductal carcinoma (PD-IDC) and 1489 women who had PD with ductal carcinoma in situ (PD-DCIS). Independent demographic and clinicopathological variables as well as survival outcomes of these patients were compared to patients with the corresponding breast cancer without concomitant PD. RESULTS: PD-IDC and PD-DCIS both had worse survival outcomes and poorer tumor characteristics than the corresponding disease without PD. Contrary to in the breast cancer alone groups, in the breast cancer with PD groups, the HR status (P = 0.182 in PD-IDC and P = 0.371 in PD-DCIS), HER2 status (P = 0.788 in PD-IDC and P = 0.643 in PD-DCIS), and combined molecular subtype (P = 0.196 in PD-IDC and P = 0.853 in PD-DCIS) were not found to affect disease prognosis. After matching tumor characteristics and treatment approaches, PD-IDC as well as PD-DCIS exhibited no significant difference in disease prognosis with corresponding IDC and DCIS. Finally, by comparative analysis, a kind of PD-DCIS (ICD-O-3 code 8543/3) showed many invasive behaviors (31.8% of 8543/3 patients had stage I-III cancer) and was associated with worse survival outcomes than the other type of PD-DCIS. CONCLUSIONS: Breast cancer with concomitant PD was associated with more aggressive tumor characteristics and worse survival outcomes. The HR status, HER2 status, and combined molecular subtype could not affect the prognosis of breast cancer with PD. Moreover, a portion of the PD-DCIS cases were invasive breast cancer cases that required special treatment.


Assuntos
Neoplasias da Mama/epidemiologia , Doença de Paget Mamária/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais , Neoplasias da Mama/etiologia , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Doença de Paget Mamária/etiologia , Doença de Paget Mamária/mortalidade , Doença de Paget Mamária/patologia , Vigilância da População , Prognóstico , Programa de SEER
13.
J Surg Res ; 241: 178-187, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31026796

RESUMO

BACKGROUND: We aimed to analyze the association between Paget's disease (PD) and breast cancer (BC) subtypes and compare the effect of breast-conserving surgery (BCS) as a local treatment with mastectomy for PD. MATERIALS AND METHODS: Data of patients with histologic type International Classification of Diseases-0-3 8540-8543 who were treated from 1973 to 2014 were retrieved from the Surveillance, Epidemiology, and End Results database of the National Cancer Institute. A chi-square test was used to identify differences in categorical data among different groups. Overall survival (OS) was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards models, sequential landmark analysis, and propensity score-matched analysis. RESULTS: The study cohort included 5398 patients. Triple-negative BC accounted for the fewest patients with PD-only (1/22, 4.54%), Paget's disease-ductal carcinoma in situ (PD-DCIS) (3/48, 6.25%), and Paget's disease-invading ductal carcinoma (PD-IDC) (23/352, 6.53%). According to the results of the log-rank test and Cox analysis, the 10-year OS rates were similar for the BCS and mastectomy subgroups among patients with PD-DCIS or PD-IDC. Furthermore, there were no significant differences in survival benefits among the different surgeries after propensity score matching. Landmark analyses for OS of patients with PD-DCIS or PD-IDC surviving more than 1, 3, and 5 y showed no significant differences in survival. There were statistical differences in 10-year OS rates for patients with PD-DCIS or PD-IDC who underwent radiation therapy, or not, following BCS (both, P < 0.001). CONCLUSIONS: For patients with PD-DCIS or PD-IDC, breast conservation therapy with lumpectomy and radiation is an effective local treatment strategy, compared with mastectomy.


Assuntos
Neoplasias da Mama Masculina/terapia , Neoplasias da Mama/terapia , Carcinoma Ductal de Mama/terapia , Carcinoma Intraductal não Infiltrante/terapia , Mastectomia Radical/estatística & dados numéricos , Mastectomia Segmentar/estatística & dados numéricos , Doença de Paget Mamária/terapia , Mama/patologia , Mama/cirurgia , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Neoplasias da Mama Masculina/mortalidade , Neoplasias da Mama Masculina/patologia , Carcinoma Ductal de Mama/mortalidade , Carcinoma Ductal de Mama/patologia , Carcinoma Intraductal não Infiltrante/mortalidade , Carcinoma Intraductal não Infiltrante/patologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Excisão de Linfonodo/estatística & dados numéricos , Masculino , Mastectomia Radical/métodos , Mastectomia Radical/tendências , Mastectomia Segmentar/métodos , Mastectomia Segmentar/tendências , Doença de Paget Mamária/mortalidade , Doença de Paget Mamária/patologia , Seleção de Pacientes , Radioterapia Adjuvante/estatística & dados numéricos , Estudos Retrospectivos , Programa de SEER/estatística & dados numéricos , Resultado do Tratamento
14.
Prog. obstet. ginecol. (Ed. impr.) ; 62(1): 43-46, ene.-feb. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-184893

RESUMO

La enfermedad de Paget pigmentada de la mama es una variante clinicopatológica infrecuente de la enfermedad de Paget, la cual debe incluirse en el diagnóstico diferencial de las lesiones pigmentadas del pezón. Se presenta el caso de una mujer de 49 años que consulta al presentar una mácula pigmentada en el pezón derecho de 9 meses de evolución; y cuyo estudio histológico e inmunohistoquímico permitió diagnosticar una Enfermedad de Paget que se acompaña de una hiperplasia melanocitaria atípica, diferenciándola de un melanoma maligno


Pigmented mammary Paget disease is an uncommon clinicopathological variant of Paget's disease, which should be included in the differential diagnosis of pigmented lesions on the nipple. We present the case of a 49-year-old woman with a 9-month-old pigmented lesión on her right nipple. The histological and immunohistochemical study allowed the diagnosis of a Paget's disease with intense atypical melanocytic hyperplasia, differentiating it from a malignant melanoma


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Doença de Paget Mamária/patologia , Neoplasias da Mama/patologia , Mamilos/patologia , Melanoma/patologia , Mastectomia Segmentar/métodos , Diagnóstico Diferencial , Mamilos/cirurgia
15.
Arch Pathol Lab Med ; 143(2): 206-211, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30124327

RESUMO

CONTEXT.­: Paget disease of the breast, in most cases, represents intraepidermal spread of ductal carcinoma in situ. Molecular subtypes of invasive carcinoma of the breast have prognostic and therapeutic significance and show characteristic distribution. Little is known about the distribution of molecular subtypes in Paget disease of the breast. OBJECTIVES.­: To examine the distribution of molecular subtypes in Paget disease of the breast and to compare them to concurrent invasive carcinoma of the breast, if present. DESIGN.­: We examined 48 cases of Paget disease of the breast with immunohistochemistry and antibodies against estrogen and progesterone receptors, human epidermal growth factor receptor 2 (HER2), and Ki-67, as well as HER2 chromogenic in situ hybridization, to classify the cases into molecular subtypes. Then, we compared the results to the molecular subtypes of associated invasive carcinoma of the breast, if present. RESULTS.­: The HER2 subtype was the most common found in Paget disease of the breast, followed by the luminal B subtype and 2 cases of the triple-negative subtype. The associated invasive carcinoma cases were most often of the luminal B subtype, followed by the HER2 subtype and the triple-negative subtype. The molecular subtype of Paget disease and invasive carcinoma was congruent in most of the cases. CONCLUSIONS.­: Molecular subtypes of invasive carcinoma of the breast can already be detected in Paget disease. The distribution of molecular subtypes of Paget disease and of Paget disease-associated invasive carcinoma differs from invasive carcinoma without associated Paget disease, with the HER2 subtype overrepresented in Paget disease and associated invasive carcinoma and the luminal and triple-negative subtypes underrepresented.


Assuntos
Biomarcadores Tumorais/análise , Neoplasias da Mama/patologia , Doença de Paget Mamária/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imuno-Histoquímica/métodos , Hibridização In Situ/métodos , Masculino , Pessoa de Meia-Idade , Receptor ErbB-2/análise , Receptores Estrogênicos/análise , Receptores de Progesterona/análise
18.
Am J Dermatopathol ; 40(10): 711-720, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30234560

RESUMO

BACKGROUND: Mammary Paget disease and extramammary Paget disease (EMPD) have different prognoses. Because they are indistinguishable on histopathological grounds, they must be distinguished on a topographical basis. OBJECTIVE: To study cases of Paget disease of the breast, which show similarities to EMPD. METHODS: Cases were selected by 2 different approaches: (1) those with an exceptionally good evolution and no evidence of subjacent tumor and (2) those expressing MUC5AC. RESULTS: Five cases were collected. All cases showed an indolent behavior with a known long clinical history in 2 cases (9 and 25 years, respectively) and a long follow-up in all cases but one (4-8 years). In all cases but one, surgery was performed, and no parenchymal tumor was found (either intraductal or infiltrating). All cases expressed cytokeratin 7 and MUC5AC without expression of MUC2, S100, or p40. LIMITATIONS: The short number of cases is a limitation of this study. In addition, case 5 is recent, so we have a very short follow-up. CONCLUSIONS: Some cases of mammary Paget disease behave like EMPD with slow progression and with no underlying associated tumor. Immunoexpression of MUC5AC might be a clue to identify them.


Assuntos
Neoplasias da Mama/patologia , Doença de Paget Extramamária/patologia , Doença de Paget Mamária/patologia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/análise , Biópsia , Neoplasias da Mama/química , Neoplasias da Mama/cirurgia , Diagnóstico Diferencial , Progressão da Doença , Feminino , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Mucina-5AC/análise , Doença de Paget Extramamária/química , Doença de Paget Extramamária/cirurgia , Doença de Paget Mamária/química , Doença de Paget Mamária/cirurgia , Valor Preditivo dos Testes , Prognóstico
19.
S D Med ; 71(8): 350-353, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30110525

RESUMO

Sebaceous carcinoma in situ is a poorly understood and ill-defined entity. In situ sebaceous carcinoma exhibits a similar location pattern to its invasive counterpart in that most commonly has a periorbital distribution. Review of the literature found only seven cases of extraocular sebaceous carcinoma in situ. We present a unique and challenging case of sebaceous carcinoma in situ masquerading both clinically and histologically as Paget's disease of the breast. A 61-year-old female presented to her dermatologist complaining of a 6 mm erythematous waxy papule on her medial right breast. The patient's past medical history was significant for Muir-Torre syndrome. Clinically, the differential diagnosis included Paget disease of the breast, squamous cell carcinoma, and sebaceous carcinoma. A shave biopsy revealed an atypical proliferation of large single cells limited to the epidermis infiltrating in a pagetoid pattern, as well as cohesive nests of round neoplastic cells with mild nuclear atypia, prominent nucleoli, and vacuolated cytoplasm. Histologically, the differential diagnosis included Paget's disease of the breast, squamous cell carcinoma in situ, melanoma in situ, and sebaceous carcinoma in situ. A battery of immunohistochemical stains was performed including CK7, EMA, CAM5.2, CK20, and MART-1. The lesional cells were positive for adipophilin, factor XIIIa, CK7, and EMA and were negative for CAM5.2, CK20, and MART-1 supporting a diagnosis of sebaceous carcinoma in situ. Multiple deeper sections were examined and invasion beyond the epidermis was not identified. This case adds to the paucity of information available regarding extraocular sebaceous carcinoma in situ and warns clinicians of this potential diagnostic pitfall especially in patients with Muir-Torre syndrome.


Assuntos
Adenocarcinoma Sebáceo/patologia , Neoplasias da Mama/patologia , Carcinoma in Situ/patologia , Síndrome de Muir-Torre/complicações , Doença de Paget Mamária/patologia , Neoplasias das Glândulas Sebáceas/patologia , Adenocarcinoma Sebáceo/química , Neoplasias da Mama/química , Carcinoma de Células Escamosas/patologia , Diagnóstico Diferencial , Feminino , Humanos , Imuno-Histoquímica , Melanoma/patologia , Pessoa de Meia-Idade , Neoplasias das Glândulas Sebáceas/química
20.
Zhonghua Zhong Liu Za Zhi ; 40(7): 523-527, 2018 Jul 23.
Artigo em Chinês | MEDLINE | ID: mdl-30060361

RESUMO

Objective: The aim of this study was to explore the clinicopathologic characteristics and prognostic factors of Paget's disease. Methods: 137 patients with Paget's disease of the breast who were diagnosed in Cancer Hospital Chinese Academy of Medical Sciences between January 2007 and May 2016 were identified and included in the study, including 134 females and 3 males. Results: The average age at onset of the disease was 51.8 years(range, 27-78 years). Among the 137 patients, 7 cases were Paget's disease without any other underlying malignancy, who were alive during the follow-up period. The other 130 patients were diagnosed with Paget's disease and underlying ductal carcinoma in situ (DCIS) or (and) with an invasive carcinoma. The positive expression rates of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER-2) were 29.2%(40/137), 38.0%(52/137)and 78.1%(107/137), respectively. The two-year and five-year overall survival were 99.0%, 96.0%, and disease-free survival of two-year and five-year were 97.6%, 92.8%, respectively for all 137 patients. On survival analysis, longer course of disease, HER-2 positivity, tumor stage(T1-T4), and axillary lymph node metastasis were significantly associated with overall survival. Conclusions: Paget's disease of the breast is a slowly progressive malignancy with good prognosis. A longer course of disease, HER-2 positivity, tumor stage, axillary lymph node metastasis and distant metastasis were significantly associated with poor prognosis.


Assuntos
Neoplasias da Mama , Doença de Paget Mamária , Adulto , Idoso , Neoplasias da Mama/metabolismo , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/metabolismo , Carcinoma Intraductal não Infiltrante/mortalidade , Carcinoma Intraductal não Infiltrante/patologia , Intervalo Livre de Doença , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Doença de Paget Mamária/metabolismo , Doença de Paget Mamária/mortalidade , Doença de Paget Mamária/patologia , Prognóstico , Receptor ErbB-2/metabolismo , Receptores Estrogênicos/metabolismo , Receptores de Progesterona/metabolismo , Análise de Sobrevida
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