Pagets disease of uncertain origin: case report
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BioMed Central
Open Access
Case report
Pagets disease of uncertain origin: case report Ashok Subramanian*1, Hilary Birch2, Rita McAvinchey3 and Adam StaceyClear1 Address: 1Department of General Surgery, East Surrey Hospital, Canada Avenue, Redhill, Surrey, UK, 2Department of Histopathology, East Surrey Hospital, Canada Avenue, Redhill, Surrey, UK and 3Department of Radiology, East Surrey Hospital, Canada Avenue, Redhill, Surrey, UK Email: Ashok Subramanian* - [email protected]; Hilary Birch - [email protected]; Rita McAvinchey - [email protected]; Adam Stacey-Clear - [email protected] * Corresponding author
Published: 6 May 2007 International Seminars in Surgical Oncology 2007, 4:12
doi:10.1186/1477-7800-4-12
Received: 15 February 2007 Accepted: 6 May 2007
This article is available from: http://www.issoonline.com/content/4/1/12 © 2007 Subramanian et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: Pagets disease of the nipple presents as an eczematous lesion, occurs in 1 – 4% of all female breast carcinoma cases and is invariably associated with underlying malignancy either overt or occult. The majority of these cases are invasive disease although 40–45% are associated with DCIS. Case presentation: A 39 year old lady presented to our unit with a palpable lump in the right breast. Radiological and histological investigation proved this to be an extensive area of Ductal Carcinoma in Situ (DCIS) for which she underwent a simple mastectomy and immediate latissimus dorsi flap reconstruction. Histology revealed high grade DCIS with 2 small foci of invasive carcinoma. At 1 year the patient represented with a nodule adjacent to the reconstruction scar which was proved on biopsy to be consistent with Paget's disease. This was proved on formal excision. Conclusion: In the absence of underlying breast or apocrine tissue this case details a case of Paget's disease of uncertain origin.
Background
Case presentation
Pagets disease of the nipple accounts for between 1–4% of all cases of female breast carcinoma and presents as a chronic eczematous change of the nipple often with an underlying palpable lump. Classically the underlying carcinoma is invasive in nature although in 40–45% of cases the underlying pathology is DCIS. A prerequisite to the development of this condition is the presence of the nipple or at least underlying mammary tissue both of which were absent in this case. We present a case of a 39 year old lady who re-presented with Pagets disease following mastectomy and latissimus dorsi reconstruction, in the absence of a nipple or underlying breast tissue.
A 39 year old lady was referred to our breast unit with a one week history of a lump in the lateral aspect of the right breast. On examination
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