Pigmented mammary Paget disease (PMPD) is a rare subtype of mammary Paget disease that presents as a hyperpigmented patch or plaque over the areola and nipple. We herein report on an unusual case of PMPD with reticulated features in a 98-year-old female. The histology showed intraepidermal pagetoid cells containing melanin pigments without any underlying intraductal carcinoma.
Carcinoma, Intraductal, Noninfiltrating ; Female ; Humans ; Melanins ; Nipples ; Paget's Disease, Mammary

Erosive adenomatosis of the nipple is a rare, benign neoplasm, currently thought to originate from the terminal lactiferous ducts and subareolar breast tissue. Clinically, erosive adenomatosis of the nipple is often indistinguishable from that of mammary Paget's disease, and it could be misdiagnosed as intraductal carcinoma as it has a similar histological finding. We present the case of a 36-year-old woman who had a unilateral erythematous induration of the nipple that contained a palpable, firm nodule. It had first been noticed 2 years earlier. The surface was occasionally crusted, and there was a bloody discharge. Histopathological examination showed irregular, dilated tubular structures, which were lined by a peripheral layer of cuboidal cells and a luminal layer of the columnar cells that demonstrated decapitation secretion at their luminal border.
Adult ; Breast ; Breast Neoplasms ; Carcinoma, Intraductal, Noninfiltrating ; Decapitation ; Female ; Humans ; Nipples ; Paget's Disease, Mammary ; Papilloma ; Phenobarbital

No abstract available.
Breast* ; Carcinoma, Intraductal, Noninfiltrating* ; Fibroadenoma*

No abstract available.
Breast* ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating*

Pigmented mammary Paget's disease is a rare variant of mammary Paget's disease, and this mimics malignant melanoma both clinically and histopathologically. Two women aged 48 and 44 years old, respectively, presented with 2-cm pigmented patches and 1-cm pigmented erosive crusted papules without discharge or palpable masses, respectively. They had previously undergone breast-conserving surgery following the diagnosis of intraductal carcinoma of the breast. Physical examinations and imaging studies revealed no evidence of the recurrence of breast cancer. However, histopathological and immunohistochemical analyses demonstrated the presence of 1) Paget's cells in the epidermis and these cells contained melanin within their cytoplasm and 2) numerous melanophages in the upper dermis. We diagnosed the two patients with pigmented Paget's disease. Subsequent pathological analyses revealed recurrent intraductal carcinoma. We recommend that skin biopsies should be taken from patients presenting with pigmented lesions of the nipple, who have previously undergone breast-conserving treatment, to test the possibility of cancer recurrence.
Aged ; Biopsy ; Breast ; Breast Neoplasms ; Carcinoma, Intraductal, Noninfiltrating ; Cytoplasm ; Dermis ; Epidermis ; Female ; Humans ; Mastectomy, Segmental ; Melanins ; Melanoma ; Nipples ; Paget's Disease, Mammary ; Physical Examination ; Recurrence ; Skin

PURPOSE: Paget's disease of the breast (PDB) occurs in approximately 1~3% of all primary breast carcinomas. This study aimed to determine the optimal surgical treatments for PDB in this study. METHODS: The medical records of 16 patients with PDB who had been treated between January 1986 and December 1998 were clinically reviewed retrospectively. RESULTS: 13 patients had nipple changes consistent with clinical Paget' disease (CPD) including 8 who had an associated breast mass, and 5 who had no associated mass. Of the 13 patients with CPD, 12 were treated with a modified radical mastectomy while 1 was treated with a radical mastectomy. Breast cancer (BC) was found in all of 13 patients (100%) with CPD. The BC was centrally located in 46% of patients including 38% in CPD associated with the mass and 60% in CPD not associated with the mass. Out of 8 CPD patients associated with the mass, 7 (88%) had invasive cancer, 1 (12%) had a ductal carcinoma in situ (DCIS), and 2 (25%) had pathologic axillary nodes (PAN). The 5 year survival rate was 87.5%. Of the 5 CPD patients not associated with the mass, 4 (80%) had an invasive cancer, 1 (20%) had a DCIS and none had PAN. Their 5 year survival rate is 100%. CONCLUSION: All the patients with CPD had an associated BC. BC is more frequently centrally located in the CPD not associated with the mass (60%) than those associated with the mass (38%). Contrarily, the BC in CPD that was not associated with the mass was located more peripherally (40%). Therefore, the treatment of patients with CPD must be individualized in order to avoid under or overtreatment.
Breast ; Breast Neoplasms ; Carcinoma, Intraductal, Noninfiltrating ; Humans ; Mastectomy, Modified Radical ; Mastectomy, Radical ; Medical Records ; Nipples ; Paget's Disease, Mammary* ; Retrospective Studies ; Survival Rate

PURPOSE: Paget's disease of the breast (PDB) occurs in approximately 1~3% of all primary breast carcinomas. This study aimed to determine the optimal surgical treatments for PDB in this study. METHODS: The medical records of 16 patients with PDB who had been treated between January 1986 and December 1998 were clinically reviewed retrospectively. Results: 13 patients had nipple changes consistent with clinical Paget' disease (CPD) including 8 who had an associated breast mass, and 5 who had no associated mass. Of the 13 patients with CPD, 12 were treated with a modified radical mastectomy while 1 was treated with a radical mastectomy. Breast cancer (BC) was found in all of 13 patients (100%) with CPD. The BC was centrally located in 46% of patients including 38% in CPD associated with the mass and 60% in CPD not associated with the mass. Out of 8 CPD patients associated with the mass, 7 (88%) had invasive cancer, 1 (12%) had a ductal carcinoma in situ (DCIS), and 2 (25%) had pathologic axillary nodes (PAN). The 5 year survival rate was 87.5%. Of the 5 CPD patients not associated with the mass, 4 (80%) had an invasive cancer, 1 (20%) had a DCIS and none had PAN. Their 5 year survival rate is 100%. CONCLUSION:All the patients with CPD had an associated BC. BC is more frequently centrally located in the CPD not associated with the mass (60%) than those associated with the mass (38%). Contrarily, the BC in CPD that was not associated with the mass was located more peripherally (40%). Therefore, the treatment of patients with CPD must be individualized in order to avoid under or overtreatment.
Breast ; Breast Neoplasms ; Carcinoma, Intraductal, Noninfiltrating ; Humans ; Mastectomy, Modified Radical ; Mastectomy, Radical ; Medical Records ; Nipples ; Paget's Disease, Mammary* ; Retrospective Studies ; Survival Rate

PURPOSE: Architectural distortion is a suspicious abnormality for the diagnosis of breast cancer. The aim of this study was to investigate the clinical significance of sonographically detected architectural distortion. MATERIALS AND METHODS: From January 2006 to June 2008, 20 patients were identified who had sonographically detected architectural distortions without a history of trauma or surgery and abnormal mammographic findings related to an architectural distortion. All of the lesions were pathologically verified. We evaluated the clinical and pathological findings and then assessed the clinical significance of the sonographically detected architectural distortions. RESULTS: Based on the clinical findings, one (5%) of the 20 patients had a palpable lump and the remaining 19 patients had no symptoms. No patient had a family history of breast cancer. Based on the pathological findings, three (15%) patients had malignancies. The malignant lesions included invasive ductal carcinomas (n = 2) and ductal carcinoma in situ (n = 1). Four (20%) patients had high-risk lesions; atypical ductal hyperplasia (n = 3) and lobular carcinoma in situ (n = 1). The remaining 13 (65%) patients had benign lesions, however, seven (35%) out of 13 patients had mild-risk lesions (three intraductal papillomas, three moderate or florid epithelial hyperplasia and one sclerosing adenosis). CONCLUSION: Of the sonographically detected architectural distortions, 35% were breast cancers or high-risk lesions and 35% were mild-risk lesions. Thus, a biopsy might be needed for an architectural distortion without an associated mass as depicted on breast ultrasound, even though the mammographic findings are normal.
Biopsy ; Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Carcinoma, Lobular ; Humans ; Hyperplasia ; Mammography ; Papilloma, Intraductal

PURPOSE: To compare the mammographic features and histologic subtypes of ductal carcinoma in situ(DCIS) of the breast. MATERIALS AND METHODS: Mammograms of 34 patients with DCIS of the breast detected between January 1992 and November 1998 were retrospectively analyzed. Histologic subtypes were classified as either comedo or noncomedo. Mammographic findings were classified in one of four ways : microcalcification only, microcalcification with mass, mass or asymmetrical density only, or normal. Microcalcifications was classified as either predominantly casting or granular. We also determined whether microcalcification was multifocal. RESULTS: Histologic examination revealed the comedo type in eight patients and the noncomedo type in 26. Among the eight comedo-type cases, mammography demonstrated microcalcification only in five and micro-calcification with mass in three. Among 26 noncomedo-type cases, microcalcifications only was seen in ten, microcalcification with mass in two, mass or asymmetrical density only in six, and normal features in eight. Six of the comedo type were predominantly casting and two were predominantly granular. Predominantly casting calcification was present in four of 12 cases of the noncomedo type and predominatly granular was in eight. Multifocality was seen in four comedo-type cases, but in none of those that were of the noncomedo type. CONCLUSION: We conclude that the comedo subtype of DCIS of the breast is more likely than the noncomedo subtype to be accompanied by microcalcification of the predominantly casting type. Multifocally located microcalcification is a more frequent feature of the comedo subtype than of the noncomedo subtype.
Breast ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Humans ; Mammography ; Retrospective Studies

Recently developed new classifications (Holland, Van Nuys, modified Lagios) of ductal carcinoma in situ (DCIS) linked to outcome have emphasized the importance of nuclear morphology rather than architecture. We have evaluated these three classifications in ductal carcinomas composed of in situ and invasive carcinomas. The reproducibility of three classifications was assessed (n=49), and the histological grade of the DCIS was compared with the histologic differentiation (modified Bloom & Richardson method) and nuclear grade (modified Black method) of the coexisting invasive ductal carcinoma (n=45). According to Holland classification, the DCIS component was poorly differentiated in 51.0%, intermediately differentiated in 40.8%, and well differentiated in 8.2%. Using the Van Nuys classification, the DCIS component was group 3 (high grade with or without necrosis) in 44.9%, group 2 (non-high grade with necrosis) in 28.6%, and group 1 (non-high grade without necrosis) in 26.5%. According to the modified Lagios classification, the DCIS component was high-grade in 42.8%, intermediate-grade in 32.7%, and low-grade in 24.5%. The histologic grades of the three classifications revealed significant correlations between Holland and Van Nuys classification (p<0.0001) and between Holland and modified Lagios classification (p<0.0001), especially in poorly differentiated/group 3/high-grade DCIS. The reproducibility of classification of the DCIS was 71.4% in the Holland, 61.2% in the Van Nuys, and 55.1% in the modified Lagios classifications. The grade of the DCIS showed significant correlation with the grade of coexisting invasive ductal carcinoma (p<0.0001), especially in poorly differentiated/group 3/high-grade DCIS. In conclusion, DCIS grade, determined by the Holland, Van Nuys or modified Lagios classifications, is closely correlated with the histologic grade of the invasive ductal component in tumors composed of in situ and invasive ductal carcinoma, and may be a useful factor to estimate clinical behavior of DCIS. In our experience the Holland classification is recommended for DCIS classification due to its high reproducibility.
Breast* ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Classification* ; Netherlands