Paget's Disease Of The Breast: Clinical-Pathological Findings And Surveillance

Abstract

Aim: In this study we aimed to examine the clinicopathological findings and surveillance of patients with Paget’s disease of the breast (PD). Materials and Method: The medical records of 49 patients diagnosed and treated with PD at Başkent University Faculty of Medicine, General Surgery Clinic between January 2013 and October 2018 were retrospectively analyzed. Results: Mean age of the patients was 52.9±13.6 (26-90). The majority of the patients were women (n:45, 91.8%). The most frequent symptom at the time of admission was palpable mass (n:22, 44.9%). Modified radical mastectomy (MRM) was performed in 31 patients (63.3%), simple mastectomy in 16 patients (32.6%) and breast conserving surgery in 2 patients (4.1%). Sentinel lymph node biopsy (SLNB) in 7 (14.2%) patients and axillary lymph node dissection was performed in one patient. Invasive ductal carcinoma constituted the major histology concomitant with Paget Disease (89.8%). Lymph node involvement (LNI) was present in 29 (59.2%) patients. Palpable mass noticed by the patient and mass size over 20 mm was statistically associated with LNI (p:0.004 for both). Over 50 years of age was associated with a lower recurrence free survival (RFS) (39.2 months vs 64.1 months, p:0.012). RFS was lower in Her2 negative patients (p:0.002). Conclusion: PD is rare, it is an important disease that should not be missed. Although Her2 positivity is generally considered as a poor prognostic factor in breast cancers, we think that those with Her2 negativity may also have a poor prognosis in PD.

Keywords

• diagnosis
• male breast neoplasm
• paget’s disease of breast
• prognosis

Memenin Paget Hastalığında Klinik-Patolojik Bulgular ve Takip Sonuçları

Öz

Amaç: Bu çalışmada, memenin Paget hastalığı (PH) tanısı olan hastaların klinik ve patolojik verilerini ve takip sonuçlarını incelemeyi amaçladık. Gereç ve Yöntem: Ocak 2013 - Ekim 2018 tarihleri arasında Başkent Üniversitesi Tıp Fakültesi Genel Cerrahi Kliniği'nde PH tanısı ve tedavisi alan 49 hastanın tıbbi kayıtları retrospektif olarak incelendi. Bulgular: Hastaların ortalama yaşı 52.9 ± 13.6 (26-90) idi. Hastaların çoğu kadındı (45/49, %91,8). Başvuru anında en sık görülen semptom ele gelen kitle idi (n: 22, %44,9). 31 hastaya (%63,3) modifiye radikal mastektomi (MRM), 16 hastaya (%32,6) basit mastektomi ve 2 hastaya (%4,1) meme koruyucu cerrahi uygulandı. Yedi (%14,2) hastaya sentinel lenf nodu biyopsisi (SLNB) ve bir hastaya aksiller lenf nodu diseksiyonu yapıldı. İnvazif duktal karsinom, PH (%89,8) ile birlikte görülen majör histolojiyi oluşturdu. Lenf nodu tutulumu (LNI) 29 (%59,2) hastada mevcuttu. Hasta tarafından fark edilen ele gelen kitle ve 20 mm'nin üzerindeki kitle boyutu LNI ile istatistiksel olarak ilişkiliydi (her ikisi için p: 0,004). 50 yaş üstü, daha düşük hastalıksız sağ kalım ile ilişkilendirildi (39,2 aya karşı 64,1 ay, p: 0,012). Hastalıksız sağ kalım, Her2 negatif hastalarda daha düşüktü (p: 0.002). Sonuç: PH nadir görülen ancak gözden kaçmaması gereken önemli bir hastalıktır. Her2 pozitifliği genellikle meme kanserlerinde kötü prognostik faktör olarak kabul edilmekle birlikte, Her2 negatifliği olanların da PH'de kötü prognoza sahip olabileceğini düşünüyoruz.

Anahtar Kelimeler

• memenin paget hastalığı
• erkek meme neoplazmları
• prognoz

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