Memenin Paget Hastalığı Deneyimimiz

Abstract

Amaç: Memenin Paget hastalığı meme başında karekteristik egzematöz değişikliklerle seyreden, tüm meme kanserli hastaların % 1-4.3 'ünü oluşturan nadir bir hastalıktır. Bu çalışmada memenin Paget hastalığı tanısıyla cerrahi tedavi uyguladığımız hastalarımızın klinikopatolojik bulgularını ve tedavi yaklaşımımızı sunmayı amaçladık. Yöntem ve Gereçler: Kliniğimizde 2006-2013 yılları arasında memenin Paget hastalığı nedeniyle tedavi gören 13 hastanın tıbbi kayıtları geriye dönük olarak incelendi. Bulgular: Kliniğimize başvuran meme kanserli hastaların % 3,15'ini memenin Paget hastalığı oluşturduğu saptanmıştır. Hastaların ortanca yaşı 54(29-87) idi. Meme başında lezyon olan hastaların topikal tedavi kullanımı nedeniyle tanı konulmasında gecikme olduğu görüldü. Meme başında lezyon dışında memede kitle diğer başvuru şikayeti idi. Hastaların tamamına modifiye radikal mastektomi uygulandı. Hastalar ortalama 27 (3-52) ay takip edildi. Radyolojik incelemeyle yanlış negatif sonuçlar olabileceği görüldü. Özellikle DKIS olan hastalarda ultrasonografinin yararı olmadığı görüldü. Takip süresince bir hastada multipl kemik meteastazları gelişti. Diğer hastalarda nüks ya da metastaz saptanmadı. Sonuç: MemeninPaget hastalığı, meme başında egzematöz değişikliklerle karakterize, tamamına yakını altta yatan invaziv veya non-invaziv meme kanseri ile ilişkili bir hastalıktır. Nadir olarak altta malign bir patoloji olmadan da hastalık gelişmektedir. Memenin Paget hastalığı öncelikle bir klinik tanıdır. Kullanılan topikal tedaviler veya tanının sadece radyolojik bulgulara dayandırılması tanıda gecikmeye neden olabilir. Oluşabilecek nüksler göz önüne alındığında, standart tedavisi mastektomidir. Ancak uygun hastalara meme koruyucu cerrahi de yapılabilir.

Keywords

• Meme kanseri, meme başı, Paget hastalığı, meme

Experience with Paget's Disease of the Breast

Abstract

Objective: Paget's disease of the breast is a rare disease, is just 1-4.3% of all breast cancer patient and causing characteristic eczematous changes at the nipple. In this study, we aimed to present clinicopathological findings and treatment approach of the patients were treated surgically in the diagnosis of Paget's disease of thebreast. MaterialsandMethods: Thirteen patients medical records, which were treated for Paget's disease of the breast in our clinic between 2006 - 2013, were analyzed retrospectively. Results: 3.15% of patients admitted to our clinic with breast cancer has been diagnosed as Paget's disease of the breast. The median age of patients was 54 (29-87) years. It was found that the use of topical treatment of patients with lesion in the nipple causes delay in diagnosing. The other complaint of the patients was the breast mass. All patients were performed modified radical mastectomy procedure. Patients were followed up for an average of 27 (3-52) months. Radiologic examinations has shown there may be false-negative results. Ultrasonography showed no benefit, especially in patients with DCIS. There has been a patient with multiple bone metastases during follow-up. There was no recurrence or metastasis on the other patients. Conclusion: Paget's disease is primarily a clinical diagnosis. Topical treatments and diagnosing only based on radiological findings may cause delay in diagnosis. In consideration of occurrence of relapses, mastectomy is the Standard treatment. However, breast-conserving surgery can also be done in selected patients.

Keywords

• Breast cancer, nipple, Paget’s disease, mammary

References

1. Caliskan M, Gatti G, Sosnovskikh I, Rotmensz N, Botteri E, Musmeci S, Rosali dos Santos G, Viale G, Luini A. Paget’s disease of the breast: the experience of the European Institute of Oncology and review of the literature. Breast Cancer Res Treat 2008; 112: 513-521.
2. Tavassoli FA. Pathology of The Breast. Norwalk, Connecticut: Appleton and Lange: McGraw-Hill; 1999: 731- 760.
3. Rosen PP. Paget’s disease of the nipple. Rosen’s breast pathology. Philadelphia: Lippincott Williams & Wilkins; 2001: 565-580.
4. Sakorafas GH, Blanchard K, Sarr MG, Farley DR. Paget’s disease of the breast.Cancer Treat Rev 2001; 27: 9-18.
5. Kollmorgen DR, Varanasi JS, Edge SB, Carson WE 3rd. Paget’s disease of the breast: a 33-year experience. J Am Coll Surg 1998; 187: 171-177.
6. Kothari AS, Beechey-Newman N, Hamed H, Fentiman IS, D’Arrigo C, Hanby AM, Ryder K. Paget disease of the nipple: a multifocal manifestation of higher-risk disease. Cancer 2002; 95: 1-7.
7. Kanitakis J. Mammary and extramammary Paget’s disease. J Eur Acad Dermatol Venereol 2007; 21: 581-590.
8. Yim JH, Wick MR, Philpott GW, Norton JA, Doherty GM. Underlying pathology in mammary Paget’s disease. Ann Surg Oncol 1997; 4: 287-292.

9. Ascenso AC, Marques MS, Capitao-Mor M. Paget’s disease of the nipple. Clinical and pathological review of 109 female patients. Dermatologica 1985; 170: 170-179.
10. Ikeda DM, Helvie MA, Frank TS, Chapel KL, Andersson IT. Paget disease of the nipple: radiologic-pathologic correlation. Radiology 1993; 189: 89-94.
11. Gunhan-Bilgen I, Oktay A. Paget’s disease of the breast: clinical, mammographic, sonographic and pathologic findings in 52 cases. Eur J Radiol 2006; 60: 256-263.
12. Yang WT, King W, Metreweli C. Clinically and mammographically occult invasive ductal carcinoma diagnosed by ultrasound: the focally dilated duct.Australas Radiol 1997; 41: 73-75.
13. Frei KA, Bonel HM, Pelte MF, Hylton NM, Kinkel K. Paget disease of the breast: findings at magnetic resonance imaging and histopathologic correlation. Invest Radiol 2005; 40: 363-367.
14. Karakas C. Paget’s disease of the breast. J Carcinog 2011; DOI: 10. 4103/1477-3163. 90676.
15. Schelfhout VR, Coene ED, Delaey B, Thys S, Page DL, De Potter CR. Pathogenesis of Paget’s disease: epidermal heregulin-alpha, motility factor, and the HER receptor family. J Natl Cancer Inst. 2000; 92: 622-628.
16. Jahn H, Osther PJ, Nielsen EH, Rasmussen G, Andersen J. An electron microscopic study of clinical Paget’s disease of the nipple. APMIS, 1995; 103: 628-634.
17. Kawase K, Dimaio DJ, Tucker SL, Buchholz TA, Ross MI, Feig BW, Kuerer HM, Meric-Bernstam F, Babiera G, Ames FC, Singletary SE, Hunt KK. Paget’s disease of the breast: there is a role for breast-conserving therapy. Ann Surg Oncol. 2005; 12: 391-397.
18. Paone JF, Baker RR. Pathogenesis and treatment of Pag- et’s disease of the breast. Cancer, 1981; 48: 825-829.
19. Dixon AR, Galea MH, Ellis IO, Elston CW, Blamey RW. Paget’s disease of the nipple.Br J Surg 1991;78:722-3.
20. Stockdale AD, Brierley JD, White WF, Folkes A, Ros- tom AY. Radiotherapy for Paget’s disease of the nipple: a conservative alternative. Lancet, 1989; 2: 664-666.
21. Van Dongen JA, Voogd AC, Fentiman IS, Legrand C, Sylvester RJ, Tong D, van der Schueren E, Helle PA, van Zijl K, Bartelink H. Long-term results of a randomized tri- al comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Can- cer 10801 trial. J Natl Cancer Inst. 2000; 92: 1143-1150.