Paget’s disease Of the Breast and Ductal Carcinoma in Situ; Case Report

Yıl 2006, Cilt: 13 Sayı: 1, 63 - 66, 01.02.2006

Reşit Doğan Köseoğlu Hüseyin Ayhan Kayaoğlu Namık Özkan

Öz

Purpose: A case with no clinical signs of a breast mass and an macroscopic evidence of Paget's disease in the mastectomy material is reported. Material Method: Although eczematous nipple changes for 24 months were present in sixty year old woman, clinically, a palpable breast mass was not determined. After the incisional biopsy of right nipple was reported as Paget's disease of the breast, modified radical mastectomy was performed. The tissue sampling was appropriately done in macroscopical examination. After the routine tissue processing and staining procedure, the tissue sections were examined under the light microscopy. Findings: In macroscopical examination of the right mastectomy material, any occupied lesion was noted. When macroscopical examination was continued by thin slices, punctuated calcifications in a 10x9 millimeter area were noted in upper outside quadrant. Two separate foci of ductal carcinoma in situ in both of upper outside and lower inner quadrants were determined in microscopical examination. Metastatic lymph node was not present in axillary dissection material. Result: An underlying breast mass can not present in Paget's disease of the breast or the mass can be too small to determine. Furthermore, the tumoral focus can also be in character of ductal carcinoma in situ. For this reason, when the mastectomy materials of the cases of Paget's disease of the breast are evaluated, it should be kept in mind that only ductal carcinoma in situ focus could be found in mastectomy material as the underlying tumoral lesion in Paget's disease of the breast. Key words: Mammary Paget's disease, Ductal carcinoma in situ, Paget's cells

Anahtar Kelimeler

Mammary Paget's disease, Ductal carcinoma in situ, Paget's cells

Memenin Paget Hastalığı ve Duktal Karsinoma İn Situ: Olgu Sunumu +

Öz

Amaç:Memenin Paget hastalığında ele gelir bir meme kitlesinin saptanmama ve mastektomi materyalinin makroskopik incelemesinde yer kaplayan bir lezyonun görülmeme olasılığı nedeni ile olguyu takdim ediyorum. Gereç ve Yöntem: Altmış yaşındaki kadın hastanın 24 aydır sağ meme başında yaygın ekzematöz değişiklikleri olmakla birlikte klinik olarak ele gelen bir meme kitlesi mevcut değildi. Sağ meme başından yapılan insizyonel biyopsi “memenin Paget hastalığı” olarak rapor edildikten sonra modifiye radikal mastektomi uygulandı. Makroskopik inceleme sonrası alınan örnekler rutin doku takip ve boyama işlemlerinden sonra ışık mikroskobunda incelendi. Bulgular: Mastektomi materyalinin makroskopik incelemesinde herhangi bir yer kaplayıcı lezyon dikkati çekmedi. İnce dilimler halinde incelemeye devam edildiğinde üst dış kadranda 10x9 mm'lik bir alanda noktasal kalsifikasyonlar izlendi. Mikroskopik incelemede biri üst dış kadranda diğeri alt iç kadranda iki ayrı odak halinde duktal karsinoma in situ saptandı. Aksiller lenf düğümlerinde metastaz mevcut değildi. Sonuç: Meme başının Paget hastalığında altta yatan bir meme kitlesi olmayabilir ya da kitle saptanamayacak kadar küçük olabilir. Bununla birlikte tümöral odak duktal karsinoma in situ özelliğinde dahi olabilmektedir. Bu nedenle memenin Paget hastalığı tanısı konan olguların mastektomi materyalleri değerlendirilir iken atlanabilecek küçük tümör ya da duktal karsinoma in situ odaklarının olabileceği akılda tutulmalıdır. Anahtar kelimeler: Memenin Paget hastalığı, Duktal karsinoma in situ, Paget hücreleri

Anahtar Kelimeler

Memenin Paget hastalığı, Duktal karsinoma in situ, Paget hücreleri

Kaynakça

• Sakorafas GH, Blanchard K, Sarr MG, Farley DR. Paget’s disease of the breast. Cancer Treatment Reviews 2001;27:9-18.
• Fu W, Mittel VK,Young SC. Paget Disease of the Breast. Am J Clin Oncol 2001;24:397-400.
• Sheen-Chen SM, Chen HS, Chen WJ, Eng HL, Sheen CW, Chou FF. Paget Disease of the Breast-an Easily Overlooked Disease. J Surg Oncol 2001;76:261-265.
• Wood WS, Hegedus C. Mammary Paget’s Disease and Intraductal Carcinoma. Am J Dermatopathol 1988;10:183-188.
• Cohen C, Guarner J, DeRose PB. Mammary Paget’s Disease and Associated Carcinoma. An immunohistochemical study. Arch Pathol Lab Med 1993;117:291-294.
• Lagios MD, Westdahl PR, Rose MR, Concannon S. Paget’s disease of the nipple.Alternative management in cases without or with minimal extent of underlying breast carcinoma. Cancer 1984;54:545-551.
• Sagami S. Electron microscopic studies in Paget’s disease. Med J Osaka Univ 1963;14:173-188.
• Sagebiel RW. Ultrastructural observations on epidermal cells in Paget’s disease of the breast. Am J Pathol 1969;57:49-64.
• Eusebio RB, Deckers PJ. Paget’s disease of the nipple-areola complex:A plea for conservatism. Contemp Surg 1992;40:13-16.
• Chaudary MA, Millis RR, Lane EB, Miller NA. Paget’s disease of the nipple:a ten year review including clinical,pathological,and immunohistochemical findings. Breast Cancer Res Treat 1986;8:139-146.
• Hitchcock A, Topham S, Bell J, Gullick W, Elston CW, Ellis IO. Routine diagnosis of mammary Paget’s disease.A modern approach. Am J Surg Pathol 1992;16:58-61.
• Yim JH, Wick MR, Philpott GW, Norton JA and Doherty GM. Underlying pathology in mammary Paget’s disease. Ann Surg Oncol 1997;4:287-292.