Paget's Disease of the Breast Mimicking a Chronic Wound

Moises Menendez, MD, FACS, CWS; Christopher Menendez, MD; Gary Anzalone, MD

Disclosures

Wounds. 2008;20(12) 

In This Article

Abstract and Introduction

Abstract

Paget's disease of the breast is a rare malignancy of the nipple-areola complex and accounts for 1%—4% of all breast cancers. The disease is frequently associated with an underlying in-situ or invasive carcinoma in the breast tissue that extends to the nipple and areola. Paget's disease is characterized clinically by eczema-like inflammatory skin changes and histologically by malignant cell infiltration in the dermis (Paget's cells). Although Paget's presents less commonly than a palpable mass or mammography abnormality, it is an important consideration in the differential diagnosis of a persisting nipple-areola abnormality. Diagnosis may be delayed by several months or even years because of Paget's seemingly benign appearance. The following case demonstrates this particular situation. Biopsy of a chronic wound that shows no evidence of healing over time is of paramount importance, especially in the case of a chronic breast lesion.

Introduction

Paget's disease (PD) of the breast is a rare malignancy of the nipple-areola complex and accounts for 1%—4% of all breast cancers.[1] The disease is frequently associated with an underlying in-situ or invasive carcinoma in the breast tissue that extends to the nipple and areola. It is characterized clinically by eczema-like inflammatory skin changes and histologically by infiltration of the dermis by malignant cells (Paget's cells). Although less common a presentation than a palpable mass or mammography abnormality, Paget disease of the breast is an important consideration in the differential diagnosis of a persisting nipple-areola abnormality.[2] Because of its seemingly benign appearance, the diagnosis may be delayed by several months or even years, as in the following case. In general, it is of paramount importance to biopsy chronic wounds, which show no evidence of healing over time, especially in the case of a chronic breast wound.

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