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n engl j med 353;3 w ww.n ej m. or g j ul y 21, 2005

The

new england journal of

medicine

e

3

images in clinical medicine

Paget’s Disease of the Breast

Lindy Peta Fox, M.D.

Yale University School of MedicineNew Haven, CT 06520

Marc E. Grossman, M.D.

Columbia University Medical CenterNew York, NY 10032

70-year-old woman presented with an erythematous, scaly

plaque with a hyperpigmented border that had replaced the areola and com-pletely effaced the nipple of the left breast. No breast mass or lymphadenop-

athy was detected. A skin biopsy demonstrated large round cells, with sizable nuclei

and abundant, pale-staining cytoplasm, permeating singly and in groups throughout the epidermis (inset, arrow). Immunohistochemical staining identified carcinoembry-onic antigen, confirming the diagnosis of Paget’s disease. Mammography and ultraso-nography demonstrated no underlying abnormality in the left breast. A needle-core bi-opsy of a hypoechoic, ill-defined nodule at the areolar margin of the right breast showed benign, nonproliferative fibrocystic changes without atypia. The patient de-clined further treatment and was lost to follow-up. Paget’s disease is often associated with underlying in situ or invasive carcinoma of the breast. Careful physical examinationfor a palpable breast mass or lymphadenopathy is an essential part of the evaluation.

Copyright © 2005 Massachusetts Medical Society.

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