An Unusual Case of Mammary Paget’s Disease Diagnosed Using Dynamic Contrast-Enhanced MRI

Abstract

Mammary Paget's disease is a rare presentation of breast cancer. At clinical examination, it is characterized by skin lesions of the nipple-areola complex, almost always a sign of malignancy. In fact, it is often associated with an underlying mammary ductal carcinoma in situ (DCIS) or invasive carcinoma. An underlying carcinoma is also common in women with negative mammography and ultrasound (US); in these cases, magnetic resonance imaging (MRI) is a diagnostic tool useful in the detection of occult cancer. We described an unusual case of mammary Paget's disease with underlying DCIS, in a patient without nipple-areola complex alterations and/or palpable lump. On suspicion of Paget's disease, the patient underwent MRI examination that proved useful for an accurate diagnosis. Biopsy confirmed dynamic MRI findings.

Bilateral mammary Paget disease in a young adult female

“…A biopsy from the nipple-areolar region is necessary to confirm the diagnosis [1] . Mammary Paget disease must be differentiated from other conditions, such as atopic or contact dermatitis, chronic eczema, psoriasis, nipple duct adenoma, malignant melanoma, basal cell carcinoma, and Bowen disease [3] .…”

“…However, underlying carcinoma is common even in women with benign mammogram and no palpable mass. Hence, ultrasound and MRI may be useful in detecting the lesion [3] .…”

“…USG findings would include mass, ductal ectasia, flattening, asymmetry, and thickening of the nipple and the areola [3] .…”

“…MRI helps differentiate a normal nipple from an abnormal one and evaluates the extension of the tumor. MRI findings in mammary Paget disease include abnormal nipple enhancement, thickening and enhancement of the nipple-areolar complex, an associated enhancing DCIS or invasive tumor, or a combination of these [3] .…”

“…Mammary Paget disease associated with underlying breast carcinoma should be completely resected with excision of the nipple-areolar complex and radiation therapy of the remaining breast tissue [3] .…”