Paget’s disease of the male breast: a case report

Abstract

The patient was a 91-year-old man with change in nipple appearance, itching and redness, and a palpable breast mass. At presentation, mammary Paget’s disease (PD) was clinically suspected. Skin biopsy was performed and showed epidermis invaded by Paget cells, characterized by hyperchromatic nuclei and abundant pale-staining cytoplasm. Computed tomography and mammary ultrasonography confirmed the absence of an underlying invasive carcinoma, and the patient underwent right mastectomy and sentinel lymph node biopsy (SLNB). Both sentinel lymph nodes were found to be negative perioperatively, and further axillary dissection was not performed. Pathological results revealed no malignancy under the nipple, yet the Paget cells were more widely spread than expected. The patient was followed up without the need of postoperative chemotherapy. Male mammary PD is an extremely rare breast cancer, and there is no standard preoperative assessment or operative procedure. Mammography is many times unable to detect possible underlying breast carcinoma in female patients with mammary PD, and previous studies have reported that the detection rate was less than 50 %. However, some researchers reported that magnetic resonance imaging (MRI) might be more detectable to confirm the extent of the cancer. The extent of the skin change around the nipple is often different from the actual perimeter of Paget cells. In extra-mammary PD, mapping biopsy is known to be useful to determine areas free of cancer. The benefits of SLNB have also been demonstrated for the management of less invasive breast cancers, and previous reports have shown that the use of SLNB is reasonable for treatment of mammary PD without underlying invasive cancer. MRI, mapping biopsy, and SLNB are all less invasive procedures and thus may be suitable for treatment of male mammary PD.

Male Breast Cancer Associated with Paget’s Disease: A Case Report

“…Therefore, male mammary PD is extremely rare (1). Between 1980 and 2015, only nine case reports were published in the literature on male breast cancer with PD (1). Our data suggest that the prognosis of male Paget's cancer is worse than in "ordinary" male breast cancer.…”

“…Male breast cancer is also very rare, representing nearly 1.0% of all breast malignancies. Therefore, male mammary PD is extremely rare (1). Between 1980 and 2015, only nine case reports were published in the literature on male breast cancer with PD (1).…”

A Paget's disease Case of Breast without Underlying Carcinoma

“…Paget's disease is rarely seen in men as well. Although clinical and histopathological differences are not observed in male patients, Paget's disease may be worse in terms of progress [8].…”

Paget’s disease of breast with an unusual presentation of involvement of overlying skin of breast: a case report

“…14 Treatment options include; lumpectomy including nipple areola complex with whole breast radiation therapy or total mastectomy±sentinel node biopsy with or without breast reconstruction, central lumpectomy including nipple areola complex±sentinel lymph node biopsy without radiation therapy. 2,[15][16][17] Depending upon stage and other features of underlying breast tumor (presence or absence of lymph node involvement, ER/PR receptors and HER 2neu protein over expression in tumor cells, adjuvant therapy and/or hormonal therapy may also be recommended. 2,16 Unfavorable prognosis of Paget's disease depends on the presence of invasive cancer, axillary lymph node spread, histological type of breast cancer, age >60 years.…”