Paget’s disease of the breast after nipple-areola sparing mastectomy: case report

Introduction: Paget’s disease of the breast is a rare condition which is usually associated with underlying ductal in situ or invasive carcinoma. The incidence of tumor recurrence after mastectomy with preservation of the nipple-areola complex (NAC) is still unclear. Case Report: A 66-year-old woman diagnosed with a high-grade ductal carcinoma in situ underwent a nipple-areola sparing mastectomy, breast reconstruction with submuscular prosthesis, and adjuvant tamoxifen treatment. Eight years following breast surgery, the patient presented with an eczematoid lesion in the NAC. Histopathological exam was consistent with Paget’s disease of the breast. Consider-ations: Only 14 cases of Paget’s disease after nipple-areola sparing mastectomy have been published in the literature. The mean patient age reported was 48.8 years and disease occurred after a mean period of 44.6 months.

Breast neoplasms; Paget’s disease, Mammary; Neoplasm recurrence; Local.

[1] Ashikari R., Park K., Huvos A.G., Urban J.A.: “Paget’s disease of the breast”. Cancer, 1970, 26, 680.

[2] Fu W., Mittel V.K., Young S.C.: “Paget’s disease of the breast: anal-ysis of 41 patients”. Am. J. Clin. Oncol., 2001, 24, 397.

[3] Sakorafas G.H., Blanchard K., Sarr M.G., Farley D.: “Paget’s disease of the breast”. Cancer Treat. Rev., 2001, 27, 9.

[4] Karakas C.: “Paget’s disease of the breast”. J. Carcinog., 2011, 10, 31.

[5] Chen C.Y., Sun L.M., Anderson B.O.: “Paget’s Disease of the Breast: Changing Patterns of Incidence, Clinical Presentation, and Treatment in the U.S.”. Cancer. 2006, 107, 7, 1448.

[6] Mendez-Fernandez M.A., Henly W.S., Geis R.C., Schoen F.J., Haus-ner R.J.: “Paget’s disease of the breast after subcutaneous mastec-tomy and reconstruction with a silicone prosthesis”. Plast. Reconstr. Surg., 1980, 65, 683.

[7] Shearman C.P., Watts G.T.: “Paget’s disease of the nipple after sub-cutaneous mastectomy for cancer with primary reconstruction”. Ann. R. Coll. Surg. Engl., 1986, 68, 17.

[8] Peterse J.L., van Dongen J.A., Bartelink H.: “Recurrence of breast carcinoma after breast conserving treatment”. Eur. J. Surg. Oncol., 1988, 14, 123.

[9] Plastaras J.P., Harris E.E., Solin L.J.: “Paget’s disease of the nipple as local recurrence after breast-conservation treatment for early-stage breast cancer”. Clin. Breast Cancer, 2005, 6, 349.

[10] Harness J.K., Vetter T.S., Salibian A.H.: “Areola and nipple-areola-sparing mastectomy for breast cancer treatment and risk reduction: report of an initial experience in a community hospital setting”. Ann. Surg. Oncol., 2011, 18, 917.

[11] Menzies D., Barr L., Ellis H.: “Paget’s disease of the nipple occur-ring after wide local excision and radiotherapy for carcinoma of the breast”. Eur. J. Surg. Oncol., 1989, 15, 271.

[12] Schnitt S.J., Connolly J.L., Recht A., Silver B., Harris J.R.: “Breast relapse following primary radiation therapy for early breast cancer. II. Detection, pathologic features and prognostic significance”. Int. J. Radiat. Oncol. Biol. Phys., 1985, 11, 1277.

[13] Lohsiriwat V., Martella S., Rietjens M., Botteri E., Rotmensz N., Mastropasqua M.G., et al.: “Paget’s disease as a local recurrence after nipple-sparing mastectomy: clinical presentation, treatment, outcome, and risk factor analysis”. Ann. Surg. Oncol., 2012, 19, 1850.

[14] Parry R.G., Cochran T.C., Wolfort F.G.: “When is there nipple in-volvement in carcinoma of the breast?”. Plast. Reconstr. Surg., 1977, 59, 535.

[15] Goldman L.D., Goldwyn R.M.: “Some anatomical considerations of subcutaneous mastectomy”. Plast. Reconstr. Surg., 1973, 51, 501.

[16] Kothari A.S., Beechey-Newman N., Hamed H., Fentiman I.S., D’Ar-rigo C., Hanby A.M., Ryder K.: “Paget’s disease of the nipple: a mul-tifocal manifestation of higher-risk disease”. Cancer, 2002, 95, 1.

[17] Snyderman R.K.: “Subcutaneous mastectomy with immediate pros-thetic reconstruction. An operation in search of a patient”. Plast. Reconstr. Surg. 1974, 53, 582.

[18] Jamali F.R., Ricci A.Jr., Deckers P.J.: “Paget’s disease of the nipple-areola complex”. Surg. Clin. North. Am., 1996, 76, 365.

[19] Fisher E.R., Gregorio R.M., Fisher B.: “The pathology of invasive breast cancer”. Cancer, 1975, 36, 1.

[20] Paone J.F., Robinson-Baker R.: “Pathogenesis and treatment of Paget’s disease of the breast”. Cancer, 1981, 48, 825.

[21] Yim J.H., Wick M.R., Philpott G.W., Norton J.A., Doherty G.M.: “Underlying pathology in mammary Paget’s disease”. Ann. Surg. Oncol., 1997, 4, 287.

[22] Didier F., Radice D., Gandini S., Bedolis R., Rotmensz N., Mald-ifassi A., et al.: “Does nipple preservation in mastectomy improve satisfaction with cosmetic results, psychological adjustment, body image and sexuality?”. Breast. Cancer Res. Treat., 2009, 118, 623.

[23] Sukumvanich P., Bentrem D.J., Cody H.S. 3rd., Brogi E., Fey J.V., Borgen P.I., Gemignani M.L.: “The role of sentinel lymph node biopsy in Paget’s disease of the breast”. Ann. Surg. Oncol., 2007, 14, 1020.

[24] Laronga C., Hasson D., Hoover S., Cox J., Cantor A., Cox C., Carter W. B.: “Paget’s disease in the era of sentinel lymph node biopsy”. Am. J. Surg., 2006, 192, 481.

[25] Plowman P.N., Gilmore O.J., Curling M., Janvrin S.B.: “Paget’s dis-ease of the nipple occurring after conservation management of early infiltrating breast cancer”. Br. J. Surg., 1986, 73, 45.

[26] Basu C.B., Wahba M., Bullocks J.M., Elledge R.: “Paget’s disease of a nipple graft following completion of a breast reconstruction with a nipple-sparing technique”. Ann. Plast. Surg., 2008, 60, 144.

[27] Giovannini M., D’Atri C., Piubello Q., Molino A.: “Mammary Paget’s disease occurring after mastectomy”. W. J. Surg. Oncol., 2006, 4, 51.