Presentation
Bloody right nipple discharge associated with skin excoriation. Wedge biopsy of nipple showed Paget disease.
Patient Data
Heterogenous dense breast parenchymal pattern (type C).
An ill-defined microlobulated hypoechoic lesion with microcalcifications at 5 o'clock position of the right breast 3 cm from the nipple suspicious of malignancy.
Ultrasound guided biopsy was performed.
HPE: Invasive Ductal Carcinoma
Breast density pattern: type C (heterogenous dense breast fibroglandular pattern).
Right breast:
Case Discussion
Typical signs of Paget disease are erythema, eczema, scaling, erosion, ulceration and retraction of the nipple-areolar complex that may mislead to a diagnosis of a benign dermatological lesion.
In this case, there was a high index of suspicion toward underlying breast malignancy as patient also had a bloody nipple discharge.
The common histological type of breast carcinoma in Paget disease is DCIS which is a centrally-located tumor. However a peripherally-located tumor (as in this case), commonly have multifocal multicentric lesions because tumors spread along the ducts and show invasive carcinoma. The other histological type is microinvasive carcinoma.
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