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DISEASE (MPD)
MAMMARY PAGET DISEASE (MPD)/
PD OF THE NIPPLE/ PD OF THE BREAST
Epi-
dermal PAGET Glandular
stem
Toker cells
cells CELLS
ETIOLOGY OF MPD
4) Psoriasis
5) Amyloidosis
8) Drug Eruptions
9) Malignant melanoma
INVESTIGATIONS OF MPD
INVESTIGATIONS OF MPD
I. Imaging: “3”
• Mammography
• MRI
• Ultrasound
MPD: an area with microcalcifications in the lower inner left quadrant with
extension towards the nipple which shows retraction and some
calcifications within, there is also minimal extension towards the lower
outer left quadrant.
Paget's disease. Cranio-caudal mammograms of left breast of a patient
diagnosed with Paget. Area of 10 cm that affects the external cuadrants
which identifies multiple pleomorphic microcalcifications, very suspicious
of malignancy, which at higher magnification (right) continue the road of
the nipple lactiferous duct (arrow)
MPD in right breast, unifocal, isolated in nipple.
BREAST PAGET DISEASE. 75 years old woman presenting a lesion in the
left nipple since 2 weeks ago. ULTRASOUND left retroareolar area:
where microcalcifications can be identied.
INVESTIGATIONS OF MPD
1. MAMMOGRAPHY:
Radiographic changes seen in MPD include the following: “4”
1. Subareolar microcalcifications (helpful in evaluating and locating
clinically occult, nonpalpable underlying breast carcinoma)
2.Architectural distortion
3.Thickening of the nipple and the areola (reflecting edema)
4.Nipple changes (in a minority of patients)
Negative preoperative mammography findings did not
reliably exclude an underlying carcinoma.
INVESTIGATIONS OF MPD
THE EPIDERMIS:
Hyperkeratosis or parakeratosis.
Acanthosis, with papillomatosis.
Enlargement of the rete ridges.
Characteristic Paget’s cells singly or in clusters (nests) are dispersed
between the prickle cells. They vary in number, and when profuse
the Malpighian layer may be disrupted and the surface covered by a
crust.
In the later stages, the epidermis may be atrophic or eroded.
HISTOPATHOLOGY OF MPD
1. PAS STAIN:
Paget’s cells shows PAS positive diastase-resistant granules,
indicating the presence of neutral mucopolysaccharides and
supports the glandular origin of the cells.
2. Alcian blue:
Positive.
IMMUNOHISTOCHEMISTRY
1. Anti-s-100 protein
2. Melan A (MART-1)
3. HMB-45
4. Tyrosinase
5. DOPA
STAGING OF MPD
STAGING OF MPD
Stage 1 Associated with in situ ductal carcinoma just beneath the nipple
Type 1b
primary cutaneous extramammary Paget disease (15-25%) is associated
with invasive Paget disease or adenocarcinoma in situ.
Type 2
extramammary Paget disease originates from underlying anal or rectal
adenocarcinoma
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