Yonago Acta medica 2003;46:45–48

Mammary Paget’s Disease with Intraductal Spread: aPatient Report
Kunio Araki, Kohei Shomori, Hiroshige Nakamura*, Hironobu Adachi and Hisao Ito
Division of Organ Pathology, Department of Microbiology and Pathology, School of Medicine,
Tottori University Faculty of Medicine, Yonago 683-8503 and *Clinic of Thoracic surgery,
Yonago National Hospital, Yonago 683-8518 Japan
A 49-year-old woman was diagnosed with mammary Paget’s disease and underwent a
modified mastectomy. Paget’s cells were observed not only in the nipple epidermis andadjacent lactiferous ducts, but also at several branches of the lactiferous ducts in the deeper
breast. In treating mammary Paget’s disease, the possibility of intraductal spreads should
be kept in mind.
Key words: breast conservative therapy; intraductal spread; mammary Paget’s disease; modified mastectomy

Mammary Paget’s disease is usually localized in
the nipple epidermis and lactiferous duct near thenipple (Lloyd et al., 2000). Breast conservative
therapy has been attempted for such a patient(Pierce et al., 1997). However, this method may notbe appropriate for all patients with Paget’s disease,because extensive intraductal spreads of Paget’scells have been occasionally found. Here, we reporta case of a patient with mammary Paget’s disease
involved in intraductal spreads to the deeper portions of the breast.

Patient Report
A 49-year-old women was admitted with an eczematous change lasting 5 years, followed by disruption
and serous secretion of the right nipple. A cytological examination of the secretion showed a few
Paget’s cells characterized by abundant clear cytoplasms and large nucleoli (Fig. 1). No palpablemasses or nodules were recognized in the rightbreast and axillally region. Ultrasonography, mam-Fig. 1. A cytological examination of the patient’s nipple
secretion shows a few Paget’s cells characterized byabundant clear cytoplasms occasionally containing large
nucleoli (arrow) (Papanicolaou stain; original magnification × 400). Bar = 50 µm.

Abbreviations: EVG, elastic van Gieson; MRI, magnetic resonance imaging; PAS, periodic acid-Schiff
45K. Araki et al.

Fig. 2. Paget’s cells
characterized by abundant clear cytoplasmsand large nucleoli areobserved in the nipple
epidermis (hematoxylinand eosin stain; originalmagnification × 100).
Bar = 100 µm.

mography and magnetic resonance imaging(MRI) showed no abnormal findings of any
underlying mass or micro-calcification in thebreast. She was diagnosed with mammary
Paget’s disease, which was clinically corresponded to Tis N0 M0, stage 0 according to thetumor-node-metastasis classification of The
Japanese Breast Cancer Society (2000). After
giving informed consent, she underwent a
modified mastectomy with a level-II axillary
dissection, because preoperative imaging results including ultrasonography, mammography and MRI were inconclusive in detecting
any underlying tumor or intraductal spread of
Paget’s cells (Dixon et al., 1991; Kothari et al.,2002).
Macroscopically, the removed right breast
showed no solid tumor, calcification, necrosis
or hemorrhage. The specimen was sliced at 5mm-interval serial sections, fixed in 10% buf-Fig. 3. Paget’s cells spread into the superficial lactiferous ducts (arrow) near the nipple (hematoxylinand eosin stain; original magnification × 40). Bar =100 µm.

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