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Case of the Month

May 2009

Patient Data: 73 year old female patient

Clinical Info: Abnormal right nipple

Ultrasound image of the nipple with a swollen nipple with microcalcifications

Image of the patient with abnormal nipple

Detail image of the nipple

Ultrasound image of the nipple with calcifications

There is also an irregular hypoechoic infiltrating mass behind the nipple

Image of the axilla with enlarged hypoechoic rounded lymph nodes.

The clinical and ultrasound images were very suspicious for a Paget's disease of the nipple, with an infiltrating duct carcinoma with microcalcifications and ductal extension in and immediately behind the nipple. No other abnormalities of the right breast were found with ultrasound. Because of the ulcerating nipple no mammography of the right breast was performed.
Biopsy proved the lesion to be an infiltrating duct carcinoma and the abnormal lymph nodes proved to be axillary lymph node metastases.
Paget's disease of the nipple, also called Paget's disease of the breast, is a rare abnormality of the nipple-areola complex, comprising 0.5-4% of all breast cancers which is often associated with an underlying in-situ or invasive carcinoma in the breast parenchyma.
Most patients diagnosed with Paget disease of the nipple are over age 50.
The patient underwent a modified radical mastectomy and an axillary lymphe node dissection.

See also

Nicholson BT, Harvey JA, Cohen MA Nipple-areolar complex: normal anatomy and benign and malignant processes. Radiographics. 2009 Mar-Apr;29(2):509-23.
Da Costa D, Taddese A, Cure ML, Gerson D, Poppiti R Jr, Esserman LE Common and unusual diseases of the nipple-areolar complex. Radiographics. 2007 Oct;27 Suppl 1:S65-77. Review.

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