IJCRR - 7(8), April, 2015
CLINICOPATHOLOGICAL AND IMMUNOHISTOCHEMICAL PROFILE OF MAMMARY PAGET DISEASE
Author: Salma Bhat, Rohi Wani, Samina Khanday, Sheema Sheikh, Ruby Reshi, Humaira Bashir
Mammary Paget disease (MPD) is a rare manifestation of the nipple-areola complex that is often associated with an underlying in situ or invasive carcinoma. MPD is very often hormone receptor negative. However, unlike ER and PR, Her 2 neu receptor is overexpressed in the vast majority of Mammary paget disease. In this study we have evaluated the clinicopathological and immunohistochemical aspects of this disease. In this retrospective study, all cases of mammary Paget disease referred to the Department of pathology, Government Medical College Srinagar from 2006 till 2013 were evaluated. Collective data were analysed by descriptive statistical analysis methods.There were 19 cases of Mammary paget disease reported from 2006 to 2013. All but one of the MPD cases were associated with an underlying ductal carcinoma .The underlying breast malignancy was high grade with a significant proportion having axillary nodal involvement. One patient had underlying DCIS. On IHC , only two cases of MPD were ER and PR positive. There was a single triple negative MPD case. Conversely Her2 neu was strongly positive in sixteen cases of MPD .The same immunohistochemical spectrum was shared by underlying breast carcinoma including DCIS.
MPD is often associated with extensive underlying malignancy which is of high grade and is frequently Her2 neu positive with a resulting poor prognosis. Therefore for patients with clinical suspicion of MPD breast examination, mammography and even biopsy are highly recommended.
Keywords: Mammary Paget disease, Ductal carcinoma, Her2 neu
Salma Bhat, Rohi Wani, Samina Khanday, Sheema Sheikh, Ruby Reshi, Humaira Bashir. CLINICOPATHOLOGICAL AND IMMUNOHISTOCHEMICAL PROFILE OF MAMMARY PAGET DISEASE International Journal of Current Research and Review. 7(8), April, 63-66
1. Kollmorgen DR, Varanasi JS, Edge SB, Carson WE 3rd. Paget’s disease of the breast: a 33-year experience. J Am Coll Surg. 1998;187:171-177.
2. Paget J. On the disease of the mammary areola preceding cancer of the mammary gland. St. Bartholomew Hosp. Rep. 1874;10:87-89.
3. Karakas C. Pagets disease of the breast.J carcinog 2011;10:31.
4. Kanitakis J. Mammary and extramammary Paget›s disease. J Eur Acad Dermatol Venereol 2007;21:581-90.
5. Yim JH, Wick MR, Philpott GW, Norton JA, Doherty GM. Underlying pathology in mammary Paget›s disease. Ann Surg Oncol 1997;4:287-92.
6. Sakorafas GH, Blanchard K, Sarr MG, Farley DR. Paget›s disease of the breast. Cancer Treat Rev 2001;27:9-18.
7. Martin VG, Pellettiere EV, Gress D, Miller AW. Paget›s disease in an adolescent arising in a supernumerary nipple. J Cutan Pathol 1994;21:283-6.
8. Elzbieta Marczyk,Anna kruczak,Aleksandra Ambicka et al.The routine immunohistochemical evaluation in Paget disease of the nipple.Pol J Pathol 2011;4:229-235.
9. Tanskanen M, Jahkola T, Asko-Seljavaara S, et al. Her2 oncogene amplification in extramammary Paget’s disease. Histopathology 2003; 42: 575-579.
10. Schelfhout VR, Coene ED, Delaey B, Thys S, Page DL, De Potter CR. Pathogenesis of Paget›s disease: epidermal heregulin-alpha, motility factor, and the HER receptor family. J Natl Cancer Inst 2000;92:622-8.
11. Sek P, Zawrocki A, Biernat W, Piekarski JH. HER2 molecular subtype is a dominant subtype of mammary Paget›s cells. An immunohistochemical study. Histopathology 2010;57:564-71.
12. Ling H, Hu X, Xu X-L, Liu Z-B, Shao Z-M (2013) Patients with Nipple-Areola Paget’s Disease and Underlying Invasive Breast Carcinoma Have Very Poor Survival: A Matched Cohort Study. PLOS ONE 8(4).
13. Sandoval Leon AC, Drews- Elger K, Gomez Fernandez CR et al. Paget’s disease of the nipple.Breast Cancer Res Treat.2013;141(1):1-12.
14. Fouad Dina. Paget›s disease of the breast in a male with lymphomatoid papulosis: a case report. Journal of Medical Case Reports 2011; 5:43.
15. Chen CY.,Sun L-M and Anderson B-O. Paget disease of the breast: changing patterns of incidence, clinical presentation, and treatment in the U.S. Cancer. 2006 Oct 1;107(7):1448-58.
16. Xie B, Zheng H, Lan H, Cui B, Jin K, Cao F. Synchronous bilateral Paget›s disease of the breast: A case report Oncol Lett. 2012 Jul; 4(1):83-85.
17. Marques-Costa, JC; Cuzzi, T; Carneiro, S; Parish, LC; Ramos-e-Silva, M (May–Jun 2012). «Paget›s disease of the breast.». Skinmed 10 (3): 160-5.
18. M Muttarak, B Siriya, P Kongmebhol, B Chaiwun, and N Sukhamwang.Paget’s disease of the breast: clinical, imaging and pathologic findings: a review of 16 patients Biomed Imaging Interv J. 2011 Apr-Jun; 7(2): e16.
19. Goro Amano,Mioko Yajima,Yasunori Moroboshi, Yoshiki kuriya and Noriaki Ohuchi. MRI Accurately Depicts Underlying DCIS in a Patient with Paget’s Disease of the Breast Without Palpable Mass and Mammography Findings. Jpn. J. Clin. Oncol. (2005) 35 (3):149-153.
20. Lioyd J and Flanagan AM. Mammary and extramammary Paget’s disease. J Clin Pathol. Oct 2000; 53(10): 742-749..
21. Caliskan M, Gatti G, Sosnovskikh I, et al. Paget’s disease of the breast: the experience of the European Institute of Oncology and review of the literature. Breast Cancer Research and Treatment 2008;112(3):513-521.
22. Lester T1, Wang J, Bourne P, Yang Q, Fu L, Tang P. Different panels of markers should be used to predict mammary Paget’s disease associated with in situ or invasive ductal carcinoma of the breast. Ann Clin Lab Sci. 2009 Winter;39(1):17-24.
23. Kothari AS., Beechey-Newman N, Hamed H, Fentiman IS, D›Arrigo C, Hanby AM, Ryder K. Paget disease of the nipple: a multifocal manifestation of higher-risk disease. Cancer. 2002 Jul 1;95(1):1-7.
24. Siponen E1, Hukkinen K, Heikkilä P, Joensuu H, Leidenius M Surgical treatment in Paget›s disease of the breast Am J Surg. 2010 Aug;200(2):241-6.
25. Fu W1, Lobocki CA, Silberberg BK, Chelladurai M, Young SC Molecular markers in Paget disease of the breast.J Surg Oncol. 2001 Jul;77(3):171-8.
26. Liegl B,Horn LC,Moifar F.Androgen receptors are frequently expressed in mammary and extramammary Paget’s disease.Mod Pathol 2005Oct;18(10):1283-8.