Anatomicoclinical study of Paget's carcinoma ofthe breast
Keywords:
Carcinoma, Pagefs disease ofthe breast, Pagefs carcinoma, NippieAbstract
This is a study ofthe various aspects of Paget's carcinoma ofthe breast. This special and rare
patho/ogy was approached through a clinicai, pathological and therapeutic point of view, calling the
attention ofonco/ogists. Ninety eight patients were retrospective/y studied, during the period ofJanuary,
1980 and December, 1998. Ofthe 6.303 cases of breast câncer studied, the incidence of Paget's carcinoma was 1.55% (97 women andone man). Ages variedbetween 20and90 with an average of 56.9
years, and the higher incidence was between the ages of 50 and 60 (32.6%). The clinicai stages were
based on the TNM system according to the presence or absence ofskin lesions and the size ofthe tumor
when present. Diagnosis was always made based on biopsies ofthe nippie. Paget's ce/lis described as a
cell of glandular origin, abundant cytoplasm, vacuolized, discolored and pale, with a large nucieus,
hyperchromatic and irregular in shape and size, with differing numbers ofmitosis which demonstrate the
ma/ignant characteristic of these cells. Ofthe 98 cases studied, 77(78.57%) presented clinicai Paget's
carcinoma and21 cases (21.42%) were subdinicaiPagefs carcinoma. Thirty one cases (31.63%) presented
nippie skin lesions only and 67 cases (68.37%) presented palpable tumors. AxiHary metastases were
found in two cases (2.04%) in the group which presented skin lesion only, whereas in the palpable
tumor group the percentage was53.73%. As far as treatmentis concerned, surgeryis the best therapeutic
anda Patey-Merola mastectomy/s thepreferred technique. Radiotherapy, chemotherapy andhormone
therapyare usedas comp/ementary treatment when conservative surgeryis usedandin the advanced
cases. The extent ofsurgery depends on each clinicai situa tion but the determining factoris the presence
or absence of a palpable tumor. Pagefs carcinoma ofthe breast, a/though ofiow incidence, is ofgreat
importance in breast câncer. Despite its clinicai symptoms, there is an unacceptab/e deiayin diagnosis.
The majority of lesions are aiways associated with infiltrating ductal carcinoma.
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