Is Paget’s Disease Of The Breast A Progressive Disease & Alternative Treatments For It?

The pathogenesis of mammary Paget disease and the origin of Paget cells were once controversial. It is now widely accepted that mammary Paget disease is always associated with an underlying carcinoma of the breast.(1)

By thorough histologic examination, Muir documented intraepidermal extension of malignant ductal epithelial cells through the lactiferous ducts and ductules into the epidermis (epidermotropism).(1)

Mammary PD occurs almost exclusively in women; involvement of the male breast is rarely reported and may be more aggressive.(1)

Is Paget’s Disease Of The Breast Progressive?

Paget’s disease of the breast is progressive because at first it is found only at the microscopic level and then goes on rising which may eventually even involve the whole of the breast surface. As Muir (a pathologist) has determined by a histological examination that the cells found in the Paget’s disease of the breast belong to the malignant breast tumor which travels by the lactiferous ducts into the epidermis. This phenomenon is also known as epidermotropism because cells of the malignant breast tumor are attracted to the epidermis which leads to the movement of those cells towards the breast surface.

It presents as an erythematous, eczematous skin lesion with crustation and scale formation on the breast surface usually involving the area around the nipple, hence the name Paget’s disease of the nipple. Cells found in Paget’s disease are known to be positive for ‘ her to neu’ receptor which is a very common entity found in association with breast cancer.

Initially, it travels via one or few lactiferous ducts and presents as a small erythematous area on the breast surface but soon it can involve multiple lactiferous ducts and even the whole of the breast area can be converted into crustaceous and scaly lesions. Its progression also speaks about the progression of cancer within the breast.

Alternative Treatments For Paget’s Disease Of The Breast

Surgical treatment is the mainstay of treatment in this condition because it is almost 100% associated with the underlying breast cancer.(2) Mastectomy meaning the removal of breast tissue is the mainstay of treatment which could be modified or radical depending upon the size of cancerous tissue in the breast. Lymph node removal from the surrounding lymph node groups depending upon the sentinel biopsy and palpable lymph nodes has also to be done to prevent its spread from becoming metastatic cancer.

In case there is no palpable mass in the breast even in the presence of Paget’s disease of nipple/breast and the lesion is of smaller diameter then the conservative form of treatment can be approached. In this, the whole of the breast tissue is not removed but only a part can be removed such as by wedge resection, quadrantectomy, cone resection, local excision, etc.

Conclusion

There is no doubt about the fact that Paget’s disease of the breast which is also sometimes referred as Paget’s disease of the nipple is a progressive disease which starts by small erythematous area on the breast surface around the nipple and may involve whole of the breast surface with crusty and scaly lesions in later stages.

Earlier it was thought to be a separate disease but now it has been found that it is almost a hundred percent associated with underlying palpable mass which may be any type of breast cancer so it has to be treated invariably and as early as possible.

Surgical form of treatment is very effective with a radical approach to complete the whole mastectomy but sometimes depending upon the size of the lesion, a conservative treatment approach can also be followed. Laser treatment has also been used with considerable success to completely cure this condition.

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