title: Invasive Paget disease of the nipple: a brief review of the literature and report of the first case with axillary nodal metastases.
abstract: Although Paget disease of the nipple (PDN) is a well-established clinical and pathological neoplastic process, invasive PDN (IPDN) is a relatively newly described disease. The latter entity is characterized by invasive carcinoma that is localized to the nipple and is associated with PDN as well as with either intraductal and/or invasive carcinoma in the underlying breast. To our knowledge, only 17 cases of IPDN, all node negative, have been reported. Here, we report the case of a 68-year-old woman with invasive Paget disease of the left nipple. The patient had a history of intraductal carcinoma, treated by lumpectomy alone. She presented 6 years later with "eczematous" lesion of the ipsilateral nipple, a punch biopsy of which showed a superficially IPDN as well as conventional PDN. The subsequently performed wide excision of the nipple, areola, and underlying breast tissue showed the invasive carcinoma to span 0.6 cm. Then, 3 months later, the patient presented with ipsilateral palpable axillary lymphadenopathy. Axillary dissection revealed metastatic carcinoma in 7 of 19 lymph nodes. This case of IPDN not only represents the deepest extent of invasion reported thus far but also the only one known to be node positive.
authors.affiliation: Weill Cornell Medical College, New York, NY, USA.
authors.forename: Ugur
authors.initials: U
authors.lastname: Ozerdem
authors.affiliation: Weill Cornell Medical College, New York, NY, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Swistel
authors.affiliation: Weill Cornell Medical College, New York, NY, USA.
authors.forename: Lilian B
authors.initials: LB
authors.lastname: Antonio
authors.affiliation: Weill Cornell Medical College, New York, NY, USA sahoda@med.cornell.edu.
authors.forename: Syed A
authors.initials: SA
authors.lastname: Hoda
mesh_terms: D000368:Aged; D001365:Axilla / Q000473:pathology; D001943:Breast Neoplasms / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology*; D016609:Neoplasms, Second Primary / Q000473:pathology*; D009558:Nipples / Q000473:pathology*; D010144:Paget's Disease, Mammary / Q000473:pathology*
keywords: Paget disease; breast; carcinoma; invasive carcinoma; nipple