Paget’s Disease of the Breast with Underlying Invasive Ductal Carcinoma in a 64-Year-Old Woman: A Case Report

Introduction: Paget’s disease of the breast is a rare manifestation of breast carcinoma involving the nipple–areolar complex and accounts for approximately 1–4% of all breast cancers (Chen et al., 2006). It is frequently associated with underlying ductal carcinoma in situ (DCIS) or invasive carcinoma 2. Its resemblance to benign dermatologic conditions often leads to delayed diagnosis. The Aim of this article is to highlight diagnostic delay and barriers to care. Case Presentation: A 64-year-old multiparous, postmenopausal woman presented with a right nipple–areolar ulcer. Histopathology revealed Paget’s disease with an invasive ductal carcinoma component. There was no evidence of distant metastasis at diagnosis. She was subsequently counselled for neoadjuvant chemotherapy and modified radical mastectomy. Discussion: Paget’s disease is strongly associated with underlying carcinoma, most commonly invasive ductal carcinoma (Sandoval-Leon et al., 2013; Dalberg et al., 2008a). Clinical features often resemble benign dermatologic conditions, leading to diagnostic delay (Dalberg et al., 2008b). Due to the presence of an eczematous lesion, the main differential diagnosis of Paget's disease is nipple eczema, but the unilateral nature, progressive nature and lack of response to corticosteroid therapy make it possible to diagnose the disease. Though like the index case majority of the patients has had to be on prolonged non proper oncological evaluation. Diagnosis is histological, and management depends on the presence and extent of invasive disease. Mastectomy remains an appropriate treatment modality when invasive carcinoma is identified, breast conservation is not an appropriate option because of location of the lesion. Radical treatment (mastectomy) has long been considered the appropriate treatment for Paget's disease of the nipple, due to its frequent association with multifocal or multicentric breast cancer. Conclusion: Persistent nipple ulceration in elderly women warrants prompt biopsy to exclude malignancy. Early recognition and surgical intervention improve outcomes. Increased awareness is required to improve survival in this oncological condition resembling dermatological pathology.