- Email: [email protected]
Paget's disease of the male breast
Paget’s
Disease
of the Male
Breast
WILLIAM H. SINKLER, M.D. AND THOMAS J. COOPER, M.D., St. Louis, Missouri
From tbe Departments of General Surgery, Homer G. Phillips Hospital and St. Mary’s Infirmary, Saint Louis, Missouri.
0
disease in a fifty-six year oId Negro man, whose onIy symptom was bIeeding from the nippIe of six months’ duration.
NLY
seven documented cases of Paget’s disease of the maIe breast have been reported in the English Iiterature that is avaiIabIe to us for critica review. Four cases were reviewed by Sarason and Prior [I] with the addition of one of their own. Two additional cases were reported by Treves [2]. Because of the rarity and poor prognosis of this disease in the maIe, we are reporting a case of Paget’s
CASE
REPORT
F. U., a fifty-six year oId Negro man, was admitted to St. Mary’s Infirmary on JuIy 12, 1957, with a-chief compIaint of bIeeding from the Ieft nippIe. The patient stated that six months prior to hospitaIization he first noticed bIood on his undershirt where it came in contact with the Ieft nippIe.
FIG. I. Numerous Iarge neoplastic ceils with cIear cytoplasm, “Paget’s celk,” are present in the squamous epithetium over the nippIe.
FIG. 2. The duct underlying neoplastic ceIIs.
623
American
Journal
the nippIe is fiIIed by the
OJ Surgery,
Volume
98, October,
,999
S:nkIer and Cooper The bleeding was intermittent during this period. There was no history of trauma or chronic irritation to the area. He had never experienced any pain or tenderness in the breast, nor had he noticed any uIceration or change in its size. The past history was essentiaIly negative for abnormalities except for a duodenal uIcer, which was confirmed by x-ray examination and successfuhy treated medicaIIy. On examination, temperature, pulse, respiration and blood pressure were found to be within normaI Iimits. He was we11 developed, well nourished, and the occasiona bIeeding his onIy compIaint. The left breast appeared normal on inspection and was symmetrica with the right breast. On paIpation, there was oozing of dark bIood from the Iower papiIIa of the nippIe, which increased when pressure was appIied. There was a thickening of the duct in this region, but no definite mass couId be palpated. The right breast was normal There were no paIpabIe nodes in the axiIIa or supracIavicuIar regions. The Iaboratory findings were essentiaIIy within norma limits, and the x-ray examination of the chest was negative for parenchymatous disease. The preoperative diagnosis was intraducta1 papilloma with no evidence of carcinoma. The patient was scheduIed for surgery, and the breast was removed. A frozen section was not performed. The pathoIogica1 diagnosis was that of Paget’s disease associated with carcinoma of the duct. The patient was immediateIy prepared and reoperated upon. RadicaI mastectomy was performed. AI1 the tissues were submitted for pathologica studies. On pathoIogica1 examination, the first specimen (SMI-57-900) consisted of an eIIipse of skin incIud-
ing the nipple, areoIa and underIying tissues. No lesion was noted, and the entire specimen was bIocked for microscopic study. One of the origina microscopic sections showed a typical area of Paget’s disease of microscopic size (Fig. I), and the underlying carcinoma of the duct (Fig. 2) was aIso evident. Numerous recuts of the bIock did not show additiona invoivement of the epidermis indicating the smaI1 size of the area. The tissues from the radica1 resection (SMI-57934) did not show residua1 tumor, nor were any of the axiIIary lymph nodes invoIved by neopIasm. The patient’s postoperative course was normaI, and he was discharged on the eighth postoperative day. He has been re-examined on severa occasions since discharge, and has not shown any evidence of recurrence or metastasis. SUMMARY
A case of Paget’s is
reported,$
the
disease of the maIe breast eighth case we couId fmd
recorded in the EngIish Iiterature. BIeeding from the nippIe was the onIy symptom and significant physical finding. AIthough no palpabIe axiIIary nodes were found preoperatively, because of the reported poor prognosis of this disease radica1 mastectomy was performed. REFERENCES I. SARASON, E. L. and PRIOR, J. T.: Paget’s disease of the maIe breast. Ann. Surg., 135: 253, 1952. 2. TREVES, N. Paget’s disease of the male mamma. CU?ZCeT~, 7: 325, 1954.
624
Disease
of the Male
Breast
WILLIAM H. SINKLER, M.D. AND THOMAS J. COOPER, M.D., St. Louis, Missouri
From tbe Departments of General Surgery, Homer G. Phillips Hospital and St. Mary’s Infirmary, Saint Louis, Missouri.
0
disease in a fifty-six year oId Negro man, whose onIy symptom was bIeeding from the nippIe of six months’ duration.
NLY
seven documented cases of Paget’s disease of the maIe breast have been reported in the English Iiterature that is avaiIabIe to us for critica review. Four cases were reviewed by Sarason and Prior [I] with the addition of one of their own. Two additional cases were reported by Treves [2]. Because of the rarity and poor prognosis of this disease in the maIe, we are reporting a case of Paget’s
CASE
REPORT
F. U., a fifty-six year oId Negro man, was admitted to St. Mary’s Infirmary on JuIy 12, 1957, with a-chief compIaint of bIeeding from the Ieft nippIe. The patient stated that six months prior to hospitaIization he first noticed bIood on his undershirt where it came in contact with the Ieft nippIe.
FIG. I. Numerous Iarge neoplastic ceils with cIear cytoplasm, “Paget’s celk,” are present in the squamous epithetium over the nippIe.
FIG. 2. The duct underlying neoplastic ceIIs.
623
American
Journal
the nippIe is fiIIed by the
OJ Surgery,
Volume
98, October,
,999
S:nkIer and Cooper The bleeding was intermittent during this period. There was no history of trauma or chronic irritation to the area. He had never experienced any pain or tenderness in the breast, nor had he noticed any uIceration or change in its size. The past history was essentiaIly negative for abnormalities except for a duodenal uIcer, which was confirmed by x-ray examination and successfuhy treated medicaIIy. On examination, temperature, pulse, respiration and blood pressure were found to be within normaI Iimits. He was we11 developed, well nourished, and the occasiona bIeeding his onIy compIaint. The left breast appeared normal on inspection and was symmetrica with the right breast. On paIpation, there was oozing of dark bIood from the Iower papiIIa of the nippIe, which increased when pressure was appIied. There was a thickening of the duct in this region, but no definite mass couId be palpated. The right breast was normal There were no paIpabIe nodes in the axiIIa or supracIavicuIar regions. The Iaboratory findings were essentiaIIy within norma limits, and the x-ray examination of the chest was negative for parenchymatous disease. The preoperative diagnosis was intraducta1 papilloma with no evidence of carcinoma. The patient was scheduIed for surgery, and the breast was removed. A frozen section was not performed. The pathoIogica1 diagnosis was that of Paget’s disease associated with carcinoma of the duct. The patient was immediateIy prepared and reoperated upon. RadicaI mastectomy was performed. AI1 the tissues were submitted for pathologica studies. On pathoIogica1 examination, the first specimen (SMI-57-900) consisted of an eIIipse of skin incIud-
ing the nipple, areoIa and underIying tissues. No lesion was noted, and the entire specimen was bIocked for microscopic study. One of the origina microscopic sections showed a typical area of Paget’s disease of microscopic size (Fig. I), and the underlying carcinoma of the duct (Fig. 2) was aIso evident. Numerous recuts of the bIock did not show additiona invoivement of the epidermis indicating the smaI1 size of the area. The tissues from the radica1 resection (SMI-57934) did not show residua1 tumor, nor were any of the axiIIary lymph nodes invoIved by neopIasm. The patient’s postoperative course was normaI, and he was discharged on the eighth postoperative day. He has been re-examined on severa occasions since discharge, and has not shown any evidence of recurrence or metastasis. SUMMARY
A case of Paget’s is
reported,$
the
disease of the maIe breast eighth case we couId fmd
recorded in the EngIish Iiterature. BIeeding from the nippIe was the onIy symptom and significant physical finding. AIthough no palpabIe axiIIary nodes were found preoperatively, because of the reported poor prognosis of this disease radica1 mastectomy was performed. REFERENCES I. SARASON, E. L. and PRIOR, J. T.: Paget’s disease of the maIe breast. Ann. Surg., 135: 253, 1952. 2. TREVES, N. Paget’s disease of the male mamma. CU?ZCeT~, 7: 325, 1954.
624