Trigger

To date, the exact development of the cancer form “Paget’s disease” has not been determined, but two theories have been developed.One theory, currently considered the most likely, is that the cancer cells (called Paget cells) form a tumor in the breast, which then emerges through the surface and leads to visible skin changes on the nipple. According to this theory, 97% of patients with Paget’s disease already have breast cancer or a similar cell change in the breast where abnormal cells have made their way through the channels of the breast to the nipple. According to this theory, the cancer then spreads to the lymphatic vessels and then to other parts of the body. The other theory says that the cells of the nipple have spontaneously transformed into Paget cells.

Pathogenesis

According to the latest state of science, Paget’s disease of the nipple is an adenocarcinoma, which is caused by the continuous spread of a cancer in the breast (breast cancer). The tumor cells of the adenocarcinoma of the breast (breast) spread continuously and grow into the nipple (nipple) and the skin surrounding it (epidermotropic adenocarcinoma).

Symptoms

Conspicuous is a sharply defined, reddened, slightly scaly focus of inflammation, which starts from the nipple. This focus gradually increases and itches or hurts. An eczema-like appearance develops and often a tumor node is palpable behind the nipple.

Diagnostics

As soon as a unilateral eczema-like skin change in the area of the nipple and areola is detected, this skin change should be examined histopathologically (microscopically).

Histopathology

A close examination of the tissue reveals a diffuse penetration of the epidermis with Paget cells (conspicuously large, clear PAS-positive epidermal cells with bright cytoplasm and large, mostly oval nuclei). The upper skin layer (dermis) contains a so-called lymphohistiocytic inflammatory infiltrate.

Differential Diagnosis

Possible other causes for the skin change of the nipple can be

Nipple Eczema
Contact eczema ( allergy )
Psoriasis (psoriasis)
Skabies (mites)
Bowen’s disease
Superficial basal cell carcinoma