Paget's breast disease is a type of cancer that may outwardly have an eczema appearance, with skin changes involving the nipple. This condition is a rare disease that accounts for 1 to 4.3% of all breast cancers and was first described by Sir James Paget in 1874. The condition itself often appears harmless, limited to surface appearance and sometimes fired, indicating underlying breast cancer.
Video Paget's disease of the breast
Signs and symptoms
Paget's disease of the breast may affect the nipple and areola. Symptoms usually affect only one breast. Symptoms may include:
- Skin. The first symptom is usually a rash like eczema. The skin of the nipple and areola may be red, itchy and inflamed. After some time, the skin may become scaly or scaly.
- Disposal. Whitish, which may be colored like straw or bleed, can discharge from the area.
- Sensation. Some women have a burning sensation. These symptoms usually occur at a later stage, when serious damage to the skin often encourages the patient to consult. Lumps or mass in the breast occur in 50% of patients. At a later stage, the disease can cause tingling, increased sensitivity and pain.
- Nipple changed. Putting may turn upside down.
- Breasts change. There may or may not be a lump in the breast, and there may be redness, overflow and hardening of the skin, and wounds that do not heal.
Symptoms usually affect the nipple and then spread to the areola and then the breast. It is common for symptoms to wax and decrease.
Most women do not visit a doctor because they consider Paget's disease to be a mild contact dermatitis or eczema. A skin lump or irritation that does not seem to heal for more than a month indicates that specialist attention is required.
Maps Paget's disease of the breast
Pathophysiology
Paget's disease of the breast is characterized by Paget cells. Paget cells are large cells with clear cytoplasm (clear halo) and eccentric, hyperchromic nuclei found throughout the epidermis.
There is some controversy over whether these cells arise from the breast ductal system, or whether these cells are the result of in situ malignant transformation.
According to migration theory, ductal cell carcinoma in situ migrates to the lactiferous sinus and the skin of the nipple. Cancer cells interfere with normal epithelial barrier and extracellular fluid accumulates on the skin surface, producing skin from the areola skin.
Diagnosis
The recommended tests are mammograms and biopsies to confirm the diagnosis, and cytopathology may also be helpful. Paget's disease is difficult to diagnose because of its similarity to dermatitis and eczema; even in patients after ductal carcinoma in situ surgery. Eczema tends to affect the first areola, and then the nipple, whereas Paget spreads from the nipple.
During a physical exam, the doctor checks the unusual breast area, especially the appearance of the skin on and around the nipple and senses a lump or thickening area.
The most common test used to diagnose Paget's disease is a biopsy, tissue sampling from the affected area which is then examined under a microscope by a pathologist, which differentiates Paget cells from other cell types by staining the tissue to identify specific cells (immunohistochemistry). Samples of nipple fluid may also be examined under a microscope to determine whether a Paget cell is present.
Printing or eroding cytopathology may be useful: scraping cells from the affected area, or pressing them onto a glass slide for examination under a microscope.
On average, a woman may experience signs and symptoms for six to eight months before the diagnosis is made.
Treatment
Paget's disease in the breast is a type of breast cancer. Treatment usually involves a lumpectomy or mastectomy for surgically removing the tumor. Chemotherapy and/or radiotherapy may be necessary, but specific care often depends on the underlying breast cancer characteristics.
Invasive cancer or extensive ductal carcinoma in situ is primarily treated with modified radical mastectomy. This procedure consists of breast removal, a layer above the chest muscle and part of the lymph nodes from under the arm. In the case of noninvasive cancer, a simple mastectomy is performed where only the breast with a layer above the raised chest muscle.
Patients suffering from cancer that have not spread beyond the nipple and surrounding areas are often treated with surgery or breast lumpectomy. They usually undergo radiation therapy after the actual procedure to prevent recurrence. Breast surgery involves removal of the nipple, areola and the affected part of the breast.
In most cases, adjuvant treatment is part of the treatment scheme. This type of treatment is usually given to patients with cancer to prevent potential recurrence of the disease. Whether adjuvant therapy is needed depends on the type of cancer and whether the cancer cell has spread to the lymph nodes. In Paget's disease, the most common type of adjuvant therapy is radiation after breast conservative surgery.
Adjuvant therapy may also consist of anticancer drugs or hormone therapy. Hormonal therapy reduces the production of hormones in the body, or prevents hormones stimulating cancer cells to grow, and it is commonly used in cases of invasive cancer by using drugs such as tamoxifen and anastrozole.
Prognosis
The presence of three factors for prognosis has been suggested, whether there is a palpable mass of the disease, whether the lymph node is positive and whether there is underlying malignant cancer. If absent, the survival of five and 10 years is 85% and 80% respectively, with adjuvant chemotherapy even 95% and 90%. If there is a palpable mass, it is 32% and 31% respectively, with adjuvant chemotherapy (40% and 35%). Positive lymph nodes have been positively associated with palpable masses and affect the prognosis for now only 28% survive after 10 years (vs 79% without palpable mass and without affected lymph nodes). Involvement of the lymph nodes does not directly cause any damage, but only an indicator of systemic spread.
Furthermore, patients with associated breast tumors can be identified to have a 38-40% survival rate at five years and a survival rate of 22-33% at 10 years. The mortality rate of metastatic breast carcinoma in patients with Paget's breast disease and underlying cancer was 61.3%, with a 10-year cumulative survival rate of 33%.
Epidemiology
Most patients diagnosed with Paget's disease in their nipples are over 50, but rare cases have been diagnosed in patients in their 20s. The median age at diagnosis was 62 for women and 69 for men. This disease is rare in women and men.
History
This condition is named after Sir James Paget, an English surgeon who first described the condition in 1874
See also
- List of skin conditions
References
External links
directory
Source of the article : Wikipedia
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