Paget disease of the nipple presents as erythematous, eczematous nipple change with underlying breast carcinoma. The characteristic Paget cells on histology are:
- A Melanoma cells spreading from a subareolar primary tumour
- B Basal cell carcinoma extending from the periareolar skin
- C Large malignant cells with pale cytoplasm and prominent nucleoli within epidermis, originating from ductal carcinoma ✓
- D Langerhans cell histiocytosis infiltrating the nipple epidermis
Explanation
Paget disease of the nipple consists of large carcinoma cells with abundant pale (pale-to-clear) cytoplasm, prominent nucleoli, and occasionally intra-cytoplasmic mucin within the squamous epithelium of the nipple and areola. These cells represent direct epidermotropic spread of HER2-overexpressing ductal carcinoma cells migrating from the underlying ducts along the nipple epidermis without disrupting the basement membrane. They are immunoreactive for CK7, CEA, and HER2. Melanoma cells express HMB-45 and S-100; BCC cells show palisading and keratin pearls; Langerhans cells are CD1a/S-100-positive histiocytes.
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.