Paget's disease of the nipple is associated with underlying breast carcinoma in the majority of cases. What is the pathological hallmark of Paget's disease on nipple biopsy?
- A Paget cells: large cells with clear cytoplasm and prominent nucleoli within the squamous epidermis of the nipple ✓
- B Invasive lobular carcinoma cells infiltrating the dermis of the nipple
- C Hyperkeratosis and acanthosis of the nipple epidermis with eosinophilic deposits
- D Fibromatosis of the nipple stroma with epidermal atrophy
Correct answer: A. Paget cells: large cells with clear cytoplasm and prominent nucleoli within the squamous epidermis of the nipple
Explanation
Paget's disease of the nipple is characterised histologically by large cells with pale/clear cytoplasm, prominent nucleoli, and positive staining for CK7, HER2, and mucin (PAS-positive) within the squamous epithelium of the nipple-areolar complex. These are malignant glandular (adenocarcinoma) cells that have migrated from an underlying DCIS or invasive carcinoma via the lactiferous ducts. In 50-60% of cases a palpable breast mass is present; the remainder have non-palpable underlying DCIS. A negative underlying cancer is exceptionally rare.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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