Abnormal right nipple
The clinical and ultrasound images were very suspicious for a Paget's disease of the nipple, with an infiltrating duct carcinoma with microcalcifications and ductal extension in and immediately behind the nipple. No other abnormalities of the right breast were found with ultrasound. Because of the ulcerating nipple no mammography of the right breast was performed.
Biopsy proved the lesion to be an infiltrating duct carcinoma and the abnormal lymph nodes proved to be axillary lymph node metastases.
Paget's disease of the nipple, also called Paget's disease of the breast, is a rare abnormality of the nipple-areola complex, comprising 0.5-4% of all breast cancers which is often associated with an underlying in-situ or invasive carcinoma in the breast parenchyma.
Most patients diagnosed with Paget disease of the nipple are over age 50.
The patient underwent a modified radical mastectomy and an axillary lymphe node dissection.
References
Nicholson BT, Harvey JA, Cohen MA Nipple-areolar complex: normal anatomy and benign and malignant processes. Radiographics. 2009 Mar-Apr;29(2):509-23.
Da Costa D, Taddese A, Cure ML, Gerson D, Poppiti R Jr, Esserman LE Common and unusual diseases of the nipple-areolar complex. Radiographics. 2007 Oct;27 Suppl 1:S65-77. Review.
Dr. Taco Geertsma is the founder of UltrasoundCases.info and a retired radiologist and has worked in the Gelderse Vallei hospital from January 1, 1983. till July 1, 2014. He was the head of the ultrasound department for many years.
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