Case Number : Case 1268 - 04 May Posted By: Guest

Paget's. CAM5.2 positivity is against pagetoid Bowen's.

I agree with Paget´s disease diagnosis.

Paget's.

Agree, Paget's disease.

I also thought this was Paget's disease. My diagnosis is below. I thought it was curious that there were Cam 5.2 cells present in the dermis, thus my comment:

SKIN, RIGHT NIPPLE , PUNCH BIOPSY :
[b]-- PAGET'S DISEASE[/b]
[indent=1][b]COMMENT: [/b]The presence of Paget's cells within the dermis was a recent subject of study by Korean authors (Lee et al), in 2014, where they found that "the prognosis was similar for invasive mammary Paget's disease and non-invasive mammary Paget's disease, and the mammary Paget's disease must be distinguished from locally advanced breast cancer presenting as satellite skin nodules.” Thus, further correlation for breast disease is warranted at this point.[/indent]


[center]Reference:[/center]


[indent=1]Lee HW, Kim TE, Cho SY, Kim SW, Kil WH, Lee JE, Nam SJ, Cho EY. Invasive Paget disease of the breast: 20 years of experience at a single institution. Hum Pathol. 2014 Dec;45(12):2480-7. doi: 10.1016/j.humpath.2014.08.015. Epub 2014 Sep 7. PubMed PMID: 25288235.[/indent]

Mark,
Did you consider these papillary dermal cells may be necrotic neoplastic cells that have dropped out akin to colloid bodies or was there visibile invasion on H&E
Regards
Richard

Richard,

No, I didn't consider it; it didn't come up in my mind. Do you know if that has been studied any any systematic way?

Best,

Mark

No I have not but looking at the images my impression was they were limited to the papillary dermis and smaller than the cells in the epidermis - perhaps shrunken - you would be better to judge of course. Dual IHC might be of interest e.g. Ki67/Cam5.2 to see if they are still in cell cycle?
Regards
Richard

Richard, that's a thought. Actually, I posted this case because there are rare examples of extramammary Paget's disease of the nipple, and sometimes in EMPD, there are dermal elements. In my experience, I have sometimes seen tubules in the epidermis of EMPD but I have never seen them in Paget's disease of the nipple. When I saw these dermal Cam 5.2 positive cells in the dermis in the posted case, I was surprised, because I couldn't think of case of Paget's disease with dermal elements (perhaps reflecting the fact that I don't see all that many cases of it anyway), but I didn't see any tubules. My explanation is a bit convoluted, but I wondered whether anyone had ever written on the presence of dermal cells in Paget's disease; it was the reference I posted. If I ever learn any followup on this case, I will post it here.

Mark