Vergine M, Musella A, Gulotta E, Frusone F, De Luca Alberto, Maceli F, Libia A, Benedetti Panici P, Monti M
G Chir. 2018 Mar-Apr;39(2):114-117.
Paget disease of the nipple in man is a very rare breast cancer, and there are not standard procedures or guidelines. In any cases, a Paget's disease could hide an invasive ductal breast cancer.
We report the case of a 77-years old man affected by Alzheimer's disease, who presented to our attention because of an ulcerated palpable mass in the right nipple. A biopsy of the lesion showed "intra-epidermic proliferation of epitelioid cells, associated with linfo-plasmacellular infiltration of superficial dermis, compatible with Paget's disease (pTis)". We discussed the case in the multidisciplinary meeting and decided to subject the patient to surgery, so a right mastectomy plus sentinel lymph node biopsy (SLNB) were performed. Histo-pathological examination revealed "invasive ductal carcinoma of the breast, associated with a small component of in situ ductal carcinoma and Paget's disease of the nipple with superficial ulceration". Resection margins were free. Sentinel lymph node was negative. Biological features were as follows: ER 95%, PR 60%, Her-2/neu 1+, Ki-67 35%. The patient was discharged in the third post-operative day in good conditions. In the following weeks the patient's healing process was good and free of complications.
Clinical recognition of Paget's disease is very important also in man, because it can be the alarm bell for an underlying invasive ductal breast cancer, often more aggressive than in woman.
男性乳头佩吉特病是一种非常罕见的乳腺癌，目前尚无标准的治疗程序或指南。在任何情况下，佩吉特病都可能掩盖浸润性导管癌。
我们报告一例77岁患阿尔茨海默病的男性患者，因其右侧乳头出现可触及的溃疡性肿块而引起我们的注意。病变活检显示“表皮内上皮样细胞增生，伴有浅表真皮层淋巴细胞 - 浆细胞浸润，符合佩吉特病（pTis）”。我们在多学科会议上讨论了该病例，并决定对患者进行手术，因此实施了右乳房切除术加前哨淋巴结活检（SLNB）。组织病理学检查显示“乳腺浸润性导管癌，伴有小灶原位导管癌和乳头佩吉特病伴浅表溃疡”。手术切缘阴性。前哨淋巴结阴性。生物学特征如下：雌激素受体（ER）95%，孕激素受体（PR）60%，人表皮生长因子受体2（Her-2/neu）1+，Ki-67 35%。患者术后第三天情况良好出院。在接下来的几周里，患者愈合过程良好，无并发症。
佩吉特病的临床识别在男性中也非常重要，因为它可能是潜在浸润性导管癌的警钟，这种癌症通常比女性的更具侵袭性。
