Presentation
Left nipple retraction and scaly skin irritation on the nipple itself. Sent for diagnostic mammography.
Patient Data
The single mammographic view shows nipple retraction and focal skin thickening around the nipple. A vague density is present just under the nipple. There are even microcalcifications.
Ultrasound shows a solid irregular lesion under the areola; all the hallmarks of malignancy are shown. There are even microcalcifications.
Clinic photograph of the patient's nipple.
Case Discussion
The single mammographic view shows nipple retraction and focal skin thickening around the nipple. A vague density is present just under the nipple. Ultrasound shows a solid irregular lesion under the areola; all the hallmarks of malignancy are there. There are even microcalcifications. The histology was an infiltrating ductal carcinoma on the ultrasound-guided core biopsies. Node-negative in this case.
The scaly skin irritation is the key to the diagnosis. Be aware that it could indicate a sinister abnormality in the breast deep to the nipple. Look at the technologist worksheet for this observation
The Paget who described this disease in 1875 is the same Paget of bone disease fame.