PMC9893054_01
Clinical photograph showing nipple-areolar ulcer on right breast.
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Breast examination revealed an eczematous lesion confined to the right nipple associated with an ulcer on the areola (no nipple appreciated) measuring 2 x 4 cm and non-tender (Figure 1).
Plain chest X-ray showing "cannon-ball" lesions.
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There were normal findings on the abdominal pelvic ultrasound, but her plain chest X-ray showed cannonball appearance suggestive of lung metastasis (Figure 2).
(a) Histopathology of Paget's disease of the breast displaying single or clusters of cells spread throughout the epidermis; underlying dermis has chronic inflammation (H&E 100 x original magnification). (b) Photomicroscopy highlighting high power of the Paget cells with abundant pale cytoplasm, large irregular nuclei with prominent nucleoli (H&E 200 x original magnification).
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The histology report of the breast tissue biopsy revealed PD of the nipple (Figure 3) and the core biopsy of the mass revealed infiltrating ductal carcinoma and Nottingham score 7/9, positive for ER (estrogen receptor) and PR (progesterone receptor) but negative for HER-2, and her metastasis stage was cT4N0M1.