Pagets disease of uncertain origin: case report

BACKGROUND Pagets disease of the nipple presents as an eczematous lesion, occurs in 1 - 4% of all female breast carcinoma cases and is invariably associated with underlying malignancy either overt or occult. The majority of these cases are invasive disease although 40-45% are associated with DCIS. CASE PRESENTATION A 39 year old lady presented to our unit with a palpable lump in the right breast. Radiological and histological investigation proved this to be an extensive area of Ductal Carcinoma in Situ (DCIS) for which she underwent a simple mastectomy and immediate latissimus dorsi flap reconstruction. Histology revealed high grade DCIS with 2 small foci of invasive carcinoma. At 1 year the patient represented with a nodule adjacent to the reconstruction scar which was proved on biopsy to be consistent with Paget's disease. This was proved on formal excision. CONCLUSION In the absence of underlying breast or apocrine tissue this case details a case of Paget's disease of uncertain origin.