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Mammary Paget's disease. Conservative mastectomy
Enfermedad de paget mamaria. Mastectomía conservadora
Andreu Martínez Hernández
, David Martínez Ramos, Miguel Alcalde Sánchez, José Manuel Laguna Sastre
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Departamento de Cirugía General y del Aparato Digestivo, Unidad de Senología y Patología Mamaria, Hospital General Universitario de Castellón, Spain
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Conservative mastectomy" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "165" "paginaFinal" => "167" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Andreu Martínez Hernández, David Martínez Ramos, Miguel Alcalde Sánchez, José Manuel Laguna Sastre" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Andreu" "apellidos" => "Martínez Hernández" "email" => array:1 [ 0 => "andreumh92@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "David" "apellidos" => "Martínez Ramos" ] 2 => array:2 [ "nombre" => "Miguel" "apellidos" => "Alcalde Sánchez" ] 3 => array:2 [ "nombre" => "José Manuel" "apellidos" => "Laguna Sastre" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Cirugía General y del Aparato Digestivo, Unidad de Senología y Patología Mamaria, Hospital General Universitario de Castellón, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Enfermedad de paget mamaria. Mastectomía conservadora" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 974 "Ancho" => 1491 "Tamanyo" => 92471 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Irregular huge ulceration in a 76-year-old woman. Physical examination.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 76-year-old female, with no relevant medical history, presented with a large ulcerated breast lesion. On physical examination, large pendulous breasts with an irregular ulceration of the left nipple-areola complex (NAC) of approximately 100 mm x 50 mm were observed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). To palpation no other breast or axillary tumors were detected.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Radiologic findings described an ipsilateral axillary adenopathy of 16 x 9 mm, without evidence of malignancy after the core needle biopsy. The histopathological result of the skin biopsy was compatible with Paget's disease.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Surgical treatment was deemed necessary and the patient underwent a conservative mastectomy including the NAC with a W pattern mammoplasty (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2-3</a>). The patient refused surgical symmetrization with contralateral breast reduction.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Histologic results confirmed a mammary Paget's disease, and sentinel lymph node was negative.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">Paget's disease of the breast is a rare type of cancer of the NAC often associated with an underlying in situ or invasive carcinoma (in 95-98% of cases).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Although, clinical and imaging findings are complementary and should be correlated to confirm or exclude its diagnosis, open biopsy should be considered as standard for its diagnosis. To date, proper surgical treatment is controversial.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Central tumors of the breast are in a difficult location for breast conservation and in many occasions result in mastectomy. At the present time, W pattern mammoplasty (also named inverted-T scar) with NACectomy is a conservative oncoplastic technique with an adequate oncological resection and good aesthetic results.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">While NAC reconstruction can be performed during the main surgery or in subsequent interventions, in our patient it was not possible to performed a NAC reconstruction with conventional procedures due to anathomical considerations and the large ulceration skin area. In conclusion, this oncoplastic technique can be an alternative for patients with ptotic breasts and huge ulcerations such as the herein presented.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec1025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect1085">Confidentiality of data</span><p id="par1090" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their Center on the publication of patient data.</p></span><span id="sec2025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect2085">Conflict of interests</span><p id="par2090" class="elsevierStylePara elsevierViewall">David Martínez Ramos is Managing Editor of “Revista de Senologia y Patologia Mamaria”.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Discussion" ] 1 => array:2 [ "identificador" => "sec1025" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec2025" "titulo" => "Conflict of interests" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 974 "Ancho" => 1491 "Tamanyo" => 92471 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Irregular huge ulceration in a 76-year-old woman. Physical examination.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2495 "Ancho" => 2500 "Tamanyo" => 612021 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Conservative mastectomy including the NAC with a W pattern mammoplasty.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1335 "Ancho" => 1333 "Tamanyo" => 178021 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Aesthetic results two weeks after breast surgery.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Paget's disease of the breast" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G.H. Sakorafas" 1 => "K. Blanchard" 2 => "M.G. Sarr" 3 => "D.R. Farley" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/ctrv.2000.0203" "Revista" => array:6 [ "tituloSerie" => "Cancer Treat Rev." "fecha" => "2001" "volumen" => "27" "paginaInicial" => "9" "paginaFinal" => "18" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11237774" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Paget's disease of the breast: there is a role for breast-conserving therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:9 [ 0 => "K. Kawase" 1 => "D.J. Dimaio" 2 => "S.L. Tucker" 3 => "A. Thomas" 4 => "Buchholz" 5 => "I. Merrick" 6 => "Ross" 7 => "W. Barry" 8 => "Feig" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1245/ASO.2005.05.026" "Revista" => array:6 [ "tituloSerie" => "Ann Surg Oncol." "fecha" => "2005" "volumen" => "12" "paginaInicial" => "391" "paginaFinal" => "397" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15915373" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mammary Paget disease today Impact of the type of surgical treatment on survival" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Fiores" 1 => "A. Petit" 2 => "M.E. Fernandez Montoliu" 3 => "M.J. Pla" 4 => "M. Campos" 5 => "A. Guma" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Revista de Senología y Patología Mamaria." 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