MRI accurately depicts underlying DCIS in a patient with Paget's disease of the breast without palpable mass and mammography findings

Breast-conserving therapy must be carefully indicated amongpatients with Paget's disease of the breast, because the diseaseis often associated with an underlying in situ or invasive carcinoma,even when there are no palpable mass or mammography findings.We report a 52-year-old woman who complained of skin color changeof her right nipple for 11 months. No mass was palpable in herbreasts, and mammography did not show any density or calcification.Nipple biopsy revealed Paget's disease of the breast with ductalcarcinoma in situ (DCIS) in the breast epithelium just beneaththe nipple. Magnetic resonance imaging (MRI) of the breast demonstrateddiffuse segmental enhancement in two different quadrants. Accordingto the pattern of enhancement, the lesions depicted by MRI werediagnosed as an extensively spreading type of DCIS. Based oninformed consent, the patient received a total mastectomy. Thehistopathological examination demonstrated non-invasive ductalcarcinoma with comedo-necrosis. The histological mapping withsubserial sectioning demonstrated an extent of the lesions thatcorresponded accurately to the lesions defined by MRI. We concludethat MRI may play an important role in selecting candidatesfor breast-conserving therapy out of those patients with mammaryPaget's disease with no clinical evidence of an underlying breastcarcinoma.