Breast Mass Case # 9            Case: 1    2    3    4    5    6    7    8    9    <<Back    Next>>
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65 year old female with biopsy proven Paget's Disease of the left nipple
Sagittal T2W Sagittal T2W FS Axial T1W Axial T1W FS post gad
pe_t2.jpg (72567 bytes) pe_t2fs.jpg (78369 bytes) pe_t1.jpg (68333 bytes) pe_t1pg.jpg (85865 bytes) 
Abnormal thickening and enhancement of the left nipple-areolar complex, consistent with biopsy proven Paget's disease.  
Dilatation without significant enhancement of left inferior retroareolar ducts.  
High T1 intraductal signal is probably due to proteinaceous material rather than blood.
Dynamic post gadolinium T1W FS
pe_g1.jpg (89334 bytes) pe_g2.jpg (89408 bytes) pe_g3.jpg (92313 bytes) pe_g4.jpg (88015 bytes)
Enhancement curve
pe_roi_l.jpg (45825 bytes)pe_graph_l.jpg (20716 bytes)
Left nipple enhancement		 pe_roi_r.jpg (43421 bytes)pe_graph_r.jpg (20821 bytes)
Normal right nipple for comparison		 
Slow enhancement with washout of affected nipple. Progressive enhancement of normal nipple.
Subtraction

pe_s1_l.jpg (82994 bytes)
First post-enhancement phase

pe_s2_l.jpg (77877 bytes)
Third post-enhancement phase

 
Mammogram: Slight ductal prominence in the left retroareolar region is stable. There is no nipple discharge.
Ultrasound: Not performed
Diagnosis: Paget's disease of the nipple. Benign ductal ectasia.
Enhancement curves may be helpful in differentiating Paget's disease from other cases of skin thickening, 
but this unproven.