Tsai CY, Lo TC, Yu JC, Hong ZJ, Sung YK. Paget’s disease of the nipple with occult ductal carcinoma in situ despite negative conventional imaging: A case report. World J Clin Cases 2026; 14(16): 120049 [DOI: 10.12998/wjcc.v14.i16.120049]
Corresponding Author of This Article
Jyh-Cherng Yu, MD, PhD, Department of General Surgery, Tri-Service General Hospital, No. 325, Section 2, Chenggong Road, Neihu District, Taipei 114201, Taiwan. doc20106@mail.ndmutsgh.edu.tw
Research Domain of This Article
Oncology
Article-Type of This Article
Case Report
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Tsai CY, Lo TC, Yu JC, Hong ZJ, Sung YK. Paget’s disease of the nipple with occult ductal carcinoma in situ despite negative conventional imaging: A case report. World J Clin Cases 2026; 14(16): 120049 [DOI: 10.12998/wjcc.v14.i16.120049]
Chih-Yan Tsai, Tzu-Chun Lo, Department of Medicine, National Defense Medical University, Taipei 114201, Taiwan
Jyh-Cherng Yu, Zhi-Jie Hong, Department of General Surgery, Tri-Service General Hospital, Taipei 114201, Taiwan
Yu-Kai Sung, Department of Pathology and Parasitology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114201, Taiwan
Author contributions: Tsai CY and Yu JC were responsible for the clinical care of the patient, data collection, and study design; Tsai CY, Lo TC, and Yu JC performed the manuscript writing and analysis; Sung YK interpreted the pathological findings; Yu JC and Hong ZJ provided senior supervision and edited the manuscript for intellectual content; and all authors read and approved the final version of the manuscript.
AI contribution statement: ChatGPT and Gemini were utilized during the preparation of this manuscript. AI tools were used exclusively for language polishing, grammar checking, and spelling correction to improve the readability and formal tone of the manuscript. The main text content was independently written by us, and no AI was used in study design or result interpretation. All figures and tables were created by ourselves.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest to disclose related to this work.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Jyh-Cherng Yu, MD, PhD, Department of General Surgery, Tri-Service General Hospital, No. 325, Section 2, Chenggong Road, Neihu District, Taipei 114201, Taiwan. doc20106@mail.ndmutsgh.edu.tw
Received: February 13, 2026 Revised: April 3, 2026 Accepted: April 22, 2026 Published online: June 6, 2026 Processing time: 98 Days and 12.5 Hours
Abstract
BACKGROUND
Mammary Paget’s disease, also known as Paget’s disease of the breast (PDB), is a rare malignancy of the nipple-areolar complex that is frequently associated with underlying ductal carcinoma in situ (DCIS) or invasive carcinoma. However, the underlying malignancy may remain occult on conventional imaging, potentially delaying diagnosis.
CASE SUMMARY
We report the case of a 75-year-old woman with a 2-year history of a persistent erythematous lesion of the right nipple, initially treated as eczema. Mammography and ultrasonography did not reveal a definite malignant lesion. Contrast-enhanced magnetic resonance imaging demonstrated nipple inversion, skin thickening, and enhancement suspicious for Paget’s disease but did not identify a discrete breast mass. A skin biopsy confirmed Paget’s disease of the nipple. The patient subsequently underwent central partial mastectomy and sentinel lymph node biopsy. Postoperative pathology revealed high-grade multifocal DCIS underlying the nipple-areolar complex.
CONCLUSION
PDB may present as persistent unilateral nipple-areolar dermatitis with inconclusive imaging findings. This case highlights the importance of biopsy when clinical suspicion persists, as negative conventional imaging does not exclude an underlying malignancy.
Core Tip: Mammary Paget’s disease, also known as Paget’s disease of the breast, may present as chronic nipple eczema without a detectable underlying malignant lesion on conventional imaging. In this case, diagnosis required repeat biopsy and magnetic resonance imaging despite initially benign imaging findings. Clinicians should maintain a high index of suspicion and pursue histopathologic evaluation when unilateral nipple-areolar dermatitis persists, even in the absence of radiologic evidence of malignancy.
