Case Report: Rare case of advanced metastatic Paget's disease of the breast

Background A rare type of breast cancer is called Paget’s disease of the breast. It is a nipple-areolar complex condition that frequently coexists with in situ or invasive cancer. The most frequent presenting symptom is itching. The nipple-areolar complex frequently experiences eczematous alterations, which in more advanced stages result in ulcer formation and the eventual loss of the nipple and areola. The epidermotropic theory states that Paget’s cells are ductal cancer cells that have moved from the breast parenchyma to the nipple epidermis. The in situ transformation idea says that without any other pathologic process in the breast parenchyma. This case is unique because the right side of Paget’s disease of the breast was advanced and led to malignant right pleural effusion. A 71- year-old female came with complaints of itching, wound, and destruction of the right nipple and areola of the breast for three years. She also had complaints of breathlessness, weakness, and decreased appetite. This was clinically diagnosed as advanced metastatic Paget’s disease of the breast. Ultrasonography and mammography did not reveal any lump. A detailed clinical examination was done, which revealed left-sided decreased breath sounds on chest auscultation. The rest of the vitals of the patient were within normal limits. A chest X-ray posteroanterior (PA) view was done, which revealed the presence of a right-sided moderate pleural effusion. Chemotherapy was accepted well, and outcome was good. Conclusions Early detection is necessary for Paget’s illness of the breast. About 1%–3% of primary breast cancer cases are caused by Paget’s breast disease. Breast cancer is sporadic in nature. Biopsy is a must for diagnosis of disease in patients with normal ultrasound and mammogram. Disease management depends on the underlying tumor, the spread of the disease, the presence or absence of an underlying lump, and age of the patient.