General and Systemic Histopathology, C601&C602
    Slide 31: Breast skin with Paget's Disease
    Here we have the condition of malignant duct cells growing up the major excretory ducts of the breast and out into the epithelial covering of the skin.  You will actually see clusters of malignant cells in the epithelium itself.  Look down in the breast to confirm the malignancy first.  Sometimes this can be confused microscopically with an early amelanotic melanoma.  Grossly, this lesion is red and crusted and looks like a little focus of irritation on the nipple or areola.

    See this slide with the virtual microscope.

    Here you see a higher power view of the clusters of the malignant ductal epithelial cells which have actually migrated up and out of the major breast ducts to proliferate within the epithelial layer of the skin. These cells may look a bit like non-pigmented malignant melanocytes, but they are indeed from the breast ducts. The cells you see here are not within dermal lymphatics, but rather the actual epithelial surface of the breast itself. 

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