S13C18P16Paget



S13C18P16-1: At this magnification, the hyperplastic epidermis shows focal accentuation of the rete patterns (i.e., psoriasiform qualities). There are clefts in the epidermis. Some are suprabasilar in distribution; some contain isolated, individual cells. The papillary dermis contains loose infiltrates of lymphoid cells.

S13C18P16-2: At higher magnification, the defects are outlined by pale, columnar, or round, cells; the distinctive cells have abundant, pale cytoplasm. Some of the cells, both individually and in clusters, have migrated upward into the epidermis (the “pagetoid” pattern of Paget’s disease).


S13C18P16-3: The large, pale cells, outlining the defects, have enlarged nuclei with variable nucleoli. There is some variation in nuclear size. Some of the cells show rounded cytoplasmic vacuoles. The atypical cells (adenocarcinoma cells) infiltrate the epidermis, both in clusters and individually. The defects represent patterns of glandular differentiation. In the proper clinical setting, the changes are compatible with Paget’s disease (adenocarcinoma-in-situ) of either mammary, or sweat gland type.

S13C18P16-4: The large pale cells, among more normal keratinocytes, produce a pattern that is typical of the epidermal changes in lesions of Paget’s disease.

S13C18P16-5: In this field, the Paget’s cells, in the region outlined by blue arrows, form a nice glandular pattern. The cells outlining the lumen are columnar.

S13C18P16-6: With a mucicarmine stain, the cells are positive; the intracytoplasmic collections of mucin are reactive (the positive cells are secretory cells of glandular type). The neoplastic cells also are commonly positive with immunoreactions for CEA and S100 protein. Although a Fontana-Masson stain is seldom utilized in the daily practice of pathology, it should be noted that melanocytes may be overactive in lesions of Paget’s disease; they may transfer pigment to both keratinocytes and to the neoplastic cells. Lesions of Paget’s disease that are hyperpigmented may be misdiagnosed as melanocytic neoplasia.

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