Аннотация
Relevance: Paget’s breast cancer is a rare malignant tumor that mainly affects the nipple and areola. In most cases, the disease is accompanied by ductal carcinoma in situ or invasive breast cancer; however, in some cases, the primary focus remains non-visualized, the so-called “occult cancer”, which makes early diagnosis difficult. The clinical picture often mimics dermatological conditions such as dermatitis or eczema, which can delay diagnosis.The study aimed to evaluate the potential of modern radiation imaging methods in Paget’s disease of the nipple and to identify signs that allow differentiation from benign skin changes.Materials and Methods: The paper presents a clinical case of a 71-year-old patient with Paget’s disease of the right nipple and metastases to the lymph nodes in the absence of a visible invasive lesion. Diagnostic methods were Digital Mammography (DM), Contrast-Enhanced Spectral Mammography (CESM), Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI), Positron Emission Tomography/Computed Tomography (PET/CT), and morphological and immunohistochemical studies.Results: Clinical presentation included only eczema-like nipple changes. DCE-MRI and CESM were the only informative imaging methods with negative DM and ultrasound examination results. Metastatic lesion of lymph nodes was confirmed morphologically, with no invasive component of breast tissue. The case was rare and difficult to diagnose due to the absence of concomitant invasive carcinoma.Conclusion: The clinical case highlights the difficulty of diagnosing Paget’s disease in the occult nature of the primary lesion and the possibility of lymphogenous metastasis. Early initiation of treatment and a multidisciplinary approach are key in improving prognosis and therapy effectiveness.