# Paget's Presentation of High-Grade Ductal Carcinoma In Situ (DCIS) in a Very Young Female With Breast Cancer 2 (BRCA2) Mutation

## TL;DR

A young woman with a BRCA2 mutation presented with Paget's disease and ductal carcinoma in situ, leading to mastectomy and ongoing surveillance.

## Contribution

This case highlights the rare presentation of high-grade DCIS in a very young BRCA2 mutation carrier with Paget's disease.

## Key findings

- The patient had Paget's disease of the nipple with high-grade DCIS confirmed by biopsy.
- A BRCA2 gene mutation was identified through genetic analysis.
- The patient underwent mastectomy and plans for surveillance and prophylactic surgery were made.

## Abstract

This is a case of a previously healthy 29-year-old female with erythema and skin excoriations of the left breast nipple-areolar complex (NAC). After a repeat trial and failure of topical hydrocortisone, a diagnostic mammogram and nipple biopsy revealed Paget's disease (PD) of the nipple with ductal carcinoma in situ (DCIS). A subsequent genetic analysis found a breast cancer 2 (BRCA2) gene mutation. Treatment consisted of a left breast skin-sparing simple mastectomy with sentinel lymph node (SLN) biopsy and immediate tissue expander placement for implant reconstruction. Further management involved right breast short-interval surveillance with annual mammography and magnetic resonance imaging (MRI) with the possibility of prophylactic surgery along with oophorectomy after childbearing.