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The bone tissue is a specialised connective tissue composed of several components that undergo constant remodelling. The balance between bone deposition and resorption is essential for maintaining a healthy bone structure. In case of a disruption in this remodelling process, which can lead to an imbalance between bone deposition and resorption, an increase in the opacity of a vertebral body may be observed in imaging studies, resulting in what is known as the "ivory vertebra sign".

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Introduction: The following presentation explores the diagnostic potential of Contrast-Enhanced Mammography (CEM) in evaluating and managing Paget's Disease (PD) of the breast, particularly as an alternative or complementary tool to Magnetic Resonance Imaging (MRI) in cases where MRI is contraindicated or inconclusive.

Clinical Cases: Two clinical cases of PD diagnosed at our Breast Imaging Division between January and May 2024 were analyzed using CEM. These cases involved imaging techniques, including Digital Mammography (DM), Breast Ultrasound (US), MRI and CEM, alongside histopathological confirmation through nipple-areolar complex (NAC) punch biopsies.

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A 54-year-old woman was referred by her rheumatologist for evaluation of an elevated serum alkaline phosphatase (ALP) in the setting of polyarthritis. The metabolic work-up was significant for an elevated bone fraction of alkaline phosphatase isoenzymes, and high bone turnover markers, including fasting C- telopeptide (CTX). A diagnosis of Paget's disease of bone (PDB) was considered.

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Some skin tumors can extend beyond their clinical appearance. This presents an additional challenge, especially when the affected area is the genital region, which is more difficult for both the patient and the physician to access and monitor due to its location and anatomical characteristics. The treatment of these lesions is complex, and literature postulates Mohs surgery as the best therapeutic option.

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