All are true about Paget disease EXCEPT:

50% are hormone receptor positive REF: Nearly 98% of mammary Paget disease cases are associated with an underlying carcinoma, either in situ (intraductal, 10%) or infiltrating cancer (90%) Scrape cytology has been suggested as a noninvasive and reliable, rapid diagnostic screening method for mammary Paget disease. Punch, wedge, or excisional biopsy of the lesional skin of the nipple-areola complex to include the dermal and subcutaneous tissue for detailed microscopic examination provides an adequate sample for the accurate diagnosis of mammary Paget disease In cases of positive estrogen and progesterone receptors in an underlying breast carcinoma, the overlying Paget disease is negative for these receptors.