Vulvar Paget's disease: a topographic study

Four vulvectomy specimens from patients with vulvar Paget's disease were studied by means of subserial total sectioning. In each case, the extent of histologically demonstrable disease was far greater than that of the visible lesion, the outline of the involved area was highly irregular, and multiple foci of disease were present. The implications of the findings for treatment selection, intraoperative management, and histogenesis are discussed.

Perianal Paget's disease: a case report

A case of perianal Paget's disease is presented. The salient features of this disease include perianal irritation, a perianal rash, and usually, as in this patient, an associated underlying carcinoma. The disease is rare and has to be differentiated from malignant melanoma, Bowen's disease and transitional cell carcinoma. This patient was also remarkable since the associated malignancy was an equally rare carcinoma of anal gland origin.

Microscopically controlled surgery for extramammary Paget's disease

In five cases of extramammary Paget's disease (EMPD), the neoplasms were removed under complete microscopical control by means of fixed-tissue chemosurgical technique in one case and fresh-tissue technique in four cases. In each lesion there were histologically involved areas extending several centimeters into clinically normal-appearing skin. All patients have been free of the disease for periods from four months to nine years. Other authors using conventional surgery have reported a recurrence rate of 44%. Microscopically controlled surgery offers the most reliable method of removing all of the neoplastic tissue EMPD and preserves as much normal tissue as possible.

[Extramammary Paget's disease]

A case of extensive extramammary Paget's disease in the scrotum and penis is demonstrated. The disease started a few years before as eczema-like lesions. No underlying carcinoma was found. The surgical excision resulted in a good cosmetic effect.

A case of rectal carcinoma concomitant with Pagetoid lesion in the perianal region--histopathological and electron microscopic observations--

A case of extramammary Paget's disease of the perianal area adjacent to a mucinous adenocarcinoma of the rectum is presented. The histopathological examination of the case revealed that within the epidermis adjacent to the invading rectal cancer nest, the formation of glandular structures can be observed occasionally, around which so-called Paget's cells are noted to be scattered and further many points of similarity between cancer cell and Paget's cell are proved by electron microscope. Perianal skin lesion looking like Paget's disease is proved to be due to intraepidermal spread of the rectal carcinoma. Referring to the literature, this is the first report to our knowledge, to elucidate the histogenesis of perianal extramammary Paget's disease associated with a rectal carcinoma using the electron microscopy.

Current management of carcinoma of the anus and perianus

Malignant lesions of the anus and perianus account for 2.4% of malignant cancers of the colon, rectum, and anus. Based on our experience with 56 patients as well as a review of the recent literature, the following recommendations are made: Bowen's disease, Paget's extramammary disease, basal cell, and perianal epidermoid carcinomas arise in the perianus, rarely metastasize, and may be managed by wide local excision. Cloacogenic transitional cell (basaloid squamous carcinoma) and the more common epidermoid anal canal tumors require abdominoperineal resection with wide perineal excision. Therapeutic groin dissection is indicated if the inguinal nodes are or become the site of metastases, but prophylactic groin dissection is not indicated. The five-year survival for epidermoid carcinoma of anus treated by abdominoperineal resection ranges from 40 to 58%. Improvement in survival rate will require early recognition by the patient and early diagnosis and treatment by the physician. Delay in diagnosis occurs because cancer is not considered frequently enough as a possible cause for the patient's symptoms.

Extramammary perianal Paget's disease: report of a case

The case report of a patient with extramammary perianal Paget's disease who developed three histologic types of adenocarcinoma of the rectum over a period of six years is described.

Paget's disease of the vulva: a case report

A patient with Paget's disease of the vulva is described. A brief review of some recent literature underlines the controversy regarding the histogenesis of the disease, and stresses the use of simple vulvectomy in its treatment. The importance of ruling out concomitant carcinoma is also stressed.

Carcinoma of the anus

Carcinoma of the anus represents about 2% of cancers of the large bowel. From 1950 to 1970, 20 patients were treated for this condition. Included were 113 patients with squamous cell carcinoma (31 perianal), 64 with basalid squamous carcinoma, 8 with Paget's disease of the anus, 7 with melanoma, 6 with basal cell carcinoma, and 6 with adenocarcinoma. Combined abdomino-perineal resection was the treatment of choice except for perianal lesions; for these, local excision was used most frequently. Inguinal node dissection was used infrequently, and it is not possible to draw meaningful conclusions from the data. Overall survival rates for patients having anal squamous cell carcinoma are similar except when lymphatic invasion is present; then basaloid lesions have a significantly better prognosis. For rare anal carcinomas, histopathologic findings dictate the end results-- the better the findings and more satisfactory the results.

Paget's disease of the vulva and carcinoma of the breast

Vulvar Paget's disease is an intraepithelial change which is locally recurrent and has minimal if any propensity to invasion. Its major significance lies in the frequency with which concomitant carcinomas are discovered in association with the vulvar skin lesion. Adenocarcinoma of the vulvar apocrine glands is the most commonly associated tumor. Another apocrine adenocarcinoma, carcinoma of the breast, either antecedent or concomitant, is the second most frequently associated tumor, having been noted in 14 cases of vulvar Paget's disease. A case report illustrating this association is presented, and the importance of preoperative breast screening procedures in all patients with vulvar Paget's disease is demonstrated.

Perianal Paget's disease: report of two cases

A patient with extensive perianal extra-mammary Paget's disease was treated by wide local excision of the perianal skin. No underlying associated adenocarcinoma was identified, and the patient is clinically free of disease five years after treatment. A second patient had a small focus of Paget's disease confined to a hemorrhoid. The necessity for histologic evaluation of all anal lesions is emphasized.

Paget's disease of the vulva: a clinicopathologic study of eight cases

Clinicopatholigic findings in 8 patients with Paget's disease of the vulva are presented with a discussion if its pathogenesis. In 7 cases the disease was intraepithelial, and in 1 it was accompanied by underlying adenocarcinoma. The treatment of choice is surgical. The importance of early diagnosis, adequate excision, and close followup is emphasized. In 2 cases, the disease was associated with carcinoma of the breast and in 1 case with carcinoma of the liver.