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Migda M, Migda MS, Migda B, Mlosek RK, Maleńczyk M. The utility of high-frequency ultrasonography in preoperative assessment of vulvar Paget's disease - a case report. J Ultrason 2020; 19:311-313. [PMID: 32021714 PMCID: PMC6988460 DOI: 10.15557/jou.2019.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 11/22/2019] [Indexed: 11/25/2022] Open
Abstract
Paget’s disease of the vulva is a rare skin cancer accounting for less than 1% of all vulvar neoplasias. Surgery is the first treatment of choice. Unfortunately, it is insufficient in many cases, which require further treatment, and the risk of recurrence is high. We present a case of an 85-year-old woman who underwent surgery due to Paget’s disease of the vulva. A preoperative skin imaging using a high-frequency 48 MHz mechanical probe was used to assess the lesion margins. Typical high-frequency ultrasonographic features of vulvar Paget’s disease were identified and analyzed. This is the first report of high-frequency ultrasonography imaging of vulvar Paget’s disease.
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Affiliation(s)
- Michał Migda
- Clinical Unit of Obstetrics, Women's Disease and Gynecological Oncology, United District Hospital, Collegium Medicum University of Nicolaus Copernicus in Toruń, Torun, Poland.,Civis Vita Medical Center Torun, Poland
| | | | - Bartosz Migda
- Department of Diagnostic Imaging, Second Faculty of Medicine with the English Division and the Physiotherapy Division, Medical University of Warsaw, Warsaw, Poland
| | - Robert Krzysztof Mlosek
- Department of Diagnostic Imaging, Second Faculty of Medicine with the English Division and the Physiotherapy Division, Medical University of Warsaw, Warsaw, Poland
| | - Marek Maleńczyk
- Clinical Unit of Obstetrics, Women's Disease and Gynecological Oncology, United District Hospital, Collegium Medicum University of Nicolaus Copernicus in Toruń, Torun, Poland
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2
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Edey KA, Allan E, Murdoch JB, Cooper S, Bryant A. Interventions for the treatment of Paget's disease of the vulva. Cochrane Database Syst Rev 2019; 6:CD009245. [PMID: 31167037 PMCID: PMC6550364 DOI: 10.1002/14651858.cd009245.pub3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND This is an updated version of the original Cochrane Review published in Issue 10, 2013.Extramammary Paget's disease is a rare form of superficial skin cancer. The most common site of involvement is the vulva. It is seen mainly in postmenopausal white women. Paget's disease of the vulva often spreads in an occult fashion, with margins extending beyond the apparent edges of the lesion. There is a range of interventions from surgical to non-invasive techniques or treatments. The challenges of interventions are to remove or treat disease that may not be visible, without overtreatment and with minimisation of morbidity from radical surgery. There is little consensus regarding treatment. Surgery, by default, is the most common treatment, but it is challenging to excise the disease adequately, and recurrence is common, leading to repeated operations, and destruction of anatomy. Alternative treatments of photodynamic therapy, laser therapy, radiotherapy, topical treatments or even chemotherapy have been mooted, and it is important to evaluate the available evidence. It is essential to assess whether newer cell-specific treatments, such as photodynamic therapy and imiquimod, can reduce the need for radical surgery. OBJECTIVES To evaluate the benefits and harms of different treatment modalities for the management of Paget's disease of the vulva. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via Ovid) and Embase (via Ovid) up to 8 May 2018. We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of review articles. SELECTION CRITERIA We searched for randomised controlled trials (RCTs) and well-designed non-randomised studies that compared different interventions in women with Paget's disease of the vulva, DATA COLLECTION AND ANALYSIS: Two review authors independently assessed whether potentially relevant studies met the inclusion criteria. We found no trials and, therefore, analysed no data. MAIN RESULTS The search for the original version of the review identified 635 unique references. We found 31 references (which reported on 30 studies) in full text after inspection of titles and abstracts, but we excluded them all as they did not meet the inclusion criteria. However, we have included a comprehensive narrative account of studies where we identified an analysis of more than 10 women, as this forms the only evidence base in this rare disease. Surgery continues to be the mainstay of treatment in the current literature, with other treatments limited to case reports or treatment of inoperable or recurrent disease.This update between September 2013 and May 2018 identified 35 new studies. None of these met the inclusion criteria. There was only one prospective study of 5% imiquimod in recurrent Paget's disease of the vulva, which although of good quality only included eight women. AUTHORS' CONCLUSIONS Since the last version of the review was published there are many more cases in the literature reporting a clinical response to 5% imiquimod cream. There is one prospective study of eight women treated with 5% imiquimod for recurrent Paget's disease of the vulva, and one prospective trial of 20 women was due to be reported. This increasing evidence for the safety and efficacy of 5% imiquimod will be helpful for women and clinicians alike. Ideally, a multicentre RCT of reasonable size is needed, but ongoing publications of high-quality non-randomised prospective studies will enhance the current available literature.
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Affiliation(s)
| | - Ernest Allan
- Christie HospitalWilmslow RoadWithingtonManchesterUKM20 4BX
| | - John B Murdoch
- Spire Hospital BristolGynaecologyThe Glen, Redland HillDurdham DownBristolUKBS2 8EG
| | - Susan Cooper
- Churchill HospitalDepartment of DermatologyOld RoadHeadingtonOxfordUKOX3 7LJ
| | - Andrew Bryant
- Newcastle UniversityInstitute of Health & SocietyMedical School New BuildRichardson RoadNewcastle upon TyneUKNE2 4AX
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3
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Valle L, Deig C, Wright R, High W. An advanced case of extramammary Paget disease: Safe and effective treatment in an inoperable elderly patient using extensive en face electron irradiation. JAAD Case Rep 2018; 5:72-74. [PMID: 30560191 PMCID: PMC6290115 DOI: 10.1016/j.jdcr.2018.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Luca Valle
- The Colorado Health Foundation, Denver, Colorado.,University of California Los Angeles, Los Angeles, California
| | - Chris Deig
- The Colorado Health Foundation, Denver, Colorado.,Oregon Health Sciences University, Portland, Oregon
| | - Ralph Wright
- Rocky Mountain Cancer Center, Lakewood, Colorado
| | - Whitney High
- The University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Karpathiou G, Chauleur C, Hathroubi S, Habougit C, Peoc'h M. Expression of CD3, PD-L1 and CTLA-4 in mammary and extra-mammary Paget disease. Cancer Immunol Immunother 2018; 67:1297-1303. [PMID: 29943071 PMCID: PMC11028266 DOI: 10.1007/s00262-018-2189-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 06/20/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Mammary and extra-mammary Paget disease is a rare form of intra-epithelial glandular neoplasm which is characteristically recurrent and necessitates multiple excisions that have an important impact on morbidity. Local immuno-modulating treatments have been applied with promising results, but the local immune markers of Paget disease have not been studied. AIM OF THE STUDY To investigate the local immune micro-environment of Paget disease. MATERIALS AND METHODS Sixty-four specimens from 41 patients, including cases with multiple recurrences and underlying primary neoplasm, have been studied for their expression of CD3, PD-L1 and CTLA-4. RESULTS Nineteen cases were mammary; 22 were extra-mammary and involved the vulva, the anus, the inguinal region and the lower extremity. PD-L1 was not expressed by any neoplastic lesion or the associated lymphocytes. CTLA-4 expression was found in nine cases. Higher stromal CD3 expression and moderate levels of intra-epithelial CD3 expression were present in most cases. Biopsies, subsequent excision specimens and recurrences showed the same immunohistochemical profile of CD3 and PD-L1, although there were different levels of CTLA-4 in a few cases. The underlying lesions in mammary Paget disease showed the same immunohistochemical profile as the intra-epithelial neoplastic cells. The expression of the markers did not correlate with age, sex, localization or recurrence. CONCLUSION Paget disease is characterized by an intense lymphocytic response, devoid of the immune-suppressive impact of the PD-L1 pathway, but with occasional CTLA-4 expression.
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Affiliation(s)
- Georgia Karpathiou
- Department of Pathology, North Hospital, University Hospital of Saint-Etienne, 42055, Cedex 2, Saint-Étienne, France.
| | - Celine Chauleur
- Department of Obstetrics and Gynecology, North Hospital, University Hospital of St-Etienne, Cedex 2, Saint-Étienne, France
| | - Sirine Hathroubi
- Department of Pathology, North Hospital, University Hospital of Saint-Etienne, 42055, Cedex 2, Saint-Étienne, France
| | - Cyril Habougit
- Department of Pathology, North Hospital, University Hospital of Saint-Etienne, 42055, Cedex 2, Saint-Étienne, France
| | - Michel Peoc'h
- Department of Pathology, North Hospital, University Hospital of Saint-Etienne, 42055, Cedex 2, Saint-Étienne, France
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5
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Alessandrini L, Clemente N, Perin T, Giorda G, Canzonieri V, Sopracordevole F. Extramammary Paget disease of the vulva: immunohistochemical analysis of neoangiogenesis and epithelial-mesenchymal transition markers expression. Diagn Pathol 2018; 13:2. [PMID: 29368628 PMCID: PMC6389142 DOI: 10.1186/s13000-017-0680-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 12/22/2017] [Indexed: 11/10/2022] Open
Abstract
Background Extra-mammary Paget’s disease of the vulva (EMPDV) is an infrequent chronic disease that often recurs. The aim of the study was to assess the presence of neoangiogenesis and the expression of epithelial-mesenchymal transition (EMT) markers in EMPDV, and their potential correlation with stromal invasion. Methods All the women consecutively treated for EMPDV at our Institute, between January 2011 and December 2014, were studied for neoangiogenesis, analysed by microvessel density (MVD) using antibodies against CD31 and CD34. Immunohistochemical expression of E- / N-cadherin, β-catenin and SLUG was also evaluated. In each slide, three fields with the highest number of capillaries and small venules were identified at low power. In these three fields, the highest vessel density (HVD) and the average vessel density (AVD) at 200× and 400× magnification were counted. Immunohistochemical reactions for non-vascular markers were semiquantitatively scored by two pathologists, using a three-tier scale. Results Seventeen cases of EMPDV (including 10 cases of invasive disease) were included. The AVD at 200× and 400× and the HVD at 400× magnification were significantly associated with invasive EMPDV (p = 0.02, 0.03, 0.03 respectively). No significant correlation between MVD, EMT-markers expression and risk of recurrence was detected. Conclusion These results indicate that MVD, as a measure of neoangiogenesis, may be associated with histological progression of EMPDV. EMT could also be linked to an invasive potential of EMPDV but larger series are required to confirm this hypothesis.
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Affiliation(s)
- Lara Alessandrini
- Pathology Unit - CRO - IRCCS, National Cancer Institute, Aviano, Italy
| | - Nicolò Clemente
- Gynecological Oncology Unit - CRO - IRCCS, National Cancer Institute, Aviano, Italy
| | - Tiziana Perin
- Pathology Unit - CRO - IRCCS, National Cancer Institute, Aviano, Italy
| | - Giorgio Giorda
- Gynecological Oncology Unit - CRO - IRCCS, National Cancer Institute, Aviano, Italy
| | - Vincenzo Canzonieri
- Pathology Unit - CRO - IRCCS, National Cancer Institute, Aviano, Italy. .,Pathology Unit - CRO - IRCCS, National Cancer Institute, Via Franco Gallini, 2, I-33081, Aviano, (PN), Italy.
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6
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Onaiwu CO, Salcedo MP, Pessini SA, Munsell MF, Euscher EE, Reed KE, Schmeler KM. Paget's disease of the vulva: A review of 89 cases. Gynecol Oncol Rep 2016; 19:46-49. [PMID: 28124023 PMCID: PMC5220256 DOI: 10.1016/j.gore.2016.12.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 12/26/2016] [Accepted: 12/27/2016] [Indexed: 12/17/2022] Open
Abstract
The purpose of this study was to retrospectively review the clinical characteristics and outcomes of a series of women with Paget's disease of the vulva. A retrospective review was performed of 89 women with Paget's disease of the vulva evaluated at a single institution between 1966 and 2010. Medical records were reviewed for demographic information, clinical data, pathologic findings, treatment modalities and outcomes. We found that the primary treatment was surgery for 74 (83.1%) patients, with positive margins noted in 70.1% of cases. Five patients (5.6%) underwent topical treatment with imiquimod and/or 5-fluorouracil, one patient (1.1%) underwent laser ablation and treatment was unknown in 9 patients (10.1%). The majority of patients had multiple recurrences, with 18% having four or more recurrences. There were no significant differences in recurrence rates between patients who underwent surgery and those who did not. Furthermore, there was no association between positive margins following primary surgery and recurrence. Forty-one patients (46.1%) were diagnosed with 53 synchronous or metachronous cancers. Seven patients (7.9%) were found to have invasive vulvar cancer with 1 mm or more depth of invasion, but none of the patients died of Paget's disease or associated vulvar/vaginal cancer. Our findings suggest that the majority of patients with Paget's disease of the vulva develop multiple recurrences regardless of treatment modality or margin status. Alternatives to surgery are needed to better care for women with this disease. Many recurrences were noted regardless of margin status following surgery for Paget's disease. 46% of the patients with Paget's disease had synchronous or metachronous cancers. None of the patients in our study died of Paget's disease or associated vulvar cancer. Alternatives to surgery are needed to improve outcomes in these patients.
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Affiliation(s)
- Cherry O Onaiwu
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Mila Pontremoli Salcedo
- The Department of Obstetrics & Gynecology, Federal University of Health Sciences/Irmandade Santa Casa de Misericordia, Porto Alegre, Brazil
| | - Suzana A Pessini
- The Department of Obstetrics & Gynecology, Federal University of Health Sciences/Irmandade Santa Casa de Misericordia, Porto Alegre, Brazil
| | - Mark F Munsell
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Elizabeth E Euscher
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | | | - Kathleen M Schmeler
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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7
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Tomar TS, Sambasivan S, Nair RP, Thomas S, Ramadas PT. Extra Mammary Paget's Disease of Vulva-a Case Report. Indian J Surg Oncol 2016; 7:488-490. [PMID: 27872543 DOI: 10.1007/s13193-016-0551-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 08/16/2016] [Indexed: 10/21/2022] Open
Abstract
Extra mammary Paget's disease (EMPD) is a rare condition involving the vulva, anogenital region, and axilla. Vulvar disease usually presents as a slow growing well-defined itchy plaque with crustations or ulcerations over the affected area in postmenopausal women. Well-established guidelines for diagnosis and management are not available for this rare condition. Our patient is a 64-year-old postmenopausal woman with a history of similar complaints of 2 years duration, not responding to multiple topical treatments. She was diagnosed with EMPD on incisional biopsy and treated with surgery at our centre.
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Affiliation(s)
- Than Singh Tomar
- Regional Cancer Centre (RCC), Medical College Campus, Trivandrum, Kerala 695011 India
| | - Suchetha Sambasivan
- Regional Cancer Centre (RCC), Medical College Campus, Trivandrum, Kerala 695011 India
| | - Rema Prabhakaran Nair
- Regional Cancer Centre (RCC), Medical College Campus, Trivandrum, Kerala 695011 India
| | - Shaji Thomas
- Regional Cancer Centre (RCC), Medical College Campus, Trivandrum, Kerala 695011 India
| | - Preethi T Ramadas
- Regional Cancer Centre (RCC), Medical College Campus, Trivandrum, Kerala 695011 India
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8
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Tolia M, Tsoukalas N, Sofoudis C, Giaginis C, Spyropoulou D, Kardamakis D, Kouloulias V, Kyrgias G. Primary extramammary invasive Paget's vulvar disease: what is the standard, what are the challenges and what is the future for radiotherapy? BMC Cancer 2016; 16:563. [PMID: 27473174 PMCID: PMC4966592 DOI: 10.1186/s12885-016-2622-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 07/26/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Primary invasive Extramammary Paget's vulvar disease is a rare tumor that is challenging to control. Wide surgical excision represents the standard treatment approach for Primary invasive Extramammary Paget's vulvar disease. The goal of the current study was to analyze the appropriate indications of radiotherapy in Primary invasive Extramammary Paget's vulvar disease because they are still controversial. DISCUSSION We searched the Cochrane Gynecological Cancer Group Trials Register, Cochrane Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE database up to September 2015. Radiotherapy was delivered as a treatment in various settings: i) Radical in 28 cases (range: 60-63 Gy), ii) Adjuvant in 25 cases (range: 39-60 Gy), iii) Salvage in recurrence of 3 patients (63 Gy) and iv) Neoadjuvant in one patient (43.3 Gy). A radiotherapy field that covered the gross tumor site with a 2-5 cm margin for the microscopic disease has been used. Radiotherapy of the inguinal, pelvic or para-aortic lymph node should be considered only for the cases with lymph node metastases within these areas. Radiotherapy alone is an alternative therapeutic approach for patients with extensive inoperable disease or medical contraindications. Definitive radiotherapy can be used in elderly patients and/or with medical contraindications. Adjuvant radiotherapy may be considered in presence of risk factors associated with local recurrence as dermal invasion, lymph node metastasis, close or positive surgical margins, perineal, large tumor diameter, multifocal lesions, extensive disease, coexisting histology of adenocarcinoma or vulvar carcinoma, high Ki-67 expression, adnexal involvement and probably in overexpression of HER-2/neu. Salvage radiotherapy can be given in inoperable loco-regional recurrence and to those who refused additional surgery.
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Affiliation(s)
- Maria Tolia
- Department of Radiotherapy, University of Thessaly, School of Health Sciences, Faculty of Medicine, Biopolis, Larissa, 411 10, Greece.
| | - Nikolaos Tsoukalas
- Oncology Clinic, 401 General Military Hospital, Mesogeion 138 & Katehaki, 115 25, Athens, Greece
| | - Chrisostomos Sofoudis
- LITO Obstetrics, Gynaecology & Surgery Centre, 7-13 Mouson Str, Psychiko-Athens, 154 52, Greece
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, University of the Aegean, Myrina, Lemnos, 814 40, Greece
| | - Despoina Spyropoulou
- Department of Radiation Oncology, University of Patra Medical School, Patra, 265 04, Greece
| | - Dimitrios Kardamakis
- Department of Radiation Oncology, University of Patra Medical School, Patra, 265 04, Greece
| | - Vasileios Kouloulias
- Second Department of Radiology, Radiation Therapy Oncology Unit, University Hospital of Athens "ATTIKON", Rimini 1, Haidari, 124 64, Athens, Greece
| | - George Kyrgias
- Department of Radiotherapy, University of Thessaly, School of Health Sciences, Faculty of Medicine, Biopolis, Larissa, 411 10, Greece
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9
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Vasquez A, Dominguez C, Rolon M. Extramammary Paget's disease. BJR Case Rep 2016; 2:20150261. [PMID: 30363656 PMCID: PMC6180891 DOI: 10.1259/bjrcr.20150261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 10/13/2015] [Accepted: 01/26/2016] [Indexed: 11/05/2022] Open
Abstract
The purpose of this report is to describe an unusual case of extramammary Paget's disease with urethral and lymph node infiltration and demonstrate the role of MRI in the pre-operative period for the assessment, management and prognosis of the disease. Although skin wrinkles on MRI may be misinterpreted based on observer's experience, it correlates well with pathology and may provide an accurate assessment before interventional therapy.
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Affiliation(s)
- Andres Vasquez
- Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | | | - Mariam Rolon
- Department of Pathology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
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10
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Cowan RA, Black DR, Hoang LN, Park KJ, Soslow RA, Backes FJ, Gardner GJ, Abu-Rustum NR, Leitao MM, Eisenhauer EL, Chi DS. A pilot study of topical imiquimod therapy for the treatment of recurrent extramammary Paget's disease. Gynecol Oncol 2016; 142:139-143. [PMID: 27112632 DOI: 10.1016/j.ygyno.2016.04.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 04/19/2016] [Accepted: 04/21/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this prospective pilot study was to assess the clinical and histologic effects of topical imiquimod therapy on recurrent extramammary Paget's disease of the vulva. METHODS Patients with biopsy-proven recurrent extramammary Paget's disease presenting to the gynecology outpatient services at two participating institutions were recruited for conservative treatment with 5% imiquimod cream from 2007 to 2011. The topical cream was to be applied 3 times per week for 12weeks. Punch biopsy and photography were performed at baseline and at the 12-week time point. RESULTS Eight patients from two institutions were enrolled. Complete clinical and histologic response was achieved in 6 (75%) patients by the 12-week follow-up appointment. Of the two remaining patients, one had a complete clinical response but no significant histologic response; the other patient was removed from the study protocol secondary to intolerable local irritation. Two patients continue to have no evidence of disease after a median follow-up of 35months. Five are alive with disease. No patients progressed to invasive cancer while receiving therapy. CONCLUSION Topical 5% imiquimod cream is a safe and feasible option for women suffering from recurrent extramammary Paget's disease of the vulva, and should be considered as a viable alternative to surgical management. Given the rare nature of this disease, additional multi-institutional prospective studies should be conducted to explore the efficacy of this treatment regime.
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Affiliation(s)
- Renee A Cowan
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Destin R Black
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Lien N Hoang
- Gynecology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Kay J Park
- Gynecology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Robert A Soslow
- Gynecology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
| | - Floor J Backes
- Department of Gynecologic Oncology, The James Cancer Hospital and Solove Research Institute, Ohio State University Medical Center, 460 West 10(th) Avenue, Columbus, OH 43210, USA
| | - Ginger J Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
| | - Eric L Eisenhauer
- Department of Gynecologic Oncology, The James Cancer Hospital and Solove Research Institute, Ohio State University Medical Center, 460 West 10(th) Avenue, Columbus, OH 43210, USA
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA.
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11
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Effects of imiquimod on vulvar Paget's disease: a systematic review of literature. Gynecol Oncol 2015; 139:165-71. [PMID: 26193428 DOI: 10.1016/j.ygyno.2015.07.097] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 07/14/2015] [Accepted: 07/16/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To examine the effectiveness of topical imiquimod therapy for vulvar Paget's disease. METHODS A systematic literature search was conducted using three public search engines with entry keywords "Paget's disease" and "imiquimod". Case reports describing imiquimod treatment for vulvar Paget's disease were examined for demographics, treatment patterns, and outcome (63 cases). RESULTS Median age was 68, and nearly a half of cases were recurrent disease (50.8%) with surgical resection being the most common prior treatment modality (62.5%). All cases used 5% imiquimod and the median treatment duration was 4months. The most common initial treatment frequency was 3-4times/week (68.3%) followed by 5-7 (17.4%) and 1-2times/week (14.3%). Frequency-reduction due to adverse effects was seen in 9.5% with the initial 5-7times/week regimen being associated with the highest reduction rate (1-2, 3-4, and 5-7times/week: 0%, 2.3%, and 81.8%, p<0.01). In 46 (73.0%) cases, a complete remission (CR) to imiquimod therapy was reported, with 2, 4, and 6-month cumulative CR rates being 9.8%, 31.1%, and 71.6%, respectively. With median follow-up duration of 12months after the completion of imiquimod treatment, 2 (5.7%) of the 35 women who had a CR developed disease recurrence. Age, disease status (primary versus recurrent), and treatment frequency after dose reduction were not associated with CR rates (all, p>0.05). CONCLUSION Our results suggested that imiquimod therapy may be an effective possible treatment option for vulvar Paget's disease, especially for women who have experienced recurrence after multiple surgical resections or who are with poor surgical candidates.
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12
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Paget Disease of the Vulva: Diagnosis by Immunohistochemistry. Case Rep Dermatol Med 2015; 2015:162483. [PMID: 26060586 PMCID: PMC4427817 DOI: 10.1155/2015/162483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 04/12/2015] [Indexed: 11/17/2022] Open
Abstract
The objective of this paper is to report a case of extramammary Paget disease of the vulva, to describe its diagnosis, surgical treatment, and outcome, and to discuss the general characteristics of this pathology. This is a rare neoplasm, found principally in areas in which apocrine and eccrine glands are numerous. This case report is relevant to the literature since the differential diagnosis of extramammary Paget disease is difficult to be done only with the macroscopic appearance of the lesion and even with the microscopic characteristics, requiring further studies, immunohistochemistry, as to differentiate pathologies. The present report describes the case of a 63-year-old patient at the Santa Casa de Misericórdia Hospital in Vitória, Espírito Santo, Brazil, who presented with a hardened, ulcerated, and purplish lesion with hyperchromic and hypochromic spots, measuring 4 cm in diameter, located on the lower third of right labium majus, close to the vaginal fourchette. A right hemivulvectomy was performed, leaving wide margins all around. The patient progressed satisfactorily following surgery. Although extramammary Paget disease is rare, its incidence increases as a function of the patient's age. Patients should be followed up closely because of the risk of persistence and/or recurrence of the disease.
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Chokoeva AA, Tchernev G, Castelli E, Orlando E, Verma SB, Grebe M, Wollina U. Vulvar cancer: a review for dermatologists. Wien Med Wochenschr 2015; 165:164-77. [PMID: 25930015 DOI: 10.1007/s10354-015-0354-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 04/07/2015] [Indexed: 12/01/2022]
Abstract
Vulvar malignancies are important tumors of the female reproductive system. They represent a serious health issue with an incidence between 2 and 7 per 100,000 and year. We provide a review about most important cancer entities, i.e., melanoma, squamous cell carcinoma, basal cell carcinoma, neuroendocrine cancer, and skin adnexal malignancies.Squamous cell carcinoma is the most common vulvar malignancy that can develop from vulvar intraepithelial neoplasia or de novo. Basal cell carcinoma represents only 2% of all vulvar cancers. Melanoma of the vulva exists in two major types-superficial spreading and acral lentiginous. A special feature is the occurrence of multiple vulvar melanomas. Of the adnexal cancer types Paget's disease and carcinoma are seen more frequently than other adnexal malignancies. The dermatologist should be aware of this problem, since he might be the first to be consulted by patients for vulvar disease. Treatment should be interdisciplinary in close association to gynecologists, oncologists, and radiologists.
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