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Borsuk DJ, Melich G, Sugrue J, Calata J, Seitz IA, Park JJ, Prasad LM, Marecik SJ. Wide local excision of perianal Paget's disease with gluteal flap reconstruction: an interdisciplinary approach. J Vis Surg 2017; 2:159. [PMID: 29078544 DOI: 10.21037/jovs.2016.09.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 09/05/2016] [Indexed: 11/06/2022]
Abstract
Perianal Paget's disease (PPD) is an extremely rare condition characterized as intraepithelial adenocarcinoma of unclear etiology. It can be either primary or secondary. The disease typically presents as an eczema-like, erythematous, and painful skin lesion that is associated with pruritus. It is usually misdiagnosed as a common anorectal problem. Surgical excision is the preferred treatment of PPD, with the specific technique being dependent upon disease invasiveness. The treatment may involve reconstructive surgery. A 61-year-old female with a history of rectal pain and intermittent pruritus for the past two years presented with large painful lesions in her perianal area including the anal verge, diagnosed as primary PPD. After excluding other malignancies elsewhere, a laparoscopic ileostomy followed by a wide local excision (WLE) of the PPD was performed by a colorectal team. Reconstruction of the defect with gluteal advancement flaps was performed by the plastic surgeon. The patient recovered uneventfully. Her surgical site showed healing without flap compromise, widely open anal opening, and full sphincter control at the three-month follow-up exam. The patient returned to normal function after ileostomy closure. WLE with bilateral V-Y gluteal flap advancement is a feasible treatment for primary PPD.
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Affiliation(s)
- Daniel J Borsuk
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
| | - George Melich
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA.,Division of Colon and Rectal Surgery, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Jeremy Sugrue
- Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jed Calata
- Division of Colon and Rectal Surgery, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Iris A Seitz
- Edward Plastic and Reconstructive Surgery, Edward Hospital, Naperville, Illinois, USA
| | - John J Park
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
| | - Leela M Prasad
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
| | - Slawomir J Marecik
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA.,Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
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Chumbalkar V, Jennings TA, Ainechi S, Lee EC, Lee H. Extramammary Paget's Disease of Anal Canal Associated With Rectal Adenoma Without Invasive Carcinoma. Gastroenterology Res 2016; 9:99-102. [PMID: 28058078 PMCID: PMC5191897 DOI: 10.14740/gr727e] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2016] [Indexed: 01/27/2023] Open
Abstract
Extramammary Paget's disease (EMPD) is a rare disease which is found in apocrine-rich locations such as anogenital region, axilla and rarely in other sites. Perianal EMPD is often reported as the involvement of perianal skin, but involvement of anal mucosa is very rare. Based on pathogenesis and association with either synchronous or metachronous malignancy, EMPD can be divided into primary and secondary types. Treatment approach for these two types of Paget's disease and their prognosis is different, thus it is important to make the distinction. Secondary type of Paget's disease is almost always described in association with invasive malignancy. While secondary Paget's disease arising in association with ductal carcinoma in situ of the breast is common, secondary EMPD associated with precursor lesion of the rectum without invasion is exceedingly rare. We report a very rare case of secondary Paget's disease of the anal canal in association with rectal tubular adenoma (precursor lesion) without malignancy.
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Affiliation(s)
- Vaibhav Chumbalkar
- Pathology and Laboratory Medicine, Albany Medical College, Albany, NY, USA
| | - Timothy A Jennings
- Pathology and Laboratory Medicine, Albany Medical College, Albany, NY, USA
| | - Sanaz Ainechi
- Pathology and Laboratory Medicine, Albany Medical College, Albany, NY, USA
| | - Edward C Lee
- General Surgery, Albany Medical College, Albany, NY, USA
| | - Hwajeong Lee
- Pathology and Laboratory Medicine, Albany Medical College, Albany, NY, USA
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