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Pérez JC, Salgado AC, Pérez-Mies B, Rullán JAD, Ajuria-Illarramendi O, Alia EMG, Serrano Domingo JJ. Extramammary Paget Disease: a Therapeutic Challenge, for a Rare Entity. Curr Oncol Rep 2023; 25:1081-1094. [PMID: 37421583 PMCID: PMC10556167 DOI: 10.1007/s11912-023-01434-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE OF REVIEW Extramammary Paget disease (EMPD) is a rare entity which is more frequently localized at the vulva, though it only accounts for 1-2% of vulvar neoplasms. It is a primary cutaneous adenocarcinoma whose cell of origin is still a matter of controversy: it can either arise from apocrine/eccrine glands or from stem cells. The diagnosis demands a biopsy and entails a histopathological analysis by which cells show similar characteristics as breast Paget disease. RECENT FINDINGS Treatment approach can entail surgery, radiotherapy, photodynamic therapy, systemic chemotherapy, and topical chemotherapy. For metastatic disease, many different chemotherapy regimens have been explored and even targeted therapy can play an important role in this disease. Since almost 30-40% of patients overexpress HER-2, trastuzumab and anti-HER-2 therapies can be employed in this setting. Due to its low incidence, there is almost no specific evidence on therapeutic interventions for this disease. Thus, there is a neat unmet need for molecular characterization of EMPD and diagnostic tools that allow clinicians to guide treatment both in the early and in the advanced disease settings. In this review, we aim to summarize available evidence about diagnosis and treatment of EMPD, both localized and metastatic, and to provide a comprehensive analysis that may help clinicians for therapeutic decisions.
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Affiliation(s)
- Jesús Chamorro Pérez
- Medical Oncology Department, Ramón y Cajal University Hospital, Carretera de Colmenar Viejo, Km 9.100, 28034 Madrid, CP Spain
| | - Alfonso Cortes Salgado
- Medical Oncology Department, Ramón y Cajal University Hospital, Carretera de Colmenar Viejo, Km 9.100, 28034 Madrid, CP Spain
| | - Belén Pérez-Mies
- Pathology Department, Ramón y Cajal University Hospital, Carretera de Colmenar Viejo, Km 9.100, 28034 Madrid, CP Spain
| | - Jose Antonio Domínguez Rullán
- Radiation Oncology Department, Ramón y Cajal University Hospital, Carretera de Colmenar Viejo, Km 9.100, 28034 Madrid, CP Spain
| | - Odile Ajuria-Illarramendi
- Nuclear Medicine Department, Ramón y Cajal University Hospital, Carretera de Colmenar Viejo, Km 9.100, 28034 Madrid, CP Spain
| | - Eva María Guerra Alia
- Medical Oncology Department, Ramón y Cajal University Hospital, Carretera de Colmenar Viejo, Km 9.100, 28034 Madrid, CP Spain
| | - Juan José Serrano Domingo
- Medical Oncology Department, Ramón y Cajal University Hospital, Carretera de Colmenar Viejo, Km 9.100, 28034 Madrid, CP Spain
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Thomsen TV, Makki A, Hasanbegovic E, Rindom MB, Stolle LB. Treatment challenges associated with primary extramammary Paget’s disease. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01876-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
A 72-year-old man with history of itching for 8 months presented with an ill-defined, ulcerated, eczematous, thickened cutaneous lesion in the left perianal region. F-FDG PET/CT was performed, and neoplastic skin thickening with FDG uptake was seen at the left gluteal cleft. Hypermetabolic inguinal, retroperitoneal, and mediastinal lymph nodes, liver, and bone metastases were seen. Histopathology and immunohistochemistry of the perianal growth and left inguinal lymph node were positive for cytokeratin7 and gross cystic disease fluid protein and negative for cytokeratin 20 and CDX2, confirming the diagnosis of primary extramammary Paget disease with metastases.
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Bayan CAY, Khanna T, Rotemberg V, Samie FH, Zeitouni NC. A review of non-invasive imaging in extramammary Paget's disease. J Eur Acad Dermatol Venereol 2018; 32:1862-1873. [PMID: 29763511 DOI: 10.1111/jdv.15072] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 04/30/2018] [Indexed: 01/04/2023]
Abstract
Extramammary Paget's Disease (EMPD) is a rare intraepithelial adenocarcinoma that classically manifests with pruritic, erythematous and scaling plaques. The clinical picture frequently mimics inflammatory or infectious conditions and is thus commonly misdiagnosed. The assessment of tumour margins is equally challenging as tumours have a propensity to spread beyond clinically visible boundaries. Appropriate non-invasive diagnostic tools can assist in the early detection, diagnosis and management of EMPD. This paper will review the literature on non-invasive imaging modalities used in EMPD. Articles from the PubMed database were selected based on relevance to the topic of this review. Articles that were not specific to EMPD and non-invasive imaging were excluded. Search strategy is further described in the methods section below. Eighteen articles were selected for this review: six PET/CT, five reflectance confocal microscopy (RCM), two photodynamic diagnosis (PDD), two dermoscopy, two MRI and one optical coherence tomography (OCT) paper(s). Dermoscopy, PDD, RCM and OCT can help to distinguish malignant conditions, including EMPD, from benign conditions. RCM and OCT can identify atypical cells in real-time, and have the potential to improve the accuracy of surgical margins intraoperatively and overall management. Distinctive confocal characteristics of EMPD have been described using RCM. The sensitivity and specificity of these findings require additional validation. Radiographic techniques also play a central role in the diagnosis of EMPD and assessment of disease spread. PET/CT and MRI can detect primary disease, nodal and distant metastases, with superior delineation of disease spread on MRI. Limitations of PET/CT are mainly related to primary tumour thickness, and size and FDG-avidity of nodal and distant metastases. Limitations of MRI include the fact that few studies have examined its use in EMPD; additional research is warranted. Randomized controlled trials and large prospective studies evaluating the use of non-invasive imaging in EMPD are needed.
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Affiliation(s)
- C-A Y Bayan
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - T Khanna
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - V Rotemberg
- Department of Dermatology, Columbia University Medical Center, New York, NY, USA
| | - F H Samie
- Department of Dermatology, Columbia University Medical Center, New York, NY, USA
| | - N C Zeitouni
- Department of Dermatology, University of Arizona and University of Arizona Cancer Center at Dignity Health, Phoenix, AZ, USA
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Chang K, Li GX, Kong YY, Shen XX, Qu YY, Jia ZW, Wang Y, Dai B, Ye DW. Chemokine Receptors CXCR4 and CXCR7 are Associated with Tumor Aggressiveness and Prognosis in Extramammary Paget Disease. J Cancer 2017; 8:2471-2477. [PMID: 28900484 PMCID: PMC5595076 DOI: 10.7150/jca.19127] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 05/10/2017] [Indexed: 12/22/2022] Open
Abstract
Chemokines are involved in many aspects of oncogenesis, including regulation of cancer cell growth, dissemination and host-tumor response. However, the potential of the chemokine receptors, CXCR4 and CXCR7, in serving as biomarkers in extramammary Paget's disease (EMPD) has been rarely examined. Expressions of CXCR4 and CXCR7 were evaluated in 92 EMPD specimens by immunohistochemistry. High expression of CXCR4 and CXCR7 were both correlated with regional lymph node metastasis and presence of lymphovascular invasion. High expression of CXCR7 also correlated with the depth of invasion. The prognostic value of these two chemokines were also investigated in progression-free survival (PFS) and cancer-specific survival (CSS). Both high expression of CXCR4 and CXCR7 were indicative of shorter PFS and CSS. In the combined prognostic model, concomitant high expression of CXCR4 and CXCR7 were suggestive of poor prognosis compared with the other two groups. In the multivariate analysis, depth of invasion, combined prognostic model and regional lymph node metastasis at diagnosis were the independent prognostic factors for EMPD patients for PFS, and the former two factors independently impacted CSS. Our results demonstrated that CXCR4 and CXCR7 can be used as prognostic biomarkers and prediction of aggressiveness of EMPD. Therapy targeting CXCR4 and CXCR7 may helpful to prevent EMPD progression and improve the prognosis of EMPD.
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Affiliation(s)
- Kun Chang
- Department of Urology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Gao-Xiang Li
- Department of Urology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Yun-Yi Kong
- Department of Pathology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Xu-Xia Shen
- Department of Pathology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Yuan-Yuan Qu
- Department of Urology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Zhong-Wei Jia
- Department of Urology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Yue Wang
- Department of Urology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Bo Dai
- Department of Urology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Ding-Wei Ye
- Department of Urology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
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Fujiwara M, Suzuki T, Senoo A, Fukamizu H, Tokura Y. Evaluation of positron emission tomography imaging to detect lymph node metastases in patients with extramammary Paget's disease. J Dermatol 2017; 44:939-943. [DOI: 10.1111/1346-8138.13833] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 02/06/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Masao Fujiwara
- Department of Plastic and Reconstructive Surgery; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - Takahiro Suzuki
- Department of Dermatology; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - Ayumi Senoo
- Department of Plastic and Reconstructive Surgery; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - Hidekazu Fukamizu
- Department of Plastic and Reconstructive Surgery; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - Yoshiki Tokura
- Department of Dermatology; Hamamatsu University School of Medicine; Hamamatsu Japan
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Primary invasive triple extramammary Paget's disease with regional lymph node metastasis: A case report and review of the literature. DERMATOL SIN 2016. [DOI: 10.1016/j.dsi.2016.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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