1
|
Hatta N, Ogata D, Asai J, Maekawa T, Ito T, Takenouchi T, Kiniwa Y, Miyashita A, Miyagawa T, Muto I, Yamamoto Y, Nagano T, Kiyohara Y, Nakano E, Ohe S, Yamaguchi B, Fukuyama M, Matsuya T, Tsutsumida A, Namikawa K, Yamazaki N. Recent treatment and prognosis in 643 patients with extramammary Paget's disease. Exp Dermatol 2024; 33:e15030. [PMID: 38375900 DOI: 10.1111/exd.15030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/21/2024]
Abstract
Information about extramammary Paget's (EMPD) treatment is limited because of the rarity of the disease. The prognosis differs between in situ EMPD and invasive EMPD; therefore, therapy should be planned according to the disease stage. We collected data on 643 EMPD cases treated between 2015 and 2019 in Japan and assessed recent trends in EMPD treatment and prognosis based on the EMPD-oriented TNM staging. Among the 643 patients, 317 had stage 0 (49.3%), 185 had stage I (28.8%), 51 had stage II (7.9%), 18 had stage IIIA (2.8%), 48 had stage IIIB (7.5%) and 24 had stage IV (3.7%) disease. Each stage showed a distinct survival curve, with the exception of stages II and IIIA. Curative surgery was most common in patients with stage 0-III disease. Chemotherapy was the first-line therapy, mainly in patients with stage IIIB and IV disease, most commonly with docetaxel (DTX), followed by DTX + tegafur gimeracil oteracil potassium (TS-1) and TS-1. Patients with local disease exhibited a 4.4% recurrence rate. Univariate analysis revealed no prognostic differences according to age, sex or primary tumour site. SLNB was not related to disease-specific survival. In multivariate analysis, female sex significantly predicted local relapse in stage 0-I (HR 3.09; 95% CI, 1.13-8.43), and initial treatment with curative surgery was significantly protective in terms of disease-specific survival in stage II-IIIA (HR, 0.17; 95% CI, 0.04-0.71) and stage IIIB-IV (HR 0.16; 95% CI, 0.05-0.51). Further clinical studies are needed to improve the prognosis of patients with stage II-IV EMPD.
Collapse
Affiliation(s)
- Naohito Hatta
- Department of Dermatology, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Dai Ogata
- Department of Dermatology, National Cancer Center Hospital, Tokyo, Japan
| | - Jun Asai
- Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Takeo Maekawa
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Takamichi Ito
- Department of Dermatology, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Tatsuya Takenouchi
- Department of Dermatology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Yukiko Kiniwa
- Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Azusa Miyashita
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Takuya Miyagawa
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Ikko Muto
- Department of Dermatology, Kurume University School of Medicine, Kurume, Japan
| | - Yuki Yamamoto
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Tohru Nagano
- Department of Dermatology, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Yoshio Kiyohara
- Department of Dermatology, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Eiji Nakano
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shuichi Ohe
- Department of Dermatologic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Buntaro Yamaguchi
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Masahiro Fukuyama
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Taisuke Matsuya
- Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan
| | - Arata Tsutsumida
- Department of Dermatology, Shizuoka Cancer Center Hospital, Shizuoka, Japan
- Department of Dermatology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kenjiro Namikawa
- Department of Dermatology, National Cancer Center Hospital, Tokyo, Japan
| | - Naoya Yamazaki
- Department of Dermatology, National Cancer Center Hospital, Tokyo, Japan
| |
Collapse
|
2
|
Faisel L, Swanson A, Sheridan C, Walker T, Carr DR, Shahwan KT. The role of sentinel lymph node biopsy in extramammary paget disease: a systematic review. Arch Dermatol Res 2023; 315:2513-2518. [PMID: 37266674 DOI: 10.1007/s00403-023-02649-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/06/2023] [Accepted: 05/17/2023] [Indexed: 06/03/2023]
Abstract
Sentinel lymph node biopsy is increasingly used to detect subclinical nodal metastases in extramammary Paget disease. We performed a comprehensive systematic review of the literature to further explore the role of sentinel lymph node biopsy in extramammary Paget disease. Five databases were searched for relevant terms. Articles were included if they were in English and presented primary data on at least one patient with extramammary Paget disease who underwent sentinel lymph node biopsy in the absence of lymphadenopathy or known metastatic disease. Twenty-eight articles were included, with 366 subjects. Seventy-seven sentinel node biopsies (21.2%) were positive, including 12 in which the primary tumor had microinvasion (15.6%) and 56 with deep invasion (72.7%). Of the positive cases, 11 (14.3%) had no further treatment, 54 (70.1%) underwent nodal dissection, 4 (5.2%) were treated with systemic agents, and 1 (1.3%) had radiation. After a mean follow up of 24 months, 9 subjects with a positive lymph node biopsy experienced nodal recurrence (11.7%), 15 had distant metastases (19.5%), and 13 died of the disease (16.9%). In conclusion, invasive extramammary Paget disease is strongly associated with poor outcomes including nodal metastasis, distant metastasis, and disease specific death. Sentinel lymph node biopsy is a useful tool to screen for subclinical nodal metastases in invasive disease, and can be used to help guide clinical management.
Collapse
Affiliation(s)
- Lena Faisel
- The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Adam Swanson
- The University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Connor Sheridan
- The University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Trent Walker
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - David R Carr
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kathryn T Shahwan
- The University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA.
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
- Department of Dermatology, Altru Health System, 3165 Demers Avenue, Grand Forks, ND, 58201, USA.
| |
Collapse
|
3
|
Ishizuki S, Nakamura Y. Role of Sentinel Lymph Node Biopsy for Skin Cancer Based on Clinical Studies. Cancers (Basel) 2023; 15:3291. [PMID: 37444401 DOI: 10.3390/cancers15133291] [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: 05/06/2023] [Revised: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
The sentinel lymph node is the first lymph node from the primary tumor. Sentinel lymph node biopsy (SLNB) is a surgical procedure that can detect occult nodal metastasis with relatively low morbidity. It may also have a therapeutic effect via regional disease control. The Multicenter Selective Lymphadenectomy-I (MSLT-I) trial revealed a prognostic benefit from SLNB in melanoma patients. However, it remains unclear whether there is a prognostic benefit from SLNB in patients with nonmelanoma skin cancer owing to a lack of randomized prospective studies. Nevertheless, SLNB provides important information about nodal status, which is one of the strongest factors to predict prognosis and may guide additional nodal treatment. Currently, SLNB is widely used in the management of not only patients with melanoma but also those with nonmelanoma skin cancer. However, the utilization and outcomes of SLNB differ among skin cancers. In addition, SLNB is not recommended for routine use in all patients with skin cancer. In this review, we provide a summary of the role of SLNB and of the indications for SLNB in each skin cancer based on previously published articles.
Collapse
Affiliation(s)
- Shoichiro Ishizuki
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
| | - Yoshiyuki Nakamura
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
| |
Collapse
|
4
|
Maeda T, Nagai K, Uehara J, Toyoshima R, Nakagawa T, Yoshino K. Sentinel lymph node biopsy in extramammary Paget disease: A 13-year institutional experience. J Dermatol 2023; 50:57-63. [PMID: 36217770 DOI: 10.1111/1346-8138.16602] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/16/2022] [Accepted: 09/22/2022] [Indexed: 01/04/2023]
Abstract
Whether sentinel lymph node biopsy status is a prognostic factor or effective in determining treatment strategies in extramammary Paget disease remains unclear. This study aimed to investigate the significance of sentinel lymph node biopsy in extramammary Paget disease. We retrospectively reviewed the clinical information of previously untreated patients with invasive extramammary Paget disease who underwent wide local excision of the primary tumor and sentinel lymph node biopsy at our hospital between April 2008 and March 2021. Clinical data including the baseline neutrophil-to-lymphocyte ratio and recurrence-free survival were analyzed. Sentinel lymph node metastases were classified as macrometastases and micrometastases, with a cut-off value for sentinel lymph node tumor burden of 2 mm. Univariate and multivariate analyses of factors affecting sentinel lymph node biopsy positivity and recurrence-free survival rates were performed. Overall, 85 patients were included in the analysis. Patients in the sentinel lymph node biopsy-positive group (n = 26) had a significantly higher invasion level and neutrophil-to-lymphocyte ratio. According to multivariate analyses, invasion level and a high neutrophil-to-lymphocyte ratio were independent predictive factors for sentinel lymph node biopsy positivity, and the sentinel lymph node biopsy status was an independent prognostic factor for recurrence-free survival. In conclusion, sentinel lymph node biopsy provides an accurate risk classification and clinical indication for postoperative follow-up in patients with invasive extramammary Paget disease.
Collapse
Affiliation(s)
- Takuya Maeda
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Kojiro Nagai
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Jiro Uehara
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Rino Toyoshima
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Tomoe Nakagawa
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Koji Yoshino
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| |
Collapse
|
5
|
Song LB, Zhou X, Luan JC, Wang HY, Cao XC, Lu JW, Zheng YJ, Wu XF, Lu Y. Nomograms for predicting the prognosis of patients with penoscrotal extramammary Paget’s disease: A retrospective study in the SEER database and two medical centers. Front Oncol 2022; 12:973579. [DOI: 10.3389/fonc.2022.973579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/14/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundExtramammary Paget’ s disease (EMPD) is a rare cutaneous malignant tumor, and the prognostic factors associated with penoscrotal EMPD remains unclear. The purpose of this study is to investigate prognostic factors and construct nomograms to predict the outcome of patients with EMPD located in the penis or scrotum.MethodsFrom the Surveillance, Epidemiology and End Results (SEER) database, we extracted 95 patients with primary EMPD located in the penis or scrotum as the training cohort. Forty-nine penoscrotal EMPD patients were included from two medical centers as the external validation cohort. Univariate and multivariate Cox regression model were applied to investigating risk factors of cancer-specific survival (CSS) and overall survival (OS). Based on the results of multivariate Cox regression analysis, the nomograms were constructed for predicting CSS and OS of patients with penoscrotal EMPD. The concordance index (C-index), receiver operating characteristic (ROC) curves and calibration curves were applied to evaluate the practicability and accuracy of the nomograms.ResultsIn the training cohort, multivariate Cox regression analysis showed that marital status and tumor stage were independent factors of CSS, and marital status, tumor stage and surgery are associated with OS independently in patients with penoscrotal EMPD. Based on these results, we developed nomograms to predict CSS and OS respectively. The C-index values were 0.778 for CSS, and 0.668 for OS in the training set, which displayed the good discriminations. In the external validation set, the C-index values were 0.945 for CSS, and 0.703 for OS. The areas under the curve (AUC) values of nomogram predicting 1-, 3-, and 5-year CSS were 0.815, 0.833, and 0.861 respectively, and 0.839, 0.654, and 0.667 for nomogram predicting 1-, 3-, and 5-year OS respectively. In the validation set, the AUC values of nomogram predicting 1-, 3-, and 5-year CSS were 0.944, 0.896, and 0.896 respectively, and 0.777, 0.762 and 0.692 for nomogram predicting 1-, 3-, and 5-year OS respectively. Additionally, the internal calibration curves also proved that our nomograms have good accuracy.ConclusionsBy incorporating marital status, tumor stage and/or surgery, our nomograms can efficiently predict CSS and OS of patients with penoscrotal EMPD.
Collapse
|
6
|
Okumura M, Ogata D, Namikawa K, Tsutsui K, Takahashi A, Okuma K, Kashihara T, Igaki H, Akiyama M, Yamazaki N. Postoperative radiation therapy improves prognoses in extramammary Paget's disease presenting with multiple lymph node metastases. J Dermatol 2022; 49:1005-1011. [PMID: 35769003 DOI: 10.1111/1346-8138.16491] [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: 04/15/2022] [Revised: 05/17/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022]
Abstract
Invasive extramammary Paget's disease may cause lymph node and distant metastases. Complete lymph node dissection is generally performed for extramammary Paget's disease presenting with lymph node metastases. Patients with extramammary Paget's disease and multiple lymph node metastases typically have poor prognoses, and there is no effective postoperative treatment to prevent recurrence or further metastases in such patients to date. This study aimed to evaluate the efficacy of postoperative radiotherapy in patients with extramammary Paget's disease and multiple lymph node metastases. We enrolled 26 patients with extramammary Paget's disease with ≥3 lymph node metastases who were treated at the National Cancer Center Hospital in Japan between January 2000 and June 2021. The patients were divided into those who underwent complete lymph node dissection only or with postoperative radiotherapy. We evaluated recurrence-free survival, distant metastasis-free survival, and overall survival outcomes with Kaplan-Meier curves. Among the 26 enrolled patients, 16 underwent complete lymph node dissection only and 10 underwent complete lymph node dissection with postoperative radiotherapy. The median follow-up period was 16 months. The 5-year recurrence-free, distant metastasis-free, and overall survival values were 47.3%, 63.0%, and 90% in those with complete lymph node dissection and postoperative radiotherapy, while these outcomes were all 0% (p = 0.001, 0.004, and 0.009, respectively) in those with only complete lymph node dissection. Thus, survival was significantly prolonged with postoperative radiotherapy. Additional postoperative radiotherapy may substantially improve the prognoses of patients with extramammary Paget's disease and ≥3 lymph node metastases, and undergoing curative surgery.
Collapse
Affiliation(s)
- Mao Okumura
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan.,Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Dai Ogata
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kenjiro Namikawa
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Keita Tsutsui
- Department of Dermatology, Fukuoka University, Fukuoka, Japan
| | - Akira Takahashi
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kae Okuma
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tairo Kashihara
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Masashi Akiyama
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoya Yamazaki
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| |
Collapse
|
7
|
Ishizuki S, Nakamura Y. Extramammary Paget's Disease: Diagnosis, Pathogenesis, and Treatment with Focus on Recent Developments. Curr Oncol 2021; 28:2969-2986. [PMID: 34436026 PMCID: PMC8395499 DOI: 10.3390/curroncol28040260] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/01/2021] [Accepted: 08/03/2021] [Indexed: 12/31/2022] Open
Abstract
Extramammary Paget's disease (EMPD) is a rare neoplasm that usually develops in apocrine gland-bearing areas, such as the vulva, scrotum, and penis. EMPD may present with a focal, multifocal, or an ectopic lesion. Clinically, EMPD lesions often exhibit infiltrative erythema, which is sometimes similar to other skin disorders such as eczema. While primary EMPD arises as intraepithelial neoplasm of the epidermis, EMPD-like lesions may occur from epidermotropic spread of malignant cells or direct extension from an underlying internal neoplasm, known as secondary EMPD. Because treatment strategies differ for primary EMPD and secondary EMPD, accurate diagnosis based on detailed histopathological evaluation is required. In the early stages, EMPD usually shows indolent growth, and most cases are diagnosed as carcinoma in situ. However, invasive lesions may result in metastases, and deep invasion is associated with high incidence of metastases. Conventional chemotherapies have been used for EMPD treatment in patients with distant metastases, but the efficacy is not satisfactory, and the prognosis for such patients remains poor. Recent studies have provided various insights into the molecular pathogenesis of the development and advancement of EMPD, which may lead to novel treatment approaches for metastatic EMPD. This review addresses the diagnosis, pathogenesis, and treatment of EMPD with focus on recent progress in understanding this disease.
Collapse
Affiliation(s)
| | - Yoshiyuki Nakamura
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan;
| |
Collapse
|
8
|
Kawahara Y, Umeda Y, Yamaguchi B, Kamimura A, Teramoto Y, Nakamura Y. Long-term resolution of invasive extramammary Paget's disease with multiple regional lymph node metastases solely with regional lymph node dissection. J Dermatol 2021; 48:e452-e453. [PMID: 34118172 DOI: 10.1111/1346-8138.16007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/09/2021] [Accepted: 05/10/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Yu Kawahara
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yoshiyasu Umeda
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Buntaro Yamaguchi
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Anna Kamimura
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yukiko Teramoto
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yasuhiro Nakamura
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan
| |
Collapse
|
9
|
Goto H, Sugita K, Yamamoto O. Expression of Programmed Death-Ligand 1 and Programmed Death-1 in Patients with Extramammary Paget's Disease. Indian J Dermatol 2021; 66:169-173. [PMID: 34188273 PMCID: PMC8208280 DOI: 10.4103/ijd.ijd_341_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Extramammary Paget's disease (EMPD) is a rare skin cancer and sometimes has fatal prognosis. For progressive cases, therapeutic options are limited. In recent years, treatment with an anti-programmed death-1 (PD-1) antibody has improved the prognosis of various malignancies. In addition, correlations between PD-ligand 1 (PD-L1) expression in tumor cells and favorable responses to anti-PD-1 therapy have been reported for several cancers. There have been a few case series of analysis of PD-L1 expression in patients with EMPD. Aims: The purpose of this study was to investigate the relationship between the EMPD and PD-L1/PD-1 expression in Japanese EMPD patients. Materials and Methods: We investigated 39 patients with EMPD by immunohistochemical staining of PD-L1 and PD-1. We counted the number of tumor cells that were positive for PD-L1 and the number of tumor-infiltrating mononuclear cells (TIMCs) that were positive for PD-L1 and PD-1. We also analyzed correlations between the expression of PD-L1 and PD-1 in EMPD and patients’ characteristics. Results: We found that none of the Paget's cells expressed PD-L1. All of the specimens contained TIMCs, and some of the TIMCs expressed PD-L1 and PD-1. However, there was no correlation between the expression of PD-L1/PD-1 in TIMCs and patients’ characteristics. Conclusion: Although tumor cells did not express PD-L1 and the expression of PD-L1/PD-1 in TIMCs did not correlate with patients’ characteristics, future clinical studies should be carried out to explore another immune escape pathway in EMPD.
Collapse
Affiliation(s)
- Hiroyuki Goto
- Department of Medicine of Sensory and Motor Organs, Division of Dermatology, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Kazunari Sugita
- Department of Medicine of Sensory and Motor Organs, Division of Dermatology, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Osamu Yamamoto
- Department of Medicine of Sensory and Motor Organs, Division of Dermatology, Faculty of Medicine, Tottori University, Tottori, Japan
| |
Collapse
|
10
|
Fernandes L, Graça J, de Matos LV, Sampaio R, Baleiras MM, Ferreira F, Pinto MM, Miranda H, Martins A. Metastatic extramammary paget disease, a remarkable clinical case and a brief review of a rare disease. Dermatol Reports 2020; 12:8841. [PMID: 33408837 PMCID: PMC7772764 DOI: 10.4081/dr.2020.8841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/20/2020] [Indexed: 11/23/2022] Open
Abstract
Extramammary Paget Disease (EMPD) is an often-misdiagnosed rare disorder, whose cause remains unknown. Diagnosis is confirmed by skin biopsy. Primary treatment for EMPD is surgery. Recurrence is common in the first two years and prognosis is good if the disease is localized and there is no underlying associated cancer. Patients with invasive and metastatic EMPD are uncommon and exhibit a poor prognosis, even when there is good response to a first chemotherapy line. Multiple chemotherapeutic regimens, with varying levels of success, have been attempted, but standard of care is not established. The central nervous system seems to be a common metastatic site with better survival than visceral metastasis.We report a case of metastatic EMPD that addresses the difficulties associated with the treatment of this rare disease, that has no current guidelines.
Collapse
Affiliation(s)
- Leonor Fernandes
- Medical Oncology Department, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental
| | - Joana Graça
- Medical Oncology Department, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental
| | | | - Rita Sampaio
- Pathology Department, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | | | - Filipa Ferreira
- Medical Oncology Department, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental
| | - Marta Mesquita Pinto
- Medical Oncology Department, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental
| | - Helena Miranda
- Medical Oncology Department, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental
| | - Ana Martins
- Medical Oncology Department, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental
| |
Collapse
|
11
|
Tsutsui K, Takahashi A, Muto Y, Mizuta H, Jinnai S, Nakama K, Ogata D, Namikawa K, Yamazaki N. Outcomes of lymph node dissection in the treatment of extramammary Paget's disease: A single-institution study. J Dermatol 2020; 47:512-517. [PMID: 32157716 DOI: 10.1111/1346-8138.15285] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/03/2020] [Indexed: 11/30/2022]
Abstract
Extramammary Paget's disease (EMPD) often invades the dermis and metastasizes to the lymph nodes. Patients with EMPD associated with lymph node metastases have poor prognosis; to date, effective treatment has not yet been established. Lymph node dissection, aiming to control the local disease, is a standard form of management for EMPD patients with lymph node metastases (LNM). We investigated the clinical and pathological features, treatment strategies and prognostic factors of patients with metastatic EMPD who underwent lymph node dissection. We retrospectively evaluated 38 cases of extramammary Paget's disease with lymph node metastasis over 10 years. All patients underwent wide resection of the primary lesion and lymph node dissection. Univariate analysis revealed the number of metastatic nodes and lymphadenopathy as prognostic factors. In multivariate analysis, the number of metastatic lymph nodes retained statistical significance (hazard ratio, 35.3; 95% confidence interval, 3.23-387.0; P = 0.003). The 5-year survival rate was 100% and 19.1% in patients with two or less LNM and with three or more LNM, respectively. In patients with three or more LNM, the 5-year survival rate after adjuvant radiation therapy was better than that after surgery alone (75% vs 0%). In conclusion, patients with two or less LNM can be expected to have long-term survival with lymph node dissection only, while patients with three or more LNM may require adjuvant radiation therapy to improve prognosis. These results suggest that lymph node dissection may be a strategy to treat EMPD with regional LNM.
Collapse
Affiliation(s)
- Keita Tsutsui
- Department of Dermatological Oncology, National Cancer Center Hospital, Tokyo, Japan.,Department of Dermatology, Fukuoka University, Fukuoka, Japan
| | - Akira Takahashi
- Department of Dermatological Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yusuke Muto
- Department of Dermatological Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Haruki Mizuta
- Department of Dermatological Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Shunichi Jinnai
- Department of Dermatological Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kenta Nakama
- Department of Dermatological Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Dai Ogata
- Department of Dermatological Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kenjiro Namikawa
- Department of Dermatological Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Naoya Yamazaki
- Department of Dermatological Oncology, National Cancer Center Hospital, Tokyo, Japan
| |
Collapse
|
12
|
Extramammary Paget Disease: A Review of the Literature—Part I: History, Epidemiology, Pathogenesis, Presentation, Histopathology, and Diagnostic Work-up. Dermatol Surg 2020; 46:151-158. [DOI: 10.1097/dss.0000000000002064] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
13
|
Abstract
Extramammary Paget's disease (EMPD) is a rare and lethal intraepithelial malignancy that remains poorly understood. No standardized guidelines or consensus statements exist with regards to the diagnostic evaluation, therapeutic approaches and follow-up management. Complete surgical excision with negative margins has been accepted as the mainstay of treatment for EMPD to decrease the risk of local recurrence and to maximize durable cure. Non-invasive therapies, such as laser therapy, photodynamic therapy, radiotherapy and topical chemotherapy have been utilized, but are best reserved for non-surgical candidates. While the debate on the surgical approach between wide local excision (WLE) and Mohs micrographic surgery (MMS) continues, several studies have demonstrated the ability of WLE to be performed safely and effectively and to yield equally satisfactory outcomes with similar rates of recurrence to MMS. Patients undergoing surgical excision often require complex closures with skin grafting or local flaps to close genital defects. We aim to provide an up-to-date review of the current knowledge of EMPD. In addition to discussing the clinical presentation and prognostic outcomes, we focus and elaborate on the diagnostic approaches and treatment alternatives available. This information may serve as a primer for the urologist who may be called upon to treat this malignancy primarily or to provide wound coverage secondarily.
Collapse
Affiliation(s)
- Joon Yau Leong
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia PA, USA
| | - Paul H Chung
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia PA, USA
| |
Collapse
|
14
|
Local Excision of a Mucinous Adenocarcinoma of the Anal Margin (Extramammary Paget's Disease) and Reconstruction with a Bilateral V-Y Flap. Case Rep Surg 2019; 2019:9073982. [PMID: 31886008 PMCID: PMC6915020 DOI: 10.1155/2019/9073982] [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: 05/13/2019] [Accepted: 11/15/2019] [Indexed: 11/17/2022] Open
Abstract
The case of a 75-year-old female with invasive extramammary Paget's disease of the anal margin, without involvement of the anal canal, is reported. The patient underwent wide local excision of the lesion with reconstruction with a double V-Y flap, a biopsy of the inguinal sentinel node, and a laparoscopic temporary colostomy. No guidelines exist on the treatment of this rare disease, and both wide local excision and abdominoperineal resection have been proposed. In the present case, the absence of invasion of the anal canal, also confirmed by intraoperative biopsies on the resection margins, and of local lymph node metastasis, as confirmed by the sentinel lymph node biopsy, allowed a sphincter-sparing operation with good functional and oncological results.
Collapse
|
15
|
|
16
|
Lu X, Zhang P, Zhu Y, Ye D. Human epidermal growth factor receptor 2 amplification as a biomarker for treatment in patients with lymph node-metastatic penoscrotal extramammary Paget's disease. Oncol Lett 2019; 17:2677-2686. [PMID: 30854041 PMCID: PMC6365939 DOI: 10.3892/ol.2019.9930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 12/05/2018] [Indexed: 01/03/2023] Open
Abstract
The role of human epidermal growth factor receptor 2 (HER2) amplification as a biomarker for treatment in patients with lymph node (LN)-metastatic penoscrotal extramammary Paget's disease (EMPD) was investigated in the present study. A total of 11 male patients with LN-metastatic penoscrotal EMPD were retrospectively reviewed. Positron emission tomography/computed tomography (PET/CT) was conducted prior to surgery. Immunohistochemistry and fluorescence in situ hybridization were used to evaluate HER2 gene amplification in LN samples. Sanger sequencing was used to investigate HER2 mutations. A literature review of the prevalence of HER2 amplification in EMPD and the efficacy of HER2-targeted therapy was also undertaken. PET/CT is effective in detecting metastatic sites. The sensitivity and specificity of PET/CT was 90.9 and 100.0% for inguinal LNs, and 85.7 and 80.0% for pelvic LNs, respectively. The median time from LN dissection to disease progression was 15.9±1.5 months. Of the 11 patients, 3 (27.3%) indicated HER2 amplification. Patients with HER2 amplification showed shorter median times from disease discovery to LN metastasis (HER2 amplification vs HER2 non-amplification; 15.6 vs. 10.0 months; P=0.50) and from LN dissection to disease progression (HER2 amplification vs. HER2 non-amplification, 16.2 vs. 13.6 months; P=0.11). However, the aforementioned observations were not indicated to be statistically significant. No HER2 mutations were identified. Trastuzumab, a HER2-targeted monoclonal antibody, was administered to 2 of the patients with HER2 amplification. A literature review of the prevalence of HER2 amplification in EMPD and the efficacy of HER2-targeted therapy showed similar results. Altogether, 485 cases of EMPD were reported, 35 of which had metastases. The results in the present study suggest that PET/CT should be used on all metastatic EMPD patients. EMPD may be effectively treated with trastuzumab. The present study and case reports from the literature provide evidence for the benefit of testing for HER2 amplification in this rare disease and highlight the requirement for a multicenter clinical trial to assess the impact of trastuzumab therapy in treating this disease.
Collapse
Affiliation(s)
- Xiaolin Lu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Peipei Zhang
- Department of Pathology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Yao Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Dingwei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| |
Collapse
|
17
|
Affiliation(s)
- Jeff Choi
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Allison Zemek
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Gordon K Lee
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Cindy Kin
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA.
| |
Collapse
|
18
|
|
19
|
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
| |
Collapse
|
20
|
van der Linden M, Meeuwis K, Bulten J, Bosse T, van Poelgeest M, de Hullu J. Paget disease of the vulva. Crit Rev Oncol Hematol 2016; 101:60-74. [DOI: 10.1016/j.critrevonc.2016.03.008] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 01/25/2016] [Accepted: 03/03/2016] [Indexed: 01/03/2023] Open
|
21
|
Fujisawa Y, Yoshino K, Kiyohara Y, Kadono T, Murata Y, Uhara H, Hatta N, Uchi H, Matsushita S, Takenouchi T, Hayashi T, Fujimoto M, Ohara K. The role of sentinel lymph node biopsy in the management of invasive extramammary Paget's disease: Multi-center, retrospective study of 151 patients. J Dermatol Sci 2015; 79:38-42. [DOI: 10.1016/j.jdermsci.2015.03.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/20/2015] [Accepted: 03/25/2015] [Indexed: 10/23/2022]
|
22
|
Cohen JM, Granter SR, Werchniak AE. Risk stratification in extramammary Paget disease. Clin Exp Dermatol 2015; 40:473-8. [DOI: 10.1111/ced.12690] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2015] [Indexed: 12/01/2022]
Affiliation(s)
| | - S. R. Granter
- Division of Dermatopathology; Department of Pathology; Brigham and Women's Hospital and Harvard Medical School; Boston MA USA
| | - A. E. Werchniak
- Department of Dermatology; Brigham and Women's Hospital and Harvard Medical School; Boston MA USA
- Center for Cutaneous Oncology; Dana-Farber Cancer Institute and Harvard Medical School; Boston MA USA
| |
Collapse
|
23
|
Koh YX, Tay TKY, Xu S, Lee CM, Teo MCC. A clinical series and literature review of the management of inguinal nodal metastases in patients with primary extramammary Paget disease of the scrotum. Asian J Surg 2015; 38:40-6. [DOI: 10.1016/j.asjsur.2014.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 08/13/2014] [Accepted: 08/15/2014] [Indexed: 10/24/2022] Open
|
24
|
Fukushima S, Masuguchi S, Igata T, Harada M, Aoi J, Miyashita A, Nakahara S, Inoue Y, Jinnin M, Shiraishi S, Yamashita Y, Ishihara T, Ihn H. Evaluation of sentinel node biopsy for cutaneous squamous cell carcinoma. J Dermatol 2014; 41:539-41. [DOI: 10.1111/1346-8138.12508] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 04/02/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Satoshi Fukushima
- Department of Dermatology and Plastic Surgery; Faculty of Life Sciences; Kumamoto Japan
| | - Shinichi Masuguchi
- Department of Dermatology and Plastic Surgery; Faculty of Life Sciences; Kumamoto Japan
| | - Toshikatsu Igata
- Department of Dermatology and Plastic Surgery; Faculty of Life Sciences; Kumamoto Japan
| | - Miho Harada
- Department of Dermatology and Plastic Surgery; Faculty of Life Sciences; Kumamoto Japan
| | - Jun Aoi
- Department of Dermatology and Plastic Surgery; Faculty of Life Sciences; Kumamoto Japan
| | - Azusa Miyashita
- Department of Dermatology and Plastic Surgery; Faculty of Life Sciences; Kumamoto Japan
| | - Satoshi Nakahara
- Department of Dermatology and Plastic Surgery; Faculty of Life Sciences; Kumamoto Japan
| | - Yuji Inoue
- Department of Dermatology and Plastic Surgery; Faculty of Life Sciences; Kumamoto Japan
| | - Masatoshi Jinnin
- Department of Dermatology and Plastic Surgery; Faculty of Life Sciences; Kumamoto Japan
| | - Shinya Shiraishi
- Department of Diagnostic Radiology; Kumamoto University; Kumamoto Japan
| | | | - Tsuyoshi Ishihara
- Department of Dermatology and Plastic Surgery; Faculty of Life Sciences; Kumamoto Japan
| | - Hironobu Ihn
- Department of Dermatology and Plastic Surgery; Faculty of Life Sciences; Kumamoto Japan
| |
Collapse
|
25
|
Moretto P, Nair V, Hallani SE, Malone S, Belanger E, Morash C, Canil C. Management of penoscrotal extramammary Paget disease: case series and review of the literature. Curr Oncol 2013; 20:e311-20. [PMID: 23904770 PMCID: PMC3728060 DOI: 10.3747/co.20.1353] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Extramammary Paget disease (empd) is a rare, slow-growing neoplasm, considered to be an adenocarcinoma of the apocrine glands. In men, the penoscrotal region is the most commonly affected area. The disease can present as carcinoma in situ or as invasive disease that can subsequently metastasize to lymph nodes and distant sites. Because of the rarity of empd, the medical literature available to guide management of the disease is limited, particularly in patients with metastases. In addition, metastatic disease may pose a diagnostic challenge, because invasive cancer of the genitourinary or gastrointestinal tract can occur in association with empd. In the present case series, we describe our experience in treating penoscrotal empd with multimodality therapy, and we review the existing literature concerning its diagnosis and management.
Collapse
Affiliation(s)
- P. Moretto
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
| | - V.J. Nair
- Division of Radiation Oncology, Department of Radiology, The Ottawa Hospital Cancer Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
| | - S. El Hallani
- Division of Anatomical Pathology, Department of Pathology and Laboratory Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON
| | - S. Malone
- Division of Radiation Oncology, Department of Radiology, The Ottawa Hospital Cancer Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
| | - E. Belanger
- Division of Anatomical Pathology, Department of Pathology and Laboratory Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON
| | - C. Morash
- Division of Urology, The Ottawa Hospital Cancer Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
| | - C.M. Canil
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
| |
Collapse
|
26
|
Erratum. Dermatol Surg 2013. [DOI: 10.1111/dsu.12219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
27
|
Longo-Imedio MI. Letter: Photodynamic Therapy with Methyl-Aminolevulinate for the Treatment of Double Extramammary Paget's Disease. Dermatol Surg 2013; 39:144-5. [DOI: 10.1111/dsu.12066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|