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Joshi TP, Dokic Y, Shimizu I. Epidemiology of extramammary Paget's disease among Asian-American subgroups: A surveillance, epidemiology, and end results (SEER) program-based analysis. J Am Acad Dermatol 2024:S0190-9622(24)00763-1. [PMID: 38763292 DOI: 10.1016/j.jaad.2024.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/21/2024]
Affiliation(s)
- Tejas P Joshi
- School of Medicine, Baylor College of Medicine, Houston, Texas.
| | - Yelena Dokic
- Department of Dermatology, Baylor College of Medicine, Houston, Texas
| | - Ikue Shimizu
- Department of Dermatology, Baylor College of Medicine, Houston, Texas
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Liu YA, Collins K, Aung PP, Nagarajan P, Curry JL, Prieto VG, Torres-Cabala CA, Cho WC. TRPS1 expression in primary and secondary extramammary Paget diseases: An immunohistochemical analysis of 93 cases. Hum Pathol 2024; 143:5-9. [PMID: 38000676 DOI: 10.1016/j.humpath.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023]
Abstract
Extramammary Paget disease (EMPD) predominantly manifests de novo as primary EMPD, with less than 30 % of cases associated with underlying internal malignancy (secondary EMPD). Differentiating primary from secondary EMPDs based solely on histopathology poses challenges, often necessitating supplementary screening, such as endoscopy or imaging studies, to definitively exclude underlying carcinomas like colonic adenocarcinoma. Recently, TRPS1 immunohistochemistry, initially identified as a sensitive and specific marker for carcinomas and mesenchymal tumors of mammary origin, has been proposed for EMPD. In this study, we conducted a systematic assessment of TRPS1 expression across 93 EMPD cases, comprising 82 primary EMPDs and 11 secondary EMPDs. Our aim was to assess the potential utility of TRPS1 as a marker to differentiate between primary and secondary EMPDs. Our findings revealed that 88 % (72/82) of primary EMPDs displayed TRPS1 expression, while secondary EMPDs consistently lacked TRPS1 expression (100 %; 11/11). Within the primary EMPD group, consistent TRPS1 immunoreactivity was observed in lesions originating outside the perianal region, such as the groin/inguinal area, axilla, and trunk. Interestingly, a majority (91 %; 10/11) of primary EMPDs originating in the perianal region exhibited an absence of TRPS1 expression. Upon excluding cases of perianal primary EMPDs, the sensitivity and specificity of TRPS1 for primary EMPDs reached 100 %. Our findings suggest that TRPS1 expression holds notable sensitivity and specificity for primary EMPDs, particularly when arising from non-perianal cutaneous sites. Hence, in suitable clinical contexts, TRPS1 immunohistochemistry may emerge as a promising and valuable tool for distinguishing primary and secondary EMPDs.
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Affiliation(s)
- Yi A Liu
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Katrina Collins
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Phyu P Aung
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Priyadharsini Nagarajan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Jonathan L Curry
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Victor G Prieto
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Carlos A Torres-Cabala
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Woo Cheal Cho
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
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Yuan X, Xue R, Cao X. Network meta-analysis of treatments for perineal extramammary paget's disease: Focusing on performance of recurrence prevention. PLoS One 2023; 18:e0294152. [PMID: 37956192 PMCID: PMC10642846 DOI: 10.1371/journal.pone.0294152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION Perineal extramammary paget's disease (EMPD) is characterized with high recurrence rate. Although numerous therapeutic measures for this disease have been reported so far, it is unknown whether there is significant difference in their recurrence-preventing efficiency. This study aims to compare the recurrence outcomes of reported perineal EMPD treatments. METHODS We searched public databases of for published studies concerning perineal EMPD treatments. After screening by inclusion and exclusion criteria, we extracted the data relevant to recurrence rate, and conducted network meta-analysis (NMA) by using Bayesian random-effects approach. RESULTS Our analysis included 29 previous studies (involving both male and female patients) and 11 treatment designs which are wide local excision (WLE), local excision (LE), Mohs micrographic surgery (MMS), radiotherapy (RT), radical vulvectomy (RV), photodynamic therapy (PDT), lasers (LS), imiquimod, and WLE+RT, WLE+PDT, WLE+LS. Comparing with WLE, the MMS showed significant advantage in reducing recurrence [OR: 0.18 (0.03-0.87)], while none of the rest treatments has statistically significant results. After removing outlier studies, MMS still has the significant advantages [OR: 0.35 (0.11-0.82)], and LE turned to be the treatment with worst performance [OR: 13 (2.50-110)]. Covariance analysis of follow-up length, gender differences, and lesion locations indicated only short follow-up time could affect the recurrence statistics, which tend to conceal the real differences. Funnel plot demonstrated there is no significant small study effect. CONCLUSION MMS has the best performance on reducing perineal EMPD recurrence, while LE exhibits the worst capability in such regard. Recurrence-preventing abilities of other treatments have no significant difference between each other.
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Affiliation(s)
- Xiaobin Yuan
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- First College of Clinical Medicine, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Ruizhi Xue
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- First College of Clinical Medicine, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xiaoming Cao
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- First College of Clinical Medicine, Shanxi Medical University, Taiyuan, Shanxi, China
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Sohn BS, Kim J, Kim M, Hong JY, Lee J, Park SE, Kim H, Lee HJ, Kang EJ, Lee SI, Lee IH, Huh SJ, Jo J, Kim HY. Treatment outcomes of advanced/metastatic extramammary Paget's disease in Korean patients: KCSG-RC20-06. Cancer Med 2023; 12:15159-15175. [PMID: 37264748 PMCID: PMC10417073 DOI: 10.1002/cam4.6190] [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: 10/15/2022] [Revised: 05/15/2023] [Accepted: 05/21/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Extramammary Paget's disease (EMPD) is rare. There are no standard treatments due to its rarity and few clinical trials. METHODS The objective of this multicenter study was to investigate treatment outcomes of Korean patients with advanced/metastatic EMPD. Data were collected retrospectively from 14 institutions participating in Korean Cancer Study Group (KCSG) Rare Cancer Committee. RESULTS A total of 37 patients were identified. Of these 37 patients, 6 received locoregional therapy as a first-line treatment. In 31 patients who received systemic chemotherapy as a first-line treatment, platinum-based chemotherapy (n = 22) achieved an objective response rate (ORR) of 45.5% and a median progression-free survival (PFS) of 7.89 months. Taxane-based chemotherapy (n = 8) achieved an objective response rate of 62.5% and median PFS of 9.73 months. In second-line chemotherapy, platinum-based chemotherapy (n = 4) had a disease control rate (DCR) of 75.0% and median PFS of 3.45 months. Taxane-based chemotherapy (n = 8) had a DCR of 75.0% and a median PFS of 8.67 months. Six patients received anti-human epidermal growth factor receptor 2 (HER2) antibody during first- and second-line chemotherapy. Overall, systemic chemotherapy combined with anti-HER2 antibody had an ORR of 100% and a median PFS of 13.31 months. The ORR and PFS with systemic chemotherapy combined with trastuzumab was better than platinum- and taxane-based chemotherapy only. CONCLUSIONS Due to its rarity, advanced or metastatic EMPD still has no established standard treatment. Results of our study indicate that the combination of trastuzumab with taxane has longer survival than trastuzumab monotherapy or conventional platinum- or taxane-based chemotherapy.
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Affiliation(s)
- Byeong Seok Sohn
- Department of Internal Medicine, Sanggye Paik HospitalInje University College of MedicineSeoulSouth Korea
| | - Jeongeun Kim
- Department of Oncology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
| | - Miso Kim
- Department of Internal MedicineSeoul National University College of Medicine and Seoul National University HospitalSeoulSouth Korea
| | - Jung Yong Hong
- Division of Hematology‐Oncology, Department of MedicineSamsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
| | - Jieun Lee
- Division of Medical Oncology, Department of Internal MedicineSeoul St. Mary's Hospital, College of Medicine, The Catholic University of KoreaSeoulSouth Korea
| | - Song Ee Park
- Division of Hematology‐Oncology, Department of MedicineChung‐Ang University College of MedicineSeoulSouth Korea
| | - Hyojeong Kim
- Division of Hemato‐Oncology, Department of Internal MedicinePusan National University School of MedicineBusanSouth Korea
| | - Hyo Jin Lee
- Division of Hematology/Oncology, Department of Internal MedicineCollege of Medicine, Chungnam National UniversityDaejeonSouth Korea
| | - Eun Joo Kang
- Division of Hematology‐Oncology, Department of Internal MedicineKorea University Guro Hospital, Korea University College of MedicineSeoulSouth Korea
| | - Soon Il Lee
- Division of Hematology‐Oncology, Department of Internal MedicineDankook University College of MedicineCheonanSouth Korea
| | - In Hee Lee
- Department of Oncology/HematologyKyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National UniversityDaeguSouth Korea
| | - Seok Jae Huh
- Department of Internal MedicineDong‐A University College of MedicineBusanSouth Korea
| | - Jeongmin Jo
- Department of Hematology‐OncologyEwha Womans University Medical CenterSeoulSouth Korea
| | - Ho Young Kim
- Department of Hematological OncologyHallym University Sacred Heart Hospital, Hallym University College of MedicineAnyang‐siSouth Korea
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Local Recurrence Rates of Extramammary Paget Disease Are Lower After Mohs Micrographic Surgery Compared With Wide Local Excision: A Systematic Review and Meta-Analysis. Dermatol Surg 2023; 49:8-12. [PMID: 36206405 DOI: 10.1097/dss.0000000000003601] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Extramammary Paget disease (EMPD) is a rare, slow growing neoplasm that presents most commonly in the anogenital region of older adults. OBJECTIVE To analyze the difference in local recurrence rates of EMPD in patients treated with wide local excision (WLE) versus Mohs micrographic surgery (MMS). MATERIALS AND METHODS A systematic review of the literature and meta-analysis were performed. Inclusion criteria were adults greater than 18 years of age with a diagnosis of EMPD who have undergone surgical intervention and had follow-up data. Studies were independently reviewed by 2 coinvestigators with discrepancies resolved by the principal investigator. RESULTS Twenty-seven studies met the inclusion criteria. Patients had a 2.67 times higher chance of local recurrence after WLE than MMS (95% confidence interval [CI]:1.47, 4.85; p = .001). Meta-analysis of single-arm studies revealed a 7.3% local recurrence rate after MMS (95% CI: 0.039, 0.107; p < .001) versus a 26.3% recurrence rate after WLE (95% CI: 0.149, 0.376; p < .001). After excluding recurrent tumors, the odds ratio for recurrence in WLE versus MMS was 2.3 (95% CI: 0.285, 18.43, p = .435). CONCLUSION There is a clinically and statistically increased risk of local recurrence of EMPD after WLE compared with MMS.
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ZENG D, LONG H, MA D, ZENG X, SU X, HUANG Y, ZHU S, ZHU B. Extramammary Paget's disease: a clinical features analysis of 31 patients in China. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2022. [DOI: 10.23736/s0393-3660.19.04222-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lee JY, Hou PC, Lee CN, Wong TW, Hsu TC, Wu CL. A clinicopathological study of perianal paget disease: A single center-based cohort study and literature review. DERMATOL SIN 2022. [DOI: 10.4103/1027-8117.361417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Ho JC, Yen CH, Lee CH. Extramammary Paget's disease: A retrospective study in a medical center in Taiwan. DERMATOL SIN 2022. [DOI: 10.4103/ds.ds_19_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Noor F, Saleem MH, Chen JT, Javed MR, Al-Megrin WA, Aslam S. Integrative bioinformatics approaches to map key biological markers and therapeutic drugs in Extramammary Paget's disease of the scrotum. PLoS One 2021; 16:e0254678. [PMID: 34292991 PMCID: PMC8297842 DOI: 10.1371/journal.pone.0254678] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/30/2021] [Indexed: 12/16/2022] Open
Abstract
Extramammary Paget’s disease (EMPD) is an intra-epidermal adenocarcinoma. Till now, the mechanisms underlying the pathogenesis of scrotal EMPD is poorly known. This present study aims to explore the knowledge of molecular mechanism of scrotal EMPD by identifying the hub genes and candidate drugs using integrated bioinformatics approaches. Firstly, the microarray datasets (GSE117285) were downloaded from the GEO database and then analyzed using GEO2R in order to obtain differentially expressed genes (DEGs). Moreover, hub genes were identified on the basis of their degree of connectivity using Cytohubba plugin of cytoscape tool. Finally, GEPIA and DGIdb were used for the survival analysis and selection of therapeutic candidates, respectively. A total of 786 DEGs were identified, of which 10 genes were considered as hub genes on the basis of the highest degree of connectivity. After the survival analysis of ten hub genes, a total of 5 genes were found to be altered in EMPD patients. Furthermore, 14 drugs of CHEK1, CCNA2, and CDK1 were found to have therapeutic potential against EMPD. This study updates the information and yields a new perspective in the context of understanding the pathogenesis of EMPD. In future, hub genes and candidate drugs might be capable of improving the personalized detection and therapies for EMPD.
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Affiliation(s)
- Fatima Noor
- Department of Bioinformatics and Biotechnology, Government College University, Faisalabad, Pakistan
| | | | - Jen-Tsung Chen
- Department of Life Sciences, National University of Kaohsiung, Kaohsiung, Taiwan
| | - Muhammad Rizwan Javed
- Department of Bioinformatics and Biotechnology, Government College University, Faisalabad, Pakistan
| | - Wafa Abdullah Al-Megrin
- Biology Department, Faculty of Science, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Sidra Aslam
- Department of Bioinformatics and Biotechnology, Government College University, Faisalabad, Pakistan
- * E-mail:
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Yin S, Xu L, Wang S, Feng J, Liu L, Liu G, Wang J, Zhan S, Zhao Z, Gao P. Prevalence of extramammary Paget's disease in urban China: a population-based study. Orphanet J Rare Dis 2021; 16:134. [PMID: 33731175 PMCID: PMC7972239 DOI: 10.1186/s13023-021-01715-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 01/26/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Extramammary Paget's disease (EMPD) is an intraepithelial adenocarcinoma. The chronic relapsing clinical course and unbearable clinical symptoms of extramammary Paget's disease usually result in a markedly diminished quality of life. No national data are available on descriptive epidemiology of EMPD in China, the most populous country over the world. This population-based study aimed to estimate the prevalence and associated sex and age patterns of EMPD in China. METHODS This study was conducted using data from China's Urban Employee Basic Medical Insurance and Urban Resident Basic Medical Insurance, covering approximately 0.43 billion Chinese urban residents in 2016. Patients with EMPD were identified based on the diagnostic names and codes in claim data. RESULTS A total of 53 males and 31 females with EMPD were found. The crude prevalence in 2016 was 0.04 per 100,000 population [95% confidence interval (CI) 0.02-0.06], ranging from 0.01 (95% CI 0.00-0.02) in North or Northeast China to 0.08 (95% CI 0.03-0.16) in Southwest China. The rate was higher in males (0.05, 95% CI 0.03-0.08) compared with females (0.03, 95% CI 0.02-0.05). The mean age of patients was 65.87 (standard deviation: 14.21) years, with the peak prevalence appeared in patients aged 70-79 (0.28, 95% CI 0.16-0.42). CONCLUSIONS The prevalence of EMPD was markedly lower than those in the United States and Europe, and varied across regions in China. Chinese patients were much younger, with significant male predominance. Further studies are warranted to examine potential pathophysiologic mechanism.
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Affiliation(s)
- Shilu Yin
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Lu Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Shengfeng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
| | - Jingnan Feng
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Lili Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Guozhen Liu
- Peking University Health Information Technology Co. Ltd, 52 North Fourth Ring West Road, Haidian District, Beijing, 100080, China
| | - Jinxi Wang
- Shanghai Songsheng Business Consulting Co. Ltd, 6 Chaoyang Men North street, Dongcheng District, Beijing, 100000, China
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
- Research Center of Clinical Epidemiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
- Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
| | - Zhenmin Zhao
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
| | - Pei Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
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Abstract
BACKGROUND Vulvar cancers, although rare, are becoming an increasingly serious threat to women's health. Cancer of the vulva accounted for 0.3% of all new cancers in the United States in 2019, with 6,070 newly diagnosed cases. This review details the epidemiology, pathogenesis, diagnosis, staging, and treatment of vulvar malignancies. OBJECTIVE To review cancer entities of the vulva, including vulvar intraepithelial neoplasms, squamous cell carcinoma (SCC), malignant melanoma, basal cell carcinoma, neuroendocrine tumors, and adenocarcinomas. MATERIALS AND METHODS Literature review using PubMed search for articles related to cancer of the vulva. RESULTS Vulvar intraepithelial neoplasms represent premalignant precursors to SCC of the vulva. There are several different histopathologic subtypes of SCC, and treatment is dependent on characteristics of primary tumor and lymph node involvement. Melanoma is the second most common cancer to affect the vulva, and staging is based on tumor, node, and metastatic spread. CONCLUSION Vulvar malignancies are rare, and diagnosis is dependent on biopsy and pathologic evaluation. Treatment for vulvar malignancies depends on histopathologic diagnosis but ranges from wide local excision with or without lymph node biopsy or dissection to radiation therapy with chemo- or immunotherapy. Overall survival varies by diagnosis.
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MESH Headings
- Adenocarcinoma/diagnosis
- Adenocarcinoma/epidemiology
- Adenocarcinoma/pathology
- Adenocarcinoma/therapy
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biopsy
- Carcinoma in Situ/diagnosis
- Carcinoma in Situ/epidemiology
- Carcinoma in Situ/pathology
- Carcinoma in Situ/therapy
- Carcinoma, Basal Cell/diagnosis
- Carcinoma, Basal Cell/epidemiology
- Carcinoma, Basal Cell/pathology
- Carcinoma, Basal Cell/therapy
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/epidemiology
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/therapy
- Chemotherapy, Adjuvant/methods
- Disease-Free Survival
- Female
- Humans
- Lymph Nodes/pathology
- Melanoma/diagnosis
- Melanoma/epidemiology
- Melanoma/pathology
- Melanoma/therapy
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/prevention & control
- Neoplasm Staging
- Radiotherapy, Adjuvant/methods
- Treatment Outcome
- Vulva/diagnostic imaging
- Vulva/pathology
- Vulva/surgery
- Vulvar Neoplasms/diagnosis
- Vulvar Neoplasms/epidemiology
- Vulvar Neoplasms/pathology
- Vulvar Neoplasms/therapy
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Affiliation(s)
- Basia M Michalski
- Division of Dermatology, Department of Medicine, Washington University in St. Louis, Saint Louis, Missouri
| | - John D Pfeifer
- Department of Pathology and Immunology, Washington University in St. Louis, Saint Louis, Missouri
| | - David Mutch
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Alvin J. Siteman Cancer Center, Washington University in St. Louis, Saint Louis, Missouri
| | - M Laurin Council
- Division of Dermatology, Department of Medicine, Washington University in St. Louis, Saint Louis, Missouri
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Clinical characteristics and risk factors of invasion in extramammary Paget's disease of the vulva. Arch Gynecol Obstet 2020; 303:541-546. [PMID: 32990781 DOI: 10.1007/s00404-020-05803-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 09/16/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aimed to evaluate the risk factors of recurrence and invasive disease in patients with extramammary Paget's disease of the vulva (EPDV). METHODS We performed a retrospective analysis of patients who were initially diagnosed with EPDV in Fudan University Shanghai Cancer Center between May 2006 and March 2019. RESULTS Thirty-eight patients were initially diagnosed with EPDV in our institution. Among them, 29 had intraepithelial EPDV, 8 had intraepithelial EPDV with stromal invasion, and 1 had an underlying vulvar adenocarcinoma. In total, 8 (21%) patients had 12 recurrences. Of these eight patients, four had one recurrence, while other four had two recurrences. Intraepidermal EPDV recurred nine times, while intraepidermal EPDV with invasive disease recurred thrice. The first and second recurrence intervals were 62.1 (9-146) months and 22 (15-28) months, respectively. The rate of invasive disease was 23.7% (9/38) for primary EPDV and 25% (3/12) for recurrent ones. We determined that the presence of invasive disease was associated with a history of more than 10 years (p = 0.02) and inversely correlated with positive margins (p = 0.037), However, invasive disease had no statistical relations with age (p = 0.438), recurrence (p = 0.642), and lesion diameter (p = 0.08). CONCLUSIONS EPDV with a history of more than 10 years was associated with invasive disease. Close and long-term follow-up are recommended to identify those who require further treatment.
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Invasive vulvar extramammary Paget's disease in the United States. Gynecol Oncol 2020; 157:649-655. [PMID: 32268952 DOI: 10.1016/j.ygyno.2020.03.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/13/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess the incidence, treatment, and outcomes in patients with invasive vulvar extramammary Paget's disease (EMPD) in a national cohort of patients. METHODS Patients from the Surveillance, Epidemiology and End Results (SEER) database with diagnoses of vulvar EMPD from 1992 to 2016 were included. Demographic, treatment, and outcome data were analyzed. RESULTS A total of 1268 cases of invasive EMPD were identified. Of those, 69.6% had localized disease, 12.0% regional disease, 1.3% distant disease, and 17.1% were unstaged. The annual incidence of invasive vulvar EMPD was 0.36 per 100,000 person years: rates have increased >2-fold since 1992 (1992: 0.19 per 100,000 person years to 0.50 per 100,000 person years in 2016). Most patients underwent primary surgery (n = 1034; 81.5%). Five-year cancer specific survival (CSS) was 95.5% and was associated with stage. Compared to patients with localized disease, patients with distant metastases had dramatically worse CSS (HR: 85.8 (31.8-248) p < 0.0001). Synchronous cancers (diagnosed within one calendar year of EMPD diagnosis year) were observed in 35 cases (2.8%), and 195 patients (15.4%) developed a secondary malignancy (diagnosed >one year from year of EMPD diagnosis year). The most common synchronous breast, gastrointestinal tract, melanoma and the most common secondary cancers were breast, gastrointestinal tract and genitourinary tract. CONCLUSIONS The incidence of invasive vulvar EMPD has increased over time. CSS is excellent for localized disease, but those with metastatic disease are in need of novel therapies. Approximately 15% will develop a secondary malignancy, indicating that patients with invasive vulvar EMPD should undergo site specific preventative health screens during recurrence surveillance.
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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]
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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.
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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
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Abstract
BACKGROUND Extramammary Paget's disease is an uncommon intraepidermal adenocarcinoma with poorly defined clinical implications. OBJECTIVE The purpose of this research was to estimate the risk of second primary neoplasms in patients with extramammary Paget's disease. DESIGN This was a retrospective analysis of the Surveillance, Epidemiology, and End Results Registry (1973-2014). SETTINGS The study included population-based cancer registries from the United States. PATIENTS Patients who were diagnosed with anogenital Paget's disease were included. MAIN OUTCOME MEASURES Risk of second primary development was measured. RESULTS We identified 108 patients with anal Paget's disease, 421 patients with male genital (scrotum or penis) Paget's, and 1677 patients with female genital (vagina or vulva) Paget's. Median follow-up time was 5.9 years. The risk of developing colorectal adenocarcinoma was 18.5% for patients with anal Paget's disease. Eighty percent of colorectal adenocarcinoma diagnoses were synchronous (within 2 mo) to anal Paget's diagnoses, whereas metachronous tumors occurred at a median time of 2.4 years. Of patients with anal Paget's disease, 8.3% developed an anal adenocarcinoma or nonsmall cell cancer. In male patients with genital Paget's, the risk of proximal genitourinary malignancy was 9.7%, scrotal or testicular adenocarcinoma was 0.4%, and penile or scrotal squamous carcinoma was 1.7%. In female patients with genital Paget's, the risk of proximal genitourinary malignancy was 3.0%, vaginal or vulvar adenocarcinoma was 1.4%, and vaginal or vulvar squamous neoplasm was 1.0%. Five-year overall survival was 59.7%, 73.5%, and 80.7% in patients with anal, male genital, and female genital Paget's (p < 0.001). LIMITATIONS The registry did not record surveillance schedule, provider specialty, or nonprocedural therapies for extramammary Paget's disease. CONCLUSIONS In the largest published cohort of patients with extramammary Paget's disease, patients with anal Paget's had a much higher risk of both proximal and local neoplasms as compared with patients with genital Paget's. Patients with anal Paget's also experienced worse survival as compared with those with purely genital Paget's. See Video Abstract at http://links.lww.com/DCR/B20. ALTO RIESGO DE NEOPLASIAS PROXIMALES Y LOCALES EN 2206 PACIENTES CON ENFERMEDAD DE PAGET EXTRAMAMARIA ANOGENITAL:: La enfermedad de Paget extramamaria es un adenocarcinoma intraepidérmico poco frecuente con implicaciones clínicas poco definidas.Estimar el riesgo de segundas neoplasias primarias en pacientes con enfermedad de Paget extramamaria.Análisis retrospectivo del Registro de Vigilancia, Epidemiología y Resultados Finales (1973-2014).Registros de base poblacional en cáncer de los Estados Unidos.Pacientes que fueron diagnosticados con enfermedad de Paget anogenital.Riesgo de desarrollo un cáncer primario adicional.Se identificaron 108 pacientes con Paget anal, 421 pacientes con Paget genital masculino (escroto o pene) y 1677 pacientes con Paget genital femenino (vagina o vulva). Tiempo mediano de seguimiento fue de 5,9 años. El riesgo de desarrollar adenocarcinoma colorrectal fue del 18,5% para los pacientes con Paget anal. El ochenta por ciento de los diagnósticos de adenocarcinoma colorrectal fueron sincrónicos (dentro de los 2 meses) a los diagnósticos de Paget anal, mientras que los tumores metacrónicos ocurrieron en un tiempo promedio de 2,4 años. De los pacientes con Paget anal, el 8.3% desarrolló un adenocarcinoma anal o cáncer de células no pequeñas. En los pacientes masculinos con Paget genital, el riesgo de malignidad genitourinaria proximal fue del 9,7%, el adenocarcinoma escrotal o testicular fue del 0,4% y el carcinoma escamoso del pene o escroto fue del 1,7%. En pacientes femeninas con Paget genital, el riesgo de malignidad genitourinaria proximal fue de 3.0%, el adenocarcinoma vaginal o vulvar fue de 1.4% y la neoplasia escamosa vaginal o vulvar fue de 1.0%. La supervivencia general a cinco años fue del 59.7%, 73.5% y 80.7% en pacientes con anal, genital masculino y genital femenino, respectivamente (p <0.001).El registro no señalo el cronograma de vigilancia, la especialidad del proveedor o las terapias sin procedimiento para la enfermedad de Paget extramamaria.En la cohorte más grande publicada de pacientes con enfermedad de Paget extramamaria, los pacientes con Paget anal demostraron un riesgo mucho mayor de neoplasias proximales y locales en comparación con los pacientes con Paget genital. Los pacientes con Paget anal además demostraron una peor supervivencia en comparación con aquellos con Paget aislada genital. Vea el Resumen del Video en http://links.lww.com/DCR/B20.
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Shim YS, Park SH, Choi SJ, Ahn SJ, Jeong YM, Kim TB, Jeong J, Kim HJ. Sonographic findings of mass-forming extramammary Paget's disease in the scrotum. BJR Case Rep 2019; 5:20190018. [PMID: 31555478 PMCID: PMC6750622 DOI: 10.1259/bjrcr.20190018] [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: 02/18/2019] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 11/05/2022] Open
Abstract
Extramammary Paget's disease (EMPD) is a rare cutaneous malignancy involving the scrotum and may be confused with other scrotal malignancy. We describe the sonographic findings of an extremely rare case of mass-forming EMPD of the scrotal wall. Ultrasonography, which shows mild heterogeneous hyperechoic masses with a stalk connected to the dermis, can help predict the depth of vertical invasion of the lesion. The lesion extent should be precisely evaluated because the presence of dermal invasion of EMPD is the risk factor in distant metastasis and is known to result in a worse prognosis. Ultrasonography is a primary imaging modality to evaluate the extent and vertical invasion of EMPD. Surgical local wide excision is the treatment of choice for EMPD and histopathology confirmed the diagnosis.
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Affiliation(s)
- Young Sup Shim
- Department of Radiology, Gil Medical Center, Gachon University College of medicine, Incheon, South Korea
| | - So Hyun Park
- Department of Radiology, Gil Medical Center, Gachon University College of medicine, Incheon, South Korea
| | - Seung Joon Choi
- Department of Radiology, Gil Medical Center, Gachon University College of medicine, Incheon, South Korea
| | - Su-Joa Ahn
- Department of Radiology, Gil Medical Center, Gachon University College of medicine, Incheon, South Korea
| | - Yu Mi Jeong
- Department of Radiology, Gil Medical Center, Gachon University College of medicine, Incheon, South Korea
| | - Tae Beom Kim
- Department of Urology, Gil Medical Center, Gachon University College of medicine, Incheon, South Korea
| | - Juhyeon Jeong
- Department of Urology, Gil Medical Center, Gachon University College of medicine, Incheon, South Korea
| | - Hee Joo Kim
- Department of Dermatology, Gil Medical Center, Gachon University College of medicine, Incheon, South Korea
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Chung PH, Leong JY, Voelzke BB. Surgical Experience With Genital and Perineal Extramammary Paget's Disease. Urology 2019; 128:90-95. [PMID: 30902697 DOI: 10.1016/j.urology.2019.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/04/2019] [Accepted: 03/08/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe our surgical experience for the treatment and management of extramammary Paget's disease (EMPD). METHODS Our surgical approach involves excising a 2-cm margin of normal appearing skin around the EMPD-suspicious lesion. Prior to excision, the tissue is oriented and demarcated into predefined segments in coordination with a pathologist. Frozen sections are performed when necessary to guide additional excision. Xenograft or wet-to-dry dressings are applied depending on size and location of the wound while the specimen is expeditiously reviewed over the following 24-48 hours. If positive margins remain, further excision of the corresponding skin segment is performed. Delayed complex wound closure +/- split thickness skin grafting is performed once negative margins are confirmed. RESULTS Ten EMPD patients were referred to two academic centers between 2014 and 2018. Two patients had positive lymph nodes at diagnosis and underwent palliative surgery and died within 12 and 29 months. The remaining 8 patients underwent a median of 1 surgery (range 0-3) with referring providers before undergoing a median of 3 surgeries (range 2-5) at our institutions to achieve negative surgical margins and wound reconstruction (7 split thickness skin grafts, 1 secondary closure). At mean follow-up of 15 months, 1 patient recurred, required further excision, and remains disease free. CONCLUSION EMPD is a rare malignancy with poorly described treatment methodologies. Due to its multifocal distribution and asymmetric spread, obtaining negative margins can be challenging. Our systematic approach to obtaining wide margins and documenting excised skin has enabled us to achieve negative margins for this challenging malignancy.
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Affiliation(s)
- Paul H Chung
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
| | - Joon Yau Leong
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Bryan B Voelzke
- Department of Urology, University of Washington Medical Center, Seattle, WA
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19
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Kang Z, Zhu Y, Zhang QA, Dong L, Xu F, Zhang X, Guan M. Methylation and expression analysis of mismatch repair genes in extramammary Paget's disease. J Eur Acad Dermatol Venereol 2019; 33:874-879. [PMID: 30784122 DOI: 10.1111/jdv.15404] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/21/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Extramammary Paget's disease (EMPD) is a rare skin cancer with relative high frequencies of germline and somatic mismatch repair (MMR) genes mutations. However, the methylation and expression of these genes have not been validated in EMPD. OBJECTIVE This study aims to confirm the methylation and expression of MMR genes in EMPD. METHODS Immunohistochemical (IHC) staining detection and Methylation-specific PCR (MSP) were used to analyse MLH1, MSH2, MSH6 and PMS2 proteins' expression and promoters' methylation in 57 EMMD samples, and pyro-sequence was used to find highly methylated CpG sites in MSH2 promoter. RESULTS Immunohistochemical detection displayed reduced expression of MSH2 in 38.6% EMPD cases but normal expression of MLH1, MSH6 and PMS2 in all tumour tissues. Hypermethylation also was found in the promoter of MSH2 but not in other MMR genes. Pyrosequencing of MSH2 promoter showed CpG6 (-87) and CpG3 (-98) were the most common two methylated CpG dinucleotides. There is a significant correlation between reduced MSH2 expression and MSH2 methylation. CONCLUSION Reduced MSH2 expression and hypermethylation in this gene promoter were common genetic changes in EMPD, which expands our understanding of the role of MMR function in this skin cancer.
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Affiliation(s)
- Z Kang
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, P. R. China
| | - Y Zhu
- Department of Pathology, Huashan Hospital North, Fudan University, Shanghai, P. R. China
| | - Q-A Zhang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, P. R. China
| | - L Dong
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, P. R. China
| | - F Xu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, P. R. China
| | - X Zhang
- Central Laboratory, Huashan Hospital, Fudan University, Shanghai, P. R. China
| | - M Guan
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, P. R. China.,Central Laboratory, Huashan Hospital, Fudan University, Shanghai, P. R. China
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21
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22
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Intraoperative Immunostaining for Cytokeratin-7 During Mohs Micrographic Surgery Demonstrates Low Local Recurrence Rates in Extramammary Paget's Disease. Dermatol Surg 2018. [DOI: 10.1097/dss.0000000000001355] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Fukuda K, Funakoshi T. Metastatic Extramammary Paget's Disease: Pathogenesis and Novel Therapeutic Approach. Front Oncol 2018; 8:38. [PMID: 29503810 PMCID: PMC5820294 DOI: 10.3389/fonc.2018.00038] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 02/02/2018] [Indexed: 12/13/2022] Open
Abstract
Extramammary Paget’s disease (EMPD) is a rare, slow-growing, cutaneous adenocarcinoma that usually originates in the anogenital area and axillae outside the mammary glands. EMPD mostly progresses slowly and is often diagnosed as carcinoma in situ; however, upon becoming invasive, it promptly and frequently metastasizes to regional lymph nodes, leading to subsequent distant metastasis. To date, several chemotherapy regimens have been used to treat metastatic EMPD; however, they present limited effect and patients with distant metastasis exhibit a poor prognosis. Recently, basic and translational investigative research has elucidated factors and molecular mechanisms underlying the promotion of metastasis, which can lead to targeted therapy-based emerging treatment strategies. Here, we aim to discuss current therapies and their limitations; advancements in illustrating mechanisms promoting invasion, migration, and proliferation of EMPD tumor cells; and future therapeutic approaches for metastatic EMPD that may enhance clinical outcomes.
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Affiliation(s)
- Keitaro Fukuda
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, United States.,Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Takeru Funakoshi
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, United States
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Chung PH, Kampp JT, Voelzke BB. Patients' Experiences With Extramammary Paget Disease: An Online Pilot Study Querying a Patient Support Group. Urology 2017; 111:214-219. [PMID: 28893632 DOI: 10.1016/j.urology.2017.08.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/29/2017] [Accepted: 08/30/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To illustrate the heterogeneous care delivered to patients with extramammary Paget disease (EMPD), a rare and lethal malignancy with poorly described treatment methodologies, by characterizing the clinical and pathologic characteristics of an international patient support group. MATERIALS AND METHODS Institutional review board approval was obtained to develop and distribute a nonvalidated survey to patients from an international, online EMPD support group. The survey was developed to capture patient clinical and pathologic details and was distributed between January 2017 and February 2017. RESULTS Forty-two patients completed the survey. At a mean age of 64 years, patients most commonly developed rash, pruritus, or erythema in the genital and perianal regions. Patients presented to their primary care physician, gynecologist, or dermatologist and were initially treated with topical agents for benign diagnoses. After failing conservative treatments, patients underwent biopsy by a dermatologist or gynecologist and were diagnosed with EMPD on average 21 months after the onset of symptoms. Wide local and Mohs excisions were the most frequently administered treatments with positive margins reported in 43% of patients. Fewer patients underwent noninvasive treatment with imiquimod cream and radiation. In total, 29% of patients developed regional recurrence and distant disease. There was wide variation regarding medical specialties involved, diagnostic evaluation, treatment, and clinical follow-up. CONCLUSION This study provides a novel view of the varied clinical and pathologic details from patients treated across varying institutions and medical specialties. This study will hopefully educate providers of the overall disease process of EMPD and encourage the development of standardized treatment recommendations.
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Affiliation(s)
- Paul H Chung
- Department of Urology, University of Washington Medical Center, Seattle, WA.
| | - Jeremy T Kampp
- Division of Dermatology, University of Washington Medical Center, Seattle, WA
| | - Bryan B Voelzke
- Department of Urology, University of Washington Medical Center, Seattle, WA
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Invasive Extramammary Paget Disease of the Vulva With Signet Ring Cell Morphology in a Patient With Signet Ring Cell Carcinoma of the Stomach: Report of a Case. Int J Gynecol Pathol 2017; 37:147-151. [PMID: 28582341 DOI: 10.1097/pgp.0000000000000405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This report describes a rare case of invasive extramammary Paget disease of the vulva with signet ring cell morphology in a 58-yr-old woman with a history of signet ring cell carcinoma of the stomach. This case was initially misinterpreted as a metastatic gastric carcinoma to the vulva because an initial small, superficial biopsy specimen showed infiltration of signet ring cells in the dermis without intraepidermal Paget cells. However, a surgically resected specimen showed concordant immunophenotypes in both intraepidermal Paget cells and intradermal signet ring cell components with immunoreactivity to cytokeratin (CK) 7, CEA, and gross cystic disease fluid protein-15, and immunonegativity for CK20, MUC5AC, and MUC6. Gastric signet ring cell carcinoma showed immunoreactivity to CK7, CEA, MUC5AC, and MUC6, and immunonegativity for gross cystic disease fluid protein-15 and CK20. The diagnosis of primary invasive extramammary Paget disease of the vulva was also supported by a long interval after gastrectomy (7.5 yr), the solitary involvement of the vulva, and the absence of lymphovascular invasion. This case demonstrates that invasive extramammary Paget disease may have a signet ring cell morphology and immunohistochemical profile similar to those of gastric signet ring cell carcinoma, but the addition of gross cystic disease fluid protein-15 immunostain in the panel of markers is helpful in the differential diagnosis.
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Genetic Analysis of Mismatch Repair Genes Alterations in Extramammary Paget Disease. Am J Surg Pathol 2016; 40:1517-1525. [DOI: 10.1097/pas.0000000000000709] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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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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Park YJ, Kim YC. A Case of Extramammary Paget's Disease Resistant to Photodynamic Therapy and Surgery Successfully Treated with Radiotherapy. Ann Dermatol 2015; 27:99-100. [PMID: 25673944 PMCID: PMC4323615 DOI: 10.5021/ad.2015.27.1.99] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 02/17/2014] [Accepted: 03/01/2014] [Indexed: 11/08/2022] Open
Affiliation(s)
- Young Joon Park
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| | - You Chan Kim
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
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30
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Extramammary Paget Disease: A Report of 10 Cases. ACTAS DERMO-SIFILIOGRAFICAS 2015. [DOI: 10.1016/j.adengl.2014.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Enfermedad de Paget extramamaria: 10 casos. ACTAS DERMO-SIFILIOGRAFICAS 2015; 106:e1-5. [DOI: 10.1016/j.ad.2014.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 05/16/2014] [Accepted: 05/22/2014] [Indexed: 11/20/2022] Open
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Kim CW, Kim YH, Cho MS, Min BS, Baik SH, Kim NK. Perianal Paget's Disease. Ann Coloproctol 2014; 30:241-4. [PMID: 25360433 PMCID: PMC4213942 DOI: 10.3393/ac.2014.30.5.241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 06/02/2014] [Indexed: 11/18/2022] Open
Abstract
The incidence of extramammary Paget's disease (EMPD) is very low. An 84-year-old Korean man was treated with topical and oral medications at a local dermatologic clinic for a year, but the symptoms did not improve. He visited Severance Hospital and underwent a perianal skin biopsy and was finally diagnosed with EMPD. The authors performed a wide local excision according to a 1-cm margin around the lesion. For the skin and the soft tissue defects, bilateral inferior gluteal artery perforator flap transpositions were performed. The size of the lesion was 14 cm2 × 9 cm2, and the lateral and the basal margins were all disease free.
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Affiliation(s)
- Chang Woo Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yon Hee Kim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Soo Cho
- Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Soh Min
- Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hyuk Baik
- Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Kyu Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Cheng PS, Lu CL, Cheng CL, Lai FJ. Significant male predisposition in extramammary Paget disease: a nationwide population-based study in Taiwan. Br J Dermatol 2014; 171:191-3. [PMID: 24471479 DOI: 10.1111/bjd.12851] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- P S Cheng
- Department of Dermatology, Chi Mei Medical Center, No. 901, Zhonghua Rd, Yongkang District, Tainan City, 710, Taiwan
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Oashi K, Tsutsumida A, Namikawa K, Tanaka R, Omata W, Yamamoto Y, Yamazaki N. Combination chemotherapy for metastatic extramammary Paget disease. Br J Dermatol 2014; 170:1354-7. [DOI: 10.1111/bjd.12788] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2013] [Indexed: 10/25/2022]
Affiliation(s)
- K. Oashi
- Department of Dermatologic Oncology; National Cancer Center Hospital; 5-1-1 Tsukiji, Chuo-ku Tokyo 104-0045 Japan
- Department of Plastic and Reconstructive Surgery; Graduate School of Medicine; University of Hokkaido at Sapporo, Kita-15 Nishi-7, Kita-Ku, Sapporo Hokkaido, 060-8638 Japan
| | - A. Tsutsumida
- Department of Dermatologic Oncology; National Cancer Center Hospital; 5-1-1 Tsukiji, Chuo-ku Tokyo 104-0045 Japan
| | - K. Namikawa
- Department of Dermatologic Oncology; National Cancer Center Hospital; 5-1-1 Tsukiji, Chuo-ku Tokyo 104-0045 Japan
| | - R. Tanaka
- Department of Dermatologic Oncology; National Cancer Center Hospital; 5-1-1 Tsukiji, Chuo-ku Tokyo 104-0045 Japan
| | - W. Omata
- Department of Dermatologic Oncology; National Cancer Center Hospital; 5-1-1 Tsukiji, Chuo-ku Tokyo 104-0045 Japan
| | - Y. Yamamoto
- Department of Plastic and Reconstructive Surgery; Graduate School of Medicine; University of Hokkaido at Sapporo, Kita-15 Nishi-7, Kita-Ku, Sapporo Hokkaido, 060-8638 Japan
| | - N. Yamazaki
- Department of Dermatologic Oncology; National Cancer Center Hospital; 5-1-1 Tsukiji, Chuo-ku Tokyo 104-0045 Japan
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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.
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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
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Abstract
Extramammary Paget's disease is uncommon. Diagnosis has to be confirmed by histopathology. Treatment is a challenge in cases with extended tumors. We present a 70-year-old male patient with extensive genitoanal Paget's disease. Mohs surgery is the gold standard in such cases. Details of the surgical planning are discussed including wound bed preparation. Radiotherapy may be an alternative.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital, Friedrichstadt, Dresden, Germany
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Choi JH, Jue MS, Kim EJ, Joh OJ, Song KY, Park HJ. Extramammary paget disease: minimal surgical therapy. Ann Dermatol 2013; 25:213-7. [PMID: 23717014 PMCID: PMC3662916 DOI: 10.5021/ad.2013.25.2.213] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 06/21/2012] [Accepted: 07/09/2012] [Indexed: 11/21/2022] Open
Abstract
Background Extramammary Paget disease (EMPD) is an uncommon malignant neoplasm affecting apocrine gland-bearing skin which usually occurs in the anogenital area of patients older than 50 years. Although Mohs micrographic surgery (MMS) is recommended for the treatment of EMPD, wide local excision has also been performed by many other surgeons including dermatosurgeons. However, the extent of an adequate resection margin is still under debate. Objective The efficacy of minimal surgical therapy consisting of a wide excision combined with preoperative multiple scouting biopsies and postoperative topical imiquimod was investigated for the treatment of EMPD in Korean patients. Methods Between 2006 and 2012, 10 patients with primary EMPD were treated with wide surgical excision, with a surgical margin of less than 2.5 cm. Multiple preoperative scouting biopsies and postoperative topical imiquimod were also performed to delineate the lesional boundaries and to reduce the recurrence rate. Results During the 6-year follow-up period, complications and recurrences were not observed. Conclusion Minimal surgical therapy may be an effective alternative when MMS is unavailable.
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Affiliation(s)
- Ji-Hyun Choi
- Department of Dermatology, VHS Medical Center, Seoul, Korea
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Cai Y, Sheng W, Xiang L, Wu X, Yang H. Primary extramammary Paget's disease of the vulva: The clinicopathological features and treatment outcomes in a series of 43 patients. Gynecol Oncol 2013; 129:412-6. [DOI: 10.1016/j.ygyno.2013.02.029] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 02/18/2013] [Accepted: 02/20/2013] [Indexed: 10/27/2022]
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Bae JM, Choi YY, Kim H, Oh BH, Roh MR, Nam K, Chung KY. Mohs micrographic surgery for extramammary Paget disease: A pooled analysis of individual patient data. J Am Acad Dermatol 2013; 68:632-637. [DOI: 10.1016/j.jaad.2012.12.960] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 11/20/2012] [Accepted: 12/09/2012] [Indexed: 11/25/2022]
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Akaike G, Nozaki T, Matsusako M, Matsui M, Ohtake N, Eto H, Suzuki K, Saida Y. Magnetic resonance imaging for extramammary Paget's disease: radiological and pathological correlations. Skeletal Radiol 2013; 42:437-42. [PMID: 23151876 DOI: 10.1007/s00256-012-1540-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 10/22/2012] [Indexed: 02/02/2023]
Abstract
Extramammary Paget's disease (EMPD) is a rare cutaneous neoplasm that is thought to represent intraepithelial adenocarcinoma developing in an area rich in apocrine glands. Magnetic resonance imaging (MRI) findings for this disease are not well established. We report three cases of pathologically confirmed EMPD in which MRI was performed before surgery. The lesions were widespread in the epidermis and the dermis. Lesions were sharply well enhanced on gadolinium-enhanced T1-weighted imaging and appeared hyperintense on diffusion-weighted imaging in all cases. Areas with enhancement in depth corresponded well with the pathological lesion. In addition, different malignant legions were found on the same images from MRI in two cases, indicating potential associations with other malignancies. We describe the MRI findings and their pathological correlation. MRI could be useful for preoperative evaluation of disease spread and detection of associated malignancies.
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Affiliation(s)
- Gensuke Akaike
- Department of Radiology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan.
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[Metastatic extramammary Paget's disease of the scrotum]. Ann Dermatol Venereol 2012; 139:387-90. [PMID: 22578344 DOI: 10.1016/j.annder.2012.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 01/27/2012] [Accepted: 03/05/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Extra-mammary Paget's disease (EMPD) is currently considered a slowly progressing in situ adenocarcinoma. It is much more rarely associated with an invasive underlying adenocarcinoma than in mammary sites, where this association is almost always seen. However, an invasive course is to be feared where EMPD has been progressing for several years. PATIENTS AND METHODS A 59-year-old man consulted for treatment of scrotal Paget's disease present for over 15 years and treated with topical emollients alone. Two infiltrated areas had recently appeared and their excision led to a diagnosis of invasive Paget's disease at these two points. Metastasis occurred 10 months later and rapidly proved fatal. DISCUSSION Until now, non-invasive EMPD has been considered a fairly non-aggressive disease due to its indolent progression. However, it is characterised by considerable risk of relapse following surgical excision, regardless of the surgical margin. Despite a good prognosis at the intraepithelial stage, the rising life expectancy of the population means a greater likelihood of an invasive course or of the appearance of an underlying adenocarcinoma, and management of this condition can thus no longer be neglected. The present clinical case underscores the need for closer surveillance of the disease as of the intraepithelial stage.
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