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Hu J, Ge W, Mao S, Ding Q, Hu M, Jiang H. First-time versus recurrent penoscrotal extramammary Paget's disease: Clinicopathological characteristics and risk factors in 164 Chinese male patients. Indian J Dermatol Venereol Leprol 2020; 86:134-140. [PMID: 31650976 DOI: 10.4103/ijdvl.ijdvl_382_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Penoscrotal extramammary Paget's disease is a rare, slow-growing neoplasm with high frequency of local recurrence. Aims The aim of this study was to investigate the difference in clinicopathological characteristics between first-time and recurrent penoscrotal Paget's disease, and to discover the potential risk factors of recurrence. Methods Between January 2007 and February 2014, a total of 164 Chinese patients with biopsy-proven tramammary Paget's diseaseex in penis and scrotum underwent wide local resection in our institution. Among them, 142 patients with first-time disease and other 22 patients with recurrent disease were enrolled in this retrospective analysis. Results The median duration of symptoms was much shorter in recurrent disease than in first-timers (3 vs. 24 months, P < 0.001). Patients with recurrent disease tended to have lower lesion exudation rates (27.3% vs. 51.8%, P= 0.032). In addition, patients with distant stage were more likely to obtain recurrent disease compared with first-time disease (P = 0.005). Through immunohistochemical detection of extramammary Paget's specimen, we found that HER2/neu protein expression in the recurrent group was significantly higher than first-timers (P = 0.036). Limitations In this study, the information on familial history of most patients was insufficient. Moreover, due to the lack of follow-up data of our included cases, we were unable to evaluate the prognosis after diagnosis of extramammary Paget's disease. Conclusion Patients with penoscrotal Paget's disease, especially those with shorter duration of symptoms, exudation of lesions, distant-stage, Paget cells infiltrating into adnexa, and HER2/neu expression, should be followed up more carefully after surgery, as they were more likely to suffer recurrence.
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Affiliation(s)
- Jimeng Hu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenjia Ge
- Department of Nursing, Huashan Hospital, Fudan University, Shanghai, China
| | - Shanhua Mao
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiang Ding
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Mengbo Hu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Haowen Jiang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
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Marcoval J, Penín RM, Vidal A, Bermejo J. Extramammary Paget Disease. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:306-312. [PMID: 32278442 DOI: 10.1016/j.ad.2019.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/09/2019] [Accepted: 09/15/2019] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Extramammary Paget disease (EMPD) has seldom been studied in Mediterranean populations. We aimed to review the characteristics of our patients with EMPD, the presence of a neoplasm in continuity, and the long-term course of the disease. PATIENTS AND METHODS Retrospective observational study of 27 patients diagnosed with EMPD between 1990 and 2015. All clinical and pathology findings related to clinical course and outcomes were retrieved for analysis. RESULTS Twenty patients were women and 7 were men. Ages ranged from 42 to 88 years (median, 76 years). Lesions were in the following locations: vulva (16 cases), pubis-groin (5), perianal region (4), and axilla (2). Time from onset to diagnosis ranged from 1 to 60 months (median, 12 months) and maximum lesion diameter from 20 to 140mm (median, 55mm). In 3 cases (11.1%) EMPD was a secondary condition. None of the lesions developed on a previous cutaneous adnexal adenocarcinoma. Ten of the 24 primary EMPDs (41.7%) invaded the dermis. Eight of the 27 patients (29.6%) experienced local recurrence after the initial surgical treatment.Three patients (11.1%) died as a consequence of metastasis from the EMPD. CONCLUSIONS The presence of an underlying cutaneous adnexal adenocarcinoma is uncommon, but it is not unusual to find an extracutaneous adenocarcinoma in continuity. Although EMPD is a slow-growing tumor, dermal invasion is frequent and metastasis is not uncommon. Local recurrence is common even after excision with wide margins and may be delated, so long term follow-up is essential.
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Affiliation(s)
- J Marcoval
- Servicio de Dermatología, Hospital Universitari de Bellvitge, Barcelona, España.
| | - R M Penín
- Servicio de Anatomía Patológica, Hospital Universitari de Bellvitge, Barcelona, España
| | - A Vidal
- Servicio de Anatomía Patológica, Hospital Universitari de Bellvitge, Barcelona, España
| | - J Bermejo
- Servicio de Cirugía Plástica, Hospital Universitari de Bellvitge, Barcelona, España
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Zhao M, Zhou L, Sun L, Song Y, Guo Y, Zhang X, Zhao F, Wang P, Yue J, Niu D, Li Z, Huang X, Kang Q, Jia L, Lai J, Cao D. GATA3 is a sensitive marker for primary genital extramammary paget disease: an immunohistochemical study of 72 cases with comparison to gross cystic disease fluid protein 15. Diagn Pathol 2017; 12:51. [PMID: 28693610 PMCID: PMC5504764 DOI: 10.1186/s13000-017-0638-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 06/26/2017] [Indexed: 02/08/2023] Open
Abstract
Background GATA-binding protein 3 (GATA3) has been identified as a sensitive marker for breast carcinoma but its sensitivity in primary genital extramammary Paget diseases (EMPDs) has not been well studied. Methods Here we investigated immunohistochemical expression of GATA3 in 72 primary genital EMPDs (35 from female, 37 from male; 45 with intraepithelial disease only, 26 with both intraepithelial disease and invasive adenocarcinoma including 14 also metastasis, 1 with metastatic adenocarcinoma only for study). We also compared GATA3 to gross cystic disease fluid protein 15 (GCDFP15) for their sensitivity. Results Positive GATA3 staining was seen in all 71 (100%) intraepithelial diseases, 25/26 (96%; female 10/10, male 15/16) invasive adenocarcinomas and 14/15 (93%; female 3/3, male 11/12) metastatic adenocarcinomas, respectively. Positive GCDFP15 staining was seen in 46/71 (65%; female 28/34 or 82%, male 18/37 or 49%) intraepithelial diseases, 20/26 (77%; female 9/10, male 11/16) invasive adenocarcinomas, and 12/15 (80%; female 2/3, male 10/12) metastatic adenocarcinomas, respectively (GATA3 versus GCDFP15: p < 0.01 for both intraepithelial disease and invasive adenocarcinoma, p = 0.28 for metastatic adenocarcinoma). In positive-stained cases, GATA3 stained more tumor cells than GCDFP15 (79% versus 25% for intraepithelial disease, 71% vs 34% for invasive adenocarcinoma, 73% vs 50% for metastatic adenocarcinoma, p < 0.01 for all 3 components). Conclusions Our findings indicate that GATA3 is a very sensitive marker for primary genital EMPDs and is more sensitive than GCDFP15.
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Affiliation(s)
- Ming Zhao
- Department of Pathology, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Lixin Zhou
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital (Beijing Cancer Hospital), Beijing, China
| | - Li Sun
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital (Beijing Cancer Hospital), Beijing, China
| | - Yan Song
- Department of Pathology, Cancer Hospital of Chinese Academy of Medical Sciences, Beijing, China
| | - Yunquan Guo
- Department of Pathology, Xinjiang Medical University Affiliated Tumor Hospital, Urumqi, China
| | - Xun Zhang
- Department of Pathology, Cancer Hospital of Chinese Academy of Medical Sciences, Beijing, China
| | - Feng Zhao
- Department of Pathology, Xinjiang Medical University Affiliated Tumor Hospital, Urumqi, China
| | - Peng Wang
- Department of Pathology, Beijing Ditan Hospital, Beijing, China
| | - Junqiu Yue
- Department of Pathology, Hubei Cancer Hospital, Wuhan, China
| | - Dongfeng Niu
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital (Beijing Cancer Hospital), Beijing, China
| | - Zhongwu Li
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital (Beijing Cancer Hospital), Beijing, China
| | - Xiaozheng Huang
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital (Beijing Cancer Hospital), Beijing, China
| | - Qiang Kang
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital (Beijing Cancer Hospital), Beijing, China
| | - Lin Jia
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital (Beijing Cancer Hospital), Beijing, China
| | - Jinping Lai
- Department of Pathology, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Dengfeng Cao
- Department of Pathology and Immunology, Washington University School of Medicine, 660 S South Euclid Avenue Campus Box 8118, Saint Louis, MO, 63110, USA.
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Abstract
CONTEXT Immunohistochemistry is not a diagnostic test but a highly valuable tool that requires interpretation within a context. OBJECTIVE To review the current status and limitations of immunohistochemistry in dermatopathology. DATA SOURCES English-language literature published between 1980 and 2014. CONCLUSIONS Although immunohistochemistry is rarely completely specific or sensitive, it is an important adjunctive technique in dermatopathology and can be helpful in a series of diagnostic dilemmas.
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Affiliation(s)
- Tammie Ferringer
- From the Departments of Dermatology and Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania
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Shi G, Ye DW, Yao X, Zhang S, Dai B, Zhang H, Shen Y, Zhu Y, Zhu Y, Xiao W, Ma C. Extramammary Paget's diseases in men from the Shanghai area: its association with PSA level increase. APMIS 2010; 118:777-81. [PMID: 20854472 PMCID: PMC2955970 DOI: 10.1111/j.1600-0463.2010.02657.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Shi G, Ye D-W, Yao X, Zhang S, Dai B, Zhang H, Shen Y, Zhu Y, Zhu Y, Xiao W, Ma C. Extramammary Paget’s diseases in men from the Shanghai area: its association with PSA level increase. APMIS 2010; 118: 777–81. The aim of this study was to determine the incidence of prostate cancer in patients with extramammary Paget’s disease (EMPD). All cases of EMPD diagnosed between 1992 and 2007 in Shanghai Cancer Hospital were collected and analyzed for the incidence of prostate cancer. The median follow-up was 78 months. In total, 38 cases of invasive and 10 cases of in situ EMPD had been registered. A second malignancy was found in 28.9% (11/38) of patients with invasive EMPD and in 30% (3/10) of patients with in situ EMPD. Patients had an increased risk of developing a second cancer compared with the general population (standardized incidence ratio: 1.7; 95% confidence interval 1.2–2.4). Sixteen patients had serum prostate-specific antigen (PSA) level above 4 ng/mL; five developed prostate cancer, three of them with PSA levels beyond 100 ng/mL. The incidence of prostate cancer is 10.4% in this patient group. Patients with EMPD were more likely to have prostate cancer than the general population. Although the prognosis of EMPD is fairly good, a thorough search for a second tumor is recommended.
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Affiliation(s)
- Guohai Shi
- Department of Urology, Cancer Hospital, Fudan University, Shanghai, China
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Hilliard NJ, Huang C, Andea A. Pigmented extramammary Paget's disease of the axilla mimicking melanoma: case report and review of the literature. J Cutan Pathol 2009; 36:995-1000. [PMID: 19674203 DOI: 10.1111/j.1600-0560.2009.01174.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pigmented Paget's disease is a rare variant that is often confused clinically and histologically with melanoma in situ. Herein, we describe a case of pigmented extramammary Paget's disease involving the axilla of a 79-year-old white male thought initially to represent malignant melanoma clinically and histologically. Review of the literature reveals that pigmented variant of Paget's disease, either mammary or extramammary, could be initially misdiagnosed as melanoma unless this entity is considered in the differential diagnosis, and additional confirmatory studies are performed.
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Affiliation(s)
- Nicholaus J Hilliard
- Department of Dermatopathology, University of Alabama-Birmingham, Birmingham, AL 35249, USA
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