Evaluation of carcinoembryonic antigen in extramammary Paget's disease

Ultrastructural localization of carcinoembryonic antigen (CEA) glycoproteins and epithelial membrane antigen (EMA) in normal and neoplastic sweat glands

Glycoproteins of the carcinoembryonic antigen family (CEA) and epithelial membrane antigen (EMA) are established markers for glandular and mucosal tissues. However, their precise ultrastructural distribution in sweat glands has not been determined as yet. Therefore, normal human skin, 19 cases of various sweat gland neoplasms, Paget's disease, and cutaneous metastases of visceral carcinomas were stained with well-defined antibodies using a postembedding immunogold technique. In some cases, a new method of re-embedding paraffin material for immunoelectron microscopy was applied. In normal sweat glands, immunoreactivity of the endoplasmic reticulum and vesicles indicated biosynthesis and processing of CEA and EMA. Along the luminal surfaces both CEA and EMA represented an integral part of microvilli. However, a differential expression of CEA and EMA was demonstrated in apocrine epithelia, mucous cells of eccrine glands, and sweat ducts. In fetal glands, CEA was associated with formation of secretory and ductal lumina. The overall cellular distribution of CEA and EMA was highly preserved in benign sweat gland neoplasms whereas malignant neoplasms were characterized by loss of protein targeting and cellular polarity. In conclusion, these immunoelectron microscopical findings suggest a role of CEA and EMA for cell differentiation and secretory mechanisms of sweat gland epithelia.

Invasive adenocarcinoma arising in extramammary Paget's disease of the vulva

A case of extramammary Paget's disease of the vulva giving rise to an invasive microacinar adenocarcinoma is presented. Extramammary Paget's disease of the vulva is rare and documented detailed cases associated with unequivocal dermal invasion exceptional. We have reviewed the literature with particular reference to such cases.

Immunohistochemical staining properties of keratin type intermediate filaments in mammary and extramammary Paget's disease

Utilizing three different anti-keratin antibodies and the avidin-biotin peroxidase complex system on sections of formalin-fixed paraffin-embedded tissues and on cryostat sections, immunohistochemical localization of keratin type intermediate filaments in mammary Paget's disease and extramammary Paget's disease was investigated. Anti-keratin antibodies EAB-903 and EAB-904, which recognize 66K and 57K dalton keratin peptides, did not decorate any Paget's cells in either mammary or extramammary Paget's disease. On the other hand, anti-keratin antibody MAK-6, which recognizes 52.5K, 50K, 48K, 45K and 40K daltons keratin peptides, did decorate Paget's cells in both Paget's diseases. These staining properties of Paget's cells were the same as those of secretory cells in normal human sweat glands and mammary glands. Anti-keratin antibody MAK-6 is thought to be useful in the diagnosis of mammary and extramammary Paget's diseases.

Perianal Paget's disease

An early case of perianal Paget's disease is described in a 59 year old female. Literature search revealed 57 documented cases up to 1987. Diagnosis is suspected on clinical features and needs to be always confirmed by biopsy with routine stains, and, in doubtful cases, also by electron microscopy and immunohistology. The extent of the primary disease and the presence of an associated adnexal or anorectal cancer must be established. Wide surgical excision of the primary lesion, preferably with frozen section examination of the excised margins and undersurface, is the preferred treatment. Associated adnexal or anorectal cancer is treated on merit. Recurrent disease is managed by further excision, topical chemotherapy and/or laser therapy. Prognosis depends on the extent of the primary lesion, on the adequacy of the primary excision, and on the presence of an associated adnexal or anorectal cancer. In apparently cured cases, long-term surveillance is recommended.

Extramammary Paget's disease: an annotated review

The incidence, clinical features, histogenesis, and treatment of extramammary Paget's disease (EMPD) are reviewed. This unusual skin lesion is associated with an underlying adnexal neoplasm in about 50% of cases. Also, the incidence of distant organ malignancies of EMPD is higher than expected by chance. Even in the absence of a recognizable underlying cancer, EMPD may occasionally produce distant metastases, indicating the malignant potential of this condition. Histochemical, immunohistological, and lectin binding studies demonstrate that the cell of origin of EMPD is the exocrine cell of sweat glands. Although EMPD may arise from eccrine cells, derivation from apocrine cells appears more common. The treatment of the primary lesion, by wide margin excision, is fraught by a high recurrence rate. Chemosurgery may reduce local relapse of EMPD. The value of adjuvant radiation therapy is unestablished. Chemotherapy has induced remission in 2 cases of advanced EMPD and needs testing in clinical trials.

Paget's disease of the groin associated with adenocarcinoma of the urinary bladder

A 70-year-old Caucasian male developed a left groin tumor with epidermal infiltration of Paget's type. Five months later the ureter was found to be obstructed by a bladder adenocarcinoma cytologically identical to the skin lesion. Both tumors contained carcinoembryonic antibodies, using the immunoperoxidase method. Despite radiation therapy, the patient died a month later. There are no previous reports of association between urinary bladder adenocarcinoma and extramammary Paget's disease of the skin.

Mammary and extramammary Paget's disease. An immunocytochemical and ultrastructural study

Twenty-one cases of Paget's disease have been studied using histochemical, ultrastructural, and immunohistochemical methods. Eight of the tumors involved the nipple, and 13 were extramammary (11 vulvar and two anal). The antibodies used were directed against different classes of cytokeratin proteins, epithelial membrane antigen, carcinoembryonic antigen, gross cystic disease fluid protein-15, and S-100 protein. The findings of this study provide conclusive evidence that Paget's cells, regardless of their location, are adenocarcinoma cells. Intracytoplasmic mucin is scanty in Paget's cells within the nipple, but typically plentiful in the extramammary sites where the cells are frequently signet-ring cells. The common mechanism for the evolution of Paget's disease is extension of cells from an underlying carcinoma, but the possibility that some cases, particularly in the vulva, develop from intraepithelial precursors cannot be excluded.

Paget's disease of the ectopic breast with an underlying intraductal carcinoma: report of a case

Paget's disease may occur at mammary and extramammary sites. Mammary Paget's disease typically involves the nipple and adjacent skin. Almost all such cases are associated with an underlying ductal carcinoma of the breast. A case of Paget's disease occurring at the site of an ectopic breast adjacent to a supernumerary nipple and associated with an underlying intraductal carcinoma is described. A search of the literature revealed no previous report of such cases. Detailed clinical history and histopathologic, histochemical, and follow-up information on this case are presented. The literature on mammary and extramammary Paget's disease is reviewed.