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Patwardhan PP, Quiroga-Garza GM. Extramammary paget disease of the penoscrotal region. Pathol Res Pract 2023; 241:154283. [PMID: 36584497 DOI: 10.1016/j.prp.2022.154283] [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: 10/28/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Extramammary Paget disease is an uncommon slow growing intraepithelial malignant neoplasm. It can be classified into primary and secondary subtypes, with secondary subtype associated with underlying malignancy. Extramammary Paget disease of the penoscrotal region is extremely rare with very limited literature available describing its clinicopathologic characteristics. We present 6 cases of penoscrotal EMPD diagnosed at our academic medical center over a 20 year period. These included 5 cases of scrotal EMPD and 1 case of penile EMPD. The mean age at diagnosis was 68.6 yrs. (Range 61-78 years), One case of scrotal EMPD had history of renal cell carcinoma and prostatic adenocarcinoma, while one other case presented as recurrent EMPD with initial disease in the left groin. EMPD in the glans penis was associated with a history of urothelial carcinoma in the ureter with pagetoid spread. 3 cases had no progression of the disease till recent follow up, 2 were lost to follow up while 1 case rapidly deteriorated resulting in death. This case had bone metastatic and associated peritoneal carcinomatosis. Thus, Extramammary Paget disease of the penoscrotal area is extremely rare, can be primary or associated with visceral malignancies and usually tends to present at an older age. Peritoneal spread and distant metastasis are associated with rapid progression of the disease.
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Affiliation(s)
- Pranav P Patwardhan
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
| | - Gabriela M Quiroga-Garza
- UPMC Shadyside Hospital, Department of Pathology, Genitourinary Pathology COE, 5230 Centre Avenue, Pittsburgh, PA 15232, USA.
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Sasaki Y, Goto K, Sugino T, Satake K, Yoshikawa S, Kiyohara Y. Characteristic Clinicopathological Features of Secondary Extramammary Paget Disease With Underlying Anorectal Adenocarcinoma: Evenly Circumferential Perianal Distribution, Fibroepithelioma of Pinkus-like Changes, and Subepidermal Mucin Deposits Without Invasive Tumor Cells. Am J Dermatopathol 2021; 43:721-726. [PMID: 33395042 DOI: 10.1097/dad.0000000000001877] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT This study aimed to identify the clinical and histopathological characteristics of secondary extramammary Paget disease (EMPD) with underlying anorectal adenocarcinoma so as to differentiate it from primary cutaneous EMPD. Seventeen and 8 cases of primary and secondary EMPD with anorectal adenocarcinoma, respectively, were retrieved from the pathology archive and the clinical and histopathological features reviewed. The tumor samples from 21 cases were totally resected specimens, whereas 3 and 1 of secondary and primary cases were punch biopsied, respectively. All 8 (100%) cases of secondary EMPD presented evenly distributed perianal lesions. By contrast, 4 of 17 (23.5%) primary EMPD cases had perianal skin lesions and displayed an uneven, asymmetrical distribution around the anus. Fibroepithelioma of Pinkus-like changes and subepidermal mucin deposits with no or few invasive tumor cells were observed in 6 (75%) and 3 (37.5%) of the 8 secondary EMPD cases, respectively, although 3 secondary case samples were small biopsy specimens. Both the histopathological changes were not observed in any of the 17 primary EMPD cases. Evenly circumferential perianal distribution, fibroepithelioma of Pinkus-like changes, and subepidermal mucin deposits without invasive tumor cells were characteristic to cases of secondary EMPD with anorectal adenocarcinoma. These clinicopathological features could be used to differentiate between secondary and primary EMPD.
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Affiliation(s)
- Yosuke Sasaki
- Department of Dermatology, and
- Diagnostic Pathology, Shizuoka Cancer Center Hospital, Sunto, Japan
| | - Keisuke Goto
- Diagnostic Pathology, Shizuoka Cancer Center Hospital, Sunto, Japan
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
- Department of Pathology, Itabashi Central Clinical Laboratory, Tokyo, Japan
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan ; and
- Department of Dermatology, Hyogo Cancer Center, Akashi, Japan
| | - Takashi Sugino
- Diagnostic Pathology, Shizuoka Cancer Center Hospital, Sunto, 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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KIYOHARA T, ITO K. Epidermotropic secondary extramammary Paget's disease of the glans penis from retrograde lymphatic dissemination by transitional cell carcinoma of the bladder. J Dermatol 2012; 40:214-5. [DOI: 10.1111/1346-8138.12039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Takahiro KIYOHARA
- Department of Dermatology; Faculty of Medical Sciences; University of Fukui; Fukui; Japan
| | - Kei ITO
- Division of Dermatology; JR Sapporo Hospital; Sapporo; Japan
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Hegarty PK, Suh J, Fisher MB, Taylor J, Nguyen TH, Ivan D, Prieto VG, Pagliaro LC, Pettaway CA. Penoscrotal Extramammary Paget's Disease: The University of Texas M. D. Anderson Cancer Center Contemporary Experience. J Urol 2011; 186:97-102. [DOI: 10.1016/j.juro.2011.02.2685] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Paul K. Hegarty
- Department of Urologic Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Jane Suh
- Department of Urologic Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Mark B. Fisher
- Department of Urologic Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Jennifer Taylor
- Department of Urologic Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Tri H. Nguyen
- Northwest Diagnostic Clinic P. A., Mohs and Dermatology Associates, Houston, Texas
| | - Doina Ivan
- Department of Histopathology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Victor G. Prieto
- Department of Histopathology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Lance C. Pagliaro
- Department of Genitourinary Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Curtis A. Pettaway
- Department of Urologic Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
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Chiu TW, Wong PSY, Ahmed K, Lam SCK, Ying SY, Burd A. Extramammary Paget’s Disease in Chinese Males: A 21-year Experience. World J Surg 2007; 31:1941-6. [PMID: 17665242 DOI: 10.1007/s00268-007-9189-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Extramammary Paget's disease (EMPD) is a rare disease in Chinese males. Our objectives were to examine the results of our experience, to correlate them with the published literature, and thus to formulate improved management guidelines. METHODS This was a retrospective analysis of all male patients with EMPD treated at our institution. We reviewed the patients and their case notes for data such as presenting symptoms, delay to diagnosis, incidence of concurrent malignancies, treatments given, and a variety of outcome measures, including the number of patients with recurrent or residual disease. RESULTS The overall recurrence rate was 35%. The risk of recurrence was reduced if intraoperative frozen section analysis was used (25%) compared to simple wide local excision (60%). Wide local excision failed to excise the disease completely in 38%. There were no associated internal malignancies and no disease-related deaths in our sample. CONCLUSIONS We recommend intraoperative frozen sections to reduce the risk of incomplete resection and to reduce the rate of recurrence. In our population, screening for internal malignancies can be restricted to select patients, e.g., those with perianal disease, those with invasive disease, and young patients.
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Affiliation(s)
- Tor W Chiu
- Plastic and Reconstructive Surgery, Department of Surgery, Chinese University of Hong Kong, Shatin, Hong Kong.
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Dionyssopoulos A, Mandekou-Lefaki I, Vakirlis E, Manoliadis I, Nikolis A, Dionyssopoulou E. Extramammary Paget’s Disease: Isolated Localization on the Groin—Wide Local Excision With Immediate Reconstruction. Ann Surg Oncol 2006; 13:1235-40. [PMID: 16955387 DOI: 10.1245/s10434-006-9003-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Accepted: 01/20/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Extramammary Paget's disease is a rare cutaneous malignancy, which occurring frequently in the elderly and affecting primarily the genital, perianal, and axillary regions. Unfortunately, surgical and ablative treatment modalities for extramammary Paget's disease have a high recurrence rate and are often associated with significant morbidity. METHODS We present a case of a 51-year-old Caucasian man with Paget's disease of the right groin. The isolated localization of Paget's disease in the groin is extremely rare. Wide local excision of the tumor is currently the standard of care treatment. All publications found in the literature reporting this rare entity were reviewed for the purpose of further delineating a treatment regimen for this rare pathology. RESULTS Six years after surgery, the patient remains disease free with a very acceptable aesthetic result. Currently, only 11 cases of Paget's disease have been reported with an isolated localization to the groin. CONCLUSIONS Paget's disease of the groin has an extremely low incidence. Various treatments are described in the literature, early wide local excision may be the treatment of choice.
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Affiliation(s)
- Alexander Dionyssopoulos
- Division of Skin Oncologic Surgery-Plastic Surgery, First Department of Dermatology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Abstract
Malignant cutaneous adnexal neoplasms are one of the most challenging areas of dermatopathology. Tumors of the pilosebaceous apparatus can occur as single-lineage neoplasms or may manifest as complex proliferations with multilineal differentiation patterns including not only the germinative component of the hair bulb, the inner or outer root sheath epithelium and the sebaceous gland and duct, but also the sweat duct components that relate to the apocrine secretory apparatus which empties into the follicle near the follicular bulge. Eccrine and apocrine neoplasms present a bewildering array of morphologies, which often defy precise classification. The purpose of this review is to discuss in detail the malignant neoplasms of the cutaneous adnexae and their benign and prognostically indeterminate mimics.
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Affiliation(s)
- A Neil Crowson
- Department of Dermatology, University of Oklahoma and Regional Medical Laboratory, St John Medical Center, Tulsa, OK 74114-4109, USA.
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Braun-Falco O, Plewig G, Wolff HH, Burgdorf WHC. Premalignant Epithelial Tumors. Dermatology 2000. [DOI: 10.1007/978-3-642-97931-6_55] [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] Open
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Requena L, Sánchez Yus E, Núñez C, White CR, Sangueza OP. Epidermotropically metastatic breast carcinomas. Rare histopathologic variants mimicking melanoma and Paget's disease. Am J Dermatopathol 1996; 18:385-95. [PMID: 8879303 DOI: 10.1097/00000372-199608000-00010] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Epidermotropic metastases from internal malignancies are exceedingly rare. We report two examples of epidermotropic metastatic breast carcinoma with striking intraepidermal involvement. The first case mimicked melanoma because the neoplastic cells contained melanin and were disposed both as single units and as nests at the dermoepidermal junction and throughout the epidermis. In the second case, the neoplastic cells were seen as isolated neoplastic cells with large, pale cytoplasm scattered throughout the epidermis, closely resembling extramammary Paget's disease. Immunohistochemical studies in both cases demonstrated the epithelial nature of intraepidermal neoplastic cells, which showed an immunophenotype identical to the neoplastic cells present in the dermis: positive staining with anti-cytokeratins, CEA, EMA, and GCDFP-15 and negative with anti-S-100 protein and HMB-45. These findings ruled out the possibility of a collision lesion, or simultaneous occurrence of melanoma and metastatic breast carcinoma. Pagetoid intraepidermal spread of metastatic breast carcinoma, as in our two cases, is exceptional. We also discuss the histogenetic similarities between our findings and those of mammary and extramammary Paget's disease, as well as the differential diagnosis of other cutaneous disorders characterized by pagetoid intraepidermal spread of neoplastic cells.
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Affiliation(s)
- L Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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Abstract
The relative frequencies of cutaneous metastases are similar to those of the primary cancers; breast, colon, and melanoma are the most frequent in women and lung, colon, and melanoma are the most common in men. Cutaneous metastases represent an opportunity to detect a potentially treatable cancer before other evidence of it is present, to modify therapy as appropriate to the tumor stage, or possibly to use the cutaneous lesion as a source of easily accessible tumor cells for specific therapy. Cutaneous metastatic disease as the first sign of internal cancer is most commonly seen with cancer of the lung, kidney, and ovary.
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Affiliation(s)
- R A Schwartz
- New Jersey Medical School, Newark 07103-2714, USA
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Lertprasertsuke N, Tsutsumi Y. Latent perianal Paget's disease associated with mucin-producing rectal adenocarcinoma. Report of two cases. ACTA PATHOLOGICA JAPONICA 1991; 41:386-93. [PMID: 1651042 DOI: 10.1111/j.1440-1827.1991.tb01663.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Two cases of latent perianal Paget's disease associated with mucin-producing papillary adenocarcinoma of the rectum are described. In both cases, the rectal tumors appeared as polypoid lesions located just above the dentate line. The adjacent anal squamous mucosa showed lateral invasion of alcianophilic mucin-containing Paget cells. Mucin histochemistry revealed the presence of O-acylated and non-O-acylated sialic acids in both neoplastic goblet cells in the adenocarcinomas and Paget cells in the anal mucosa. The Paget cells were immunoreactive diffusely for low-molecular-weight cytokeratin (CAM 5.2) and carcinoembryonic antigen, and focally for CA19-9, epithelial membrane antigen and CA15-3. All these substances were also expressed in the rectal adenocarcinomas but were negative or showed limited expression in the anal squamous epithelium. These findings indicated secondary epidermotropic infiltration of neoplastic goblet cells from the rectal adenocarcinomas.
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Affiliation(s)
- N Lertprasertsuke
- Department of Pathology, Tokai University School of Medicine, Isehara, Japan
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Coldiron BM, Goldsmith BA, Robinson JK. Surgical treatment of extramammary Paget's disease. A report of six cases and a reexamination of Mohs micrographic surgery compared with conventional surgical excision. Cancer 1991; 67:933-8. [PMID: 1846769 DOI: 10.1002/1097-0142(19910215)67:4<933::aid-cncr2820670413>3.0.co;2-3] [Citation(s) in RCA: 147] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Extramammary Paget's disease (EMPD) is a rare cutaneous malignancy, usually on the genitalia, that almost always extends beyond clinically apparent margins. Recurrences after standard methods of surgical excision are notoriously frequent; effective treatment with Mohs micrographic surgery was first reported in 1979. It has since been suggested this malignancy may be multifocal, and reports of recurrences after resection with micrographic surgery have appeared. The authors report six cases treated with Mohs surgery, two of which recurred. They also present data on 42 additional cases obtained from a written survey of members of the American College of Mohs Micrographic Surgery and comparison cases selected from the literature. The recurrence rate after micrographic surgery appears to be at least as low as that after conventional surgical excision with vertical frozen section or paraffin section margin control. Mohs micrographic surgery allows for maximal tissue sparing of critical anatomic structures and is performed under local anesthesia as an outpatient; because of this, it may be superior to conventional surgical excision. A scheme for management of this malignancy is presented. Surgeons should be aware radical excision is not needed for most cases of extramammary Paget's disease and very long-term patient follow-up is required.
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McKee PH. Immunocytochemistry and cutaneous neoplasia ('something will turn up', Micawber 1863). Clin Exp Dermatol 1990; 15:235-44. [PMID: 2208771 DOI: 10.1111/j.1365-2230.1990.tb02082.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- P H McKee
- Department of Histopathology, St Thomas' Hospital, London, UK
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