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Mariano L, Nicosia L, Pupo D, Olivieri AM, Scolari S, Pesapane F, Latronico A, Bozzini AC, Fusco N, Blanco MC, Mazzarol G, Corso G, Galimberti VE, Venturini M, Pizzamiglio M, Cassano E. A Pictorial Exploration of Mammary Paget Disease: Insights and Perspectives. Cancers (Basel) 2023; 15:5276. [PMID: 37958452 PMCID: PMC10650713 DOI: 10.3390/cancers15215276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
Mammary Paget disease (MPD) is a rare condition primarily affecting adult women, characterized by unilateral skin changes in the nipple-areolar complex (NAC) and frequently associated with underlying breast carcinoma. Histologically, MPD is identified by large intraepidermal epithelial cells (Paget cells) with distinct characteristics. Immunohistochemical profiles aid in distinguishing MPD from other skin conditions. Clinical evaluation and imaging techniques, including magnetic resonance imaging (MRI), are recommended if MPD is suspected, although definitive diagnosis always requires histological examination. This review delves into the historical context, epidemiology, pathogenesis, clinical manifestations, and diagnosis of MPD, emphasizing the need for early detection. The classification of MPD based on pathogenesis is explored, shedding light on its varied presentations. Treatment options, including mastectomy and breast-conserving surgery, are discussed with clear guidelines for different scenarios. Adjuvant therapies are considered, particularly in cases with underlying breast cancer. Prognostic factors are outlined, underlining the importance of early intervention. Looking to the future, emerging techniques, like liquid biopsy, new immunohistochemical and molecular markers, and artificial intelligence-based image analysis, hold the potential to transform MPD diagnosis and treatment. These innovations offer hope for early detection and improved patient care, though validation through large-scale clinical trials is needed.
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Affiliation(s)
- Luciano Mariano
- Breast Imaging Division, AOU Città della Scienza e della Salute di Torino, 10126 Turin, Italy;
| | - Luca Nicosia
- Department of Biotechnology and Life Sciences, University of Insubria, Via J.H. Dunant, 3, 21100 Varese, Italy
- Breast Imaging Division, IEO—European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy; (F.P.); (A.L.); (A.C.B.); (M.P.); (E.C.)
| | - Davide Pupo
- Radiology Division, Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80138 Naples, Italy;
| | - Antonia Maria Olivieri
- Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy;
| | - Sofia Scolari
- Postgraduation School in Radiodiagnostics, Faculty of Medicine and Surgery, University of Milan, 20122 Milan, Italy;
| | - Filippo Pesapane
- Breast Imaging Division, IEO—European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy; (F.P.); (A.L.); (A.C.B.); (M.P.); (E.C.)
| | - Antuono Latronico
- Breast Imaging Division, IEO—European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy; (F.P.); (A.L.); (A.C.B.); (M.P.); (E.C.)
| | - Anna Carla Bozzini
- Breast Imaging Division, IEO—European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy; (F.P.); (A.L.); (A.C.B.); (M.P.); (E.C.)
| | - Nicola Fusco
- Division of Pathology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (N.F.); (M.C.B.); (G.M.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy;
| | - Marta Cruz Blanco
- Division of Pathology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (N.F.); (M.C.B.); (G.M.)
| | - Giovanni Mazzarol
- Division of Pathology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (N.F.); (M.C.B.); (G.M.)
| | - Giovanni Corso
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy;
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, Via Ripamonti, 435, 20141 Milan, Italy;
- European Cancer Prevention Organization (ECP), 20122 Milan, Italy
| | - Viviana Enrica Galimberti
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, Via Ripamonti, 435, 20141 Milan, Italy;
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy;
| | - Maria Pizzamiglio
- Breast Imaging Division, IEO—European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy; (F.P.); (A.L.); (A.C.B.); (M.P.); (E.C.)
| | - Enrico Cassano
- Breast Imaging Division, IEO—European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy; (F.P.); (A.L.); (A.C.B.); (M.P.); (E.C.)
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2
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Rudnicki Y, Stapleton SM, Batra R, Gan T, Mathis KL, Kelley SR. Perianal Paget's-an aggressive disease. Colorectal Dis 2023. [PMID: 36945125 DOI: 10.1111/codi.16549] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 03/23/2023]
Abstract
AIM Perianal Paget's disease (PAPD) is a rare disorder with a predisposition to anal and colorectal malignancies and an unclear prognosis. Our previous 25-year series demonstrated a non-aggressive nature. This study aims to describe our updated institutional experience. METHODS This is a retrospective review of all patients diagnosed with primary PAPD from 1991 to 2021. A prospectively maintained institutional database was searched which included demographics, clinical and pathological manifestations, treatment methods, recurrence, oncological outcome and mortality. RESULTS Thirty patients were diagnosed with PAPD. Fifteen were women (50%); the average age at diagnosis was 71 ± 10.7 years, and the average lesion size was 3.7 ± 2.6 cm. At diagnosis, 12 (40%) were harbouring invasive anal adenocarcinoma. Eight (27%) developed adenocarcinomas concurrent with PAPD recurrence at a mean interval of 9 ± 4.4 years (range 1.9-14.8). The Kaplan-Meier curve estimated overall survival of 93%, 86%, 82%, 65% and 56% at 1, 3, 5, 10 and 15 years, respectively. Median survival was 16 years. Six (20%) had disease-related mortality. Initially, nine (30%) were treated with abdominoperineal resection (APR), 15 (50%) underwent local resection, three (10%) were treated with radiotherapy, two (7%) received only topical therapy and one (3%) chose observation. Fifteen (50%) experienced recurrence of PAPD, two after undergoing APR. Five (17%) had persistent disease until death. Only 10 (33%) did not experience PAPD recurrence, seven of whom underwent APR. The mean follow-up time was 9.2 ± 6.2 years. CONCLUSIONS Perianal Paget's disease is an aggressive entity with high rates of synchronous anal adenocarcinoma at diagnosis and development of metachronous adenocarcinoma later in life.
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Affiliation(s)
- Yaron Rudnicki
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Sahael M Stapleton
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Rishi Batra
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Tong Gan
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kellie L Mathis
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Scott R Kelley
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Photodynamic therapy in the treatment of extramammary paget’s disease. BIOMEDICAL PHOTONICS 2022. [DOI: 10.24931/2413-9432-2022-11-3-24-34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Extramammary Paget’s disease (EMPD) is a rare tumor that predominantly affects the skin containing apocrine glands. Due to insufficient data on the effectiveness of different methods, there is no single therapeutic approach to the treatment of patients with EMPD and their subsequent management. The use of surgical methods, laser therapy and local cytotoxic drugs has a number of limitations. The advantages of using photodynamic therapy (PDT) in EMPD are the absence of systemic toxicity, non-invasiveness, selectivity of action, the absence of carcinogenic potential, the possibility of conducting several courses of treatment, and good cosmetic results. In our review, we analyzed those published in 2000-2022 data on the results of PDT treatment of 114 patients with EMPD. As a result of treatment, complete regression of tumor foci was achieved in 40% of patients. Most authors note that PDT is more effective for small areas (up to 4 cm2).
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Shim PJ, Zeitouni NC. Photodynamic therapy for extramammary Paget’s disease: A systematic review of the literature. Photodiagnosis Photodyn Ther 2020; 31:101911. [DOI: 10.1016/j.pdpdt.2020.101911] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/02/2020] [Indexed: 12/26/2022]
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Snast I, Sharon E, Kaftory R, Noyman Y, Oren-Shabtai M, Lapidoth M, Hodak E, Mimouni D, Mazor S, Levi A. Nonsurgical Treatments for Extramammary Paget Disease: A Systematic Review and Meta-Analysis. Dermatology 2020; 236:493-499. [PMID: 32289785 DOI: 10.1159/000506832] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 02/27/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Surgery is commonly regarded as the mainstay of treatment of extramammary Paget disease (EMPD); however, nonsurgical approaches have gained popularity in recent years. OBJECTIVES To review the published evidence for the efficacy and safety of nonsurgical modes of therapy for EMPD. METHODS A systematic review and meta-analysis of nonsurgical EMPD treatments was performed. The primary outcome was complete response (CR); secondary outcomes were clinical regression by ≥50%, adverse events, and recurrence rate. RESULTS The systematic review included 43 observational studies (341 patients; 7 prospective cohort studies, 19 retrospective cohort studies, and 17 cases series) evaluating 5 treatment modalities. Imiquimod (13 studies, 110 patients) administered at variable doses ranging from daily to twice weekly for 2-56 weeks demonstrated CR of 54% (95% CI, 40-67%; I2 = 37%) and had a satisfactory safety profile. In 14 heterogeneous studies (122 patients) evaluating photodynamic therapy (PDT), only 36% (95% CI, 22-53%; I2 = 52%) of patients achieved CR. Radiotherapy (12 studies, 67 patients) showed CR of 97%, but was associated with local and systemic side effects. Ablative lasers and topical fluorouracil and calcipotriene lacked adequate evidence of efficacy. CONCLUSIONS Imiquimod and radiotherapy are the most appropriate nonsurgical modalities for EMPD treatment given their good efficacy and safety profile. PDT has limited efficacy but may be appropriate in selected clinical settings.
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Affiliation(s)
- Igor Snast
- Division of Dermatology, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel, .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,
| | - Eran Sharon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery, Breast Surgery Clinic, Rabin Medical Center, Petah Tikva, Israel
| | - Ran Kaftory
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehonatan Noyman
- Division of Dermatology, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meital Oren-Shabtai
- Division of Dermatology, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Lapidoth
- Division of Dermatology, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emmilia Hodak
- Division of Dermatology, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Mimouni
- Division of Dermatology, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sigal Mazor
- Department of Community Dentistry, School of Dental Medicine, Hebrew University-Hadassah, Medical Center, Jerusalem, Israel
| | - Assi Levi
- Division of Dermatology, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Edey KA, Allan E, Murdoch JB, Cooper S, Bryant A. Interventions for the treatment of Paget's disease of the vulva. Cochrane Database Syst Rev 2019; 6:CD009245. [PMID: 31167037 PMCID: PMC6550364 DOI: 10.1002/14651858.cd009245.pub3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND This is an updated version of the original Cochrane Review published in Issue 10, 2013.Extramammary Paget's disease is a rare form of superficial skin cancer. The most common site of involvement is the vulva. It is seen mainly in postmenopausal white women. Paget's disease of the vulva often spreads in an occult fashion, with margins extending beyond the apparent edges of the lesion. There is a range of interventions from surgical to non-invasive techniques or treatments. The challenges of interventions are to remove or treat disease that may not be visible, without overtreatment and with minimisation of morbidity from radical surgery. There is little consensus regarding treatment. Surgery, by default, is the most common treatment, but it is challenging to excise the disease adequately, and recurrence is common, leading to repeated operations, and destruction of anatomy. Alternative treatments of photodynamic therapy, laser therapy, radiotherapy, topical treatments or even chemotherapy have been mooted, and it is important to evaluate the available evidence. It is essential to assess whether newer cell-specific treatments, such as photodynamic therapy and imiquimod, can reduce the need for radical surgery. OBJECTIVES To evaluate the benefits and harms of different treatment modalities for the management of Paget's disease of the vulva. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via Ovid) and Embase (via Ovid) up to 8 May 2018. We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of review articles. SELECTION CRITERIA We searched for randomised controlled trials (RCTs) and well-designed non-randomised studies that compared different interventions in women with Paget's disease of the vulva, DATA COLLECTION AND ANALYSIS: Two review authors independently assessed whether potentially relevant studies met the inclusion criteria. We found no trials and, therefore, analysed no data. MAIN RESULTS The search for the original version of the review identified 635 unique references. We found 31 references (which reported on 30 studies) in full text after inspection of titles and abstracts, but we excluded them all as they did not meet the inclusion criteria. However, we have included a comprehensive narrative account of studies where we identified an analysis of more than 10 women, as this forms the only evidence base in this rare disease. Surgery continues to be the mainstay of treatment in the current literature, with other treatments limited to case reports or treatment of inoperable or recurrent disease.This update between September 2013 and May 2018 identified 35 new studies. None of these met the inclusion criteria. There was only one prospective study of 5% imiquimod in recurrent Paget's disease of the vulva, which although of good quality only included eight women. AUTHORS' CONCLUSIONS Since the last version of the review was published there are many more cases in the literature reporting a clinical response to 5% imiquimod cream. There is one prospective study of eight women treated with 5% imiquimod for recurrent Paget's disease of the vulva, and one prospective trial of 20 women was due to be reported. This increasing evidence for the safety and efficacy of 5% imiquimod will be helpful for women and clinicians alike. Ideally, a multicentre RCT of reasonable size is needed, but ongoing publications of high-quality non-randomised prospective studies will enhance the current available literature.
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Affiliation(s)
| | - Ernest Allan
- Christie HospitalWilmslow RoadWithingtonManchesterUKM20 4BX
| | - John B Murdoch
- Spire Hospital BristolGynaecologyThe Glen, Redland HillDurdham DownBristolUKBS2 8EG
| | - Susan Cooper
- Churchill HospitalDepartment of DermatologyOld RoadHeadingtonOxfordUKOX3 7LJ
| | - Andrew Bryant
- Newcastle UniversityInstitute of Health & SocietyMedical School New BuildRichardson RoadNewcastle upon TyneUKNE2 4AX
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Zhou C, Hainsworth B, Sydney M, Lee M, Ormsby Z, Haggers M, Chase JG. Structural health monitoring of tissue mechanics for non-invasive diagnosis of breast cancer. ACTA ACUST UNITED AC 2018. [DOI: 10.1515/auto-2018-0065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
A hysteresis loop analysis (HLA) method for breast cancer diagnosis based on a non-invasive digital imaging elasto-tomography (DIET) screening system is evaluated using data from 3 clinical trial patients, comprising 2 healthy breasts and 4 breasts with cancer. The identified mechanical nominal stiffness with ∼2x higher values compared to healthy tissue stiffness localized the correct cancerous area (CA) or tumor location, matching the mammography detection for all 4 breasts with cancer. The difference in identified stiffness varies across different frequencies and individuals. However, the identified stiffness for all healthy breasts and/or health tissue regions are consistent across frequencies, avoiding false positive diagnosis. The overall approach can be implemented automatically without requiring a skilled operator, thus reducing the screening cost.
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Affiliation(s)
- Cong Zhou
- Department of Mechanical Engineering , 2496 University of Canterbury , Private Bag 4800 , Christchurch , New Zealand
| | - Brent Hainsworth
- Department of Mechanical Engineering , 2496 University of Canterbury , Private Bag 4800 , Christchurch , New Zealand
| | - Maxwell Sydney
- Department of Mechanical Engineering , 2496 University of Canterbury , Private Bag 4800 , Christchurch , New Zealand
| | - Michael Lee
- Department of Mechanical Engineering , 2496 University of Canterbury , Private Bag 4800 , Christchurch , New Zealand
| | | | | | - J. Geoffrey Chase
- Department of Mechanical Engineering , 2496 University of Canterbury , Private Bag 4800 , Christchurch , New Zealand
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8
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Affiliation(s)
- Jeff Choi
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Allison Zemek
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Gordon K Lee
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Cindy Kin
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA.
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Dos Santos JS, Bonafé GA, Pereira JA, Kanno DT, Martinez CAR, Ortega MM. Rare perianal extramammary Paget disease successfully treated using topical Imiquimod therapy. BMC Cancer 2018; 18:921. [PMID: 30253739 PMCID: PMC6157056 DOI: 10.1186/s12885-018-4815-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 09/13/2018] [Indexed: 11/15/2022] Open
Abstract
Background Perianal Paget’s disease (PPD) is a rare intraepithelial adenocarcinoma of the anal margin. Primary PPD likely represents intra-epithelial neoplasm from an apocrine source, whereas secondary disease may represent “pagetoid” spread from an anorectal malignancy. Case presentation Histologic CDX-2 and CK20 are hallmark markers for colorectal-derived Paget’s cells. Interestingly, our primary PPD patient presented both positive and no internal malignancy was identified. In addition, a negative CK7 marker was observed in our case in contrast with previously reported. Surgical excision is the standard treatment; however, previous studies have demonstrated good response with Imiquimod 5% cream in patients with vulval extramammary Paget disease (EMPD). The efficiency of Imiquimod treatment for PPD has not been well described. Our PPD patient was successfully treated using Imiquimod 5% cream. Conclusions This study describes a primary cutaneous PPD patient CDX-2+/CK20+/CK7- without invasion of the dermis and no associated colorectal carcinoma effectively treated using topical Imiquimod therapy, suggesting that Imiquimod might potentially be considered as a first-line treatment for PPD.
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Affiliation(s)
- Jéssica Silva Dos Santos
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, Department of Postgraduate Program in Health Science, São Francisco University (USF), Avenida São Francisco de Assis, 218, Jardim São José , Bragança Paulista, São Paulo, 12916-900, Brazil
| | - Gabriel Alves Bonafé
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, Department of Postgraduate Program in Health Science, São Francisco University (USF), Avenida São Francisco de Assis, 218, Jardim São José , Bragança Paulista, São Paulo, 12916-900, Brazil
| | - José Aires Pereira
- Department of Surgery and Proctology, São Francisco University (USF), Bragança Paulista, SP, Brazil
| | - Danilo Toshio Kanno
- Department of Surgery and Proctology, São Francisco University (USF), Bragança Paulista, SP, Brazil
| | | | - Manoela Marques Ortega
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, Department of Postgraduate Program in Health Science, São Francisco University (USF), Avenida São Francisco de Assis, 218, Jardim São José , Bragança Paulista, São Paulo, 12916-900, Brazil.
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Grandi V, Sessa M, Pisano L, Rossi R, Galvan A, Gattai R, Mori M, Tiradritti L, Bacci S, Zuccati G, Cappugi P, Pimpinelli N. Photodynamic therapy with topical photosensitizers in mucosal and semimucosal areas: Review from a dermatologic perspective. Photodiagnosis Photodyn Ther 2018; 23:119-131. [PMID: 29669264 DOI: 10.1016/j.pdpdt.2018.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 04/03/2018] [Accepted: 04/10/2018] [Indexed: 02/07/2023]
Abstract
Photodynamic Therapy is a procedure based on the interaction between a Photosensitizer, a light source with a specific wavelength and oxygen. The aim of this review is to provide a brief and updated analysis of scientific reports on the use of PDT with topical PS in the management of oncological, infectious, and inflammatory disorders involving mucosal and semimucosal areas, with a specific focus on diseases of dermatologic interest.
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Affiliation(s)
- Vieri Grandi
- University of Florence School of Health Sciences, Department of Surgical and Translational Medicine, Section of Dermatology, P. Palagi Hospital, Viale Michelangelo 41, 50125, Florence, Italy.
| | - Maurizio Sessa
- University of Campania "Luigi Vanvitelli", Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", Via L. De Crecchio 7, Naples, Italy
| | - Luigi Pisano
- University of Florence School of Health Sciences, Department of Surgical and Translational Medicine, Section of Dermatology, P. Palagi Hospital, Viale Michelangelo 41, 50125, Florence, Italy
| | - Riccardo Rossi
- University of Florence School of Health Sciences, Department of Surgical and Translational Medicine, Section of Dermatology, P. Palagi Hospital, Viale Michelangelo 41, 50125, Florence, Italy
| | - Arturo Galvan
- Private Practice Dermatologist, C.M.R, Via S. Giovanni Bosco, 24, 36015, Schio, Italy
| | - Riccardo Gattai
- University of Florence School of Health Sciences, Department of Surgical and Translational Medicine, Largo Brambilla 3, 50141, Florence, Italy
| | - Moira Mori
- University of Florence School of Health Sciences, Department of Surgical and Translational Medicine, Section of Dermatology, P. Palagi Hospital, Viale Michelangelo 41, 50125, Florence, Italy
| | - Luana Tiradritti
- University of Florence School of Health Sciences, Department of Surgical and Translational Medicine, Section of Dermatology, P. Palagi Hospital, Viale Michelangelo 41, 50125, Florence, Italy
| | - Stefano Bacci
- Department of Clinical and Experimental Medicine, Research Unit of Histology and Embriology, University of Florence, 50141, Florence, Italy
| | - Giuliano Zuccati
- University of Florence School of Health Sciences, Department of Surgical and Translational Medicine, Section of Dermatology, P. Palagi Hospital, Viale Michelangelo 41, 50125, Florence, Italy
| | - Pietro Cappugi
- University of Florence School of Health Sciences, Department of Surgical and Translational Medicine, Section of Dermatology, P. Palagi Hospital, Viale Michelangelo 41, 50125, Florence, Italy
| | - Nicola Pimpinelli
- University of Florence School of Health Sciences, Department of Surgical and Translational Medicine, Section of Dermatology, P. Palagi Hospital, Viale Michelangelo 41, 50125, Florence, Italy
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11
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Pappova T, Pec J, Kozarova A, Adamicova K. Extramammary Paget’s Disease Versus Lichen Sclerosus. ACTA MEDICA MARTINIANA 2016. [DOI: 10.1515/acm-2016-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractBurning, itching and dyspareunia are typical symptoms of many genital diseases. These subjective complaints can be misdiagnosed because of different clinical presentations. We present a case report of a postmenopausal woman treated for genital warts over a period of three years followed by the development of leukoplastic lesions in the whitish area clinical classified as Lichen sclerosus (LS). Histology of this lesion revealed carcinoma in situ. After radical surgical removal, vulvar Paget’s disease was histologically verified. LS and extramammary Paget's disease (EMPD) belong to a group of uncommon dermatoses which mainly affect the skin of the genitals in postmenopausal women. Ulceration, erosions and leukoplastic lesions can signalize the development of squamous cell carcinoma in association of lichen sclerosus, on the other hand, they can be the sign of EMPD after a long period of time using different topical agents. The importance of reaching the correct diagnosis is essential and can influence current patient investigations and invasive or non-invasive treatment.
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Affiliation(s)
- T. Pappova
- Comenius University Jessenius Faculty of Medicine and University Hospital, Department of Dermatovenerology, Martin, Slovak Republic
| | - J. Pec
- Comenius University Jessenius Faculty of Medicine and University Hospital, Department of Dermatovenerology, Martin, Slovak Republic
| | - A. Kozarova
- Comenius University Jessenius Faculty of Medicine and University Hospital, Department of Dermatovenerology, Martin, Slovak Republic
| | - K. Adamicova
- Comenius University, Jessenius Faculty of Medicine and University Hospital, Department of Pathology, Martin, Slovak Republic
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12
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Tolia M, Tsoukalas N, Sofoudis C, Giaginis C, Spyropoulou D, Kardamakis D, Kouloulias V, Kyrgias G. Primary extramammary invasive Paget's vulvar disease: what is the standard, what are the challenges and what is the future for radiotherapy? BMC Cancer 2016; 16:563. [PMID: 27473174 PMCID: PMC4966592 DOI: 10.1186/s12885-016-2622-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 07/26/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Primary invasive Extramammary Paget's vulvar disease is a rare tumor that is challenging to control. Wide surgical excision represents the standard treatment approach for Primary invasive Extramammary Paget's vulvar disease. The goal of the current study was to analyze the appropriate indications of radiotherapy in Primary invasive Extramammary Paget's vulvar disease because they are still controversial. DISCUSSION We searched the Cochrane Gynecological Cancer Group Trials Register, Cochrane Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE database up to September 2015. Radiotherapy was delivered as a treatment in various settings: i) Radical in 28 cases (range: 60-63 Gy), ii) Adjuvant in 25 cases (range: 39-60 Gy), iii) Salvage in recurrence of 3 patients (63 Gy) and iv) Neoadjuvant in one patient (43.3 Gy). A radiotherapy field that covered the gross tumor site with a 2-5 cm margin for the microscopic disease has been used. Radiotherapy of the inguinal, pelvic or para-aortic lymph node should be considered only for the cases with lymph node metastases within these areas. Radiotherapy alone is an alternative therapeutic approach for patients with extensive inoperable disease or medical contraindications. Definitive radiotherapy can be used in elderly patients and/or with medical contraindications. Adjuvant radiotherapy may be considered in presence of risk factors associated with local recurrence as dermal invasion, lymph node metastasis, close or positive surgical margins, perineal, large tumor diameter, multifocal lesions, extensive disease, coexisting histology of adenocarcinoma or vulvar carcinoma, high Ki-67 expression, adnexal involvement and probably in overexpression of HER-2/neu. Salvage radiotherapy can be given in inoperable loco-regional recurrence and to those who refused additional surgery.
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Affiliation(s)
- Maria Tolia
- Department of Radiotherapy, University of Thessaly, School of Health Sciences, Faculty of Medicine, Biopolis, Larissa, 411 10, Greece.
| | - Nikolaos Tsoukalas
- Oncology Clinic, 401 General Military Hospital, Mesogeion 138 & Katehaki, 115 25, Athens, Greece
| | - Chrisostomos Sofoudis
- LITO Obstetrics, Gynaecology & Surgery Centre, 7-13 Mouson Str, Psychiko-Athens, 154 52, Greece
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, University of the Aegean, Myrina, Lemnos, 814 40, Greece
| | - Despoina Spyropoulou
- Department of Radiation Oncology, University of Patra Medical School, Patra, 265 04, Greece
| | - Dimitrios Kardamakis
- Department of Radiation Oncology, University of Patra Medical School, Patra, 265 04, Greece
| | - Vasileios Kouloulias
- Second Department of Radiology, Radiation Therapy Oncology Unit, University Hospital of Athens "ATTIKON", Rimini 1, Haidari, 124 64, Athens, Greece
| | - George Kyrgias
- Department of Radiotherapy, University of Thessaly, School of Health Sciences, Faculty of Medicine, Biopolis, Larissa, 411 10, Greece
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van der Linden M, Meeuwis K, Bulten J, Bosse T, van Poelgeest M, de Hullu J. Paget disease of the vulva. Crit Rev Oncol Hematol 2016; 101:60-74. [DOI: 10.1016/j.critrevonc.2016.03.008] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 01/25/2016] [Accepted: 03/03/2016] [Indexed: 01/03/2023] Open
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Lencastre A, Cabete J, Apetato MM. Case for diagnosis. An Bras Dermatol 2013; 88:828-30. [PMID: 24173197 PMCID: PMC3798368 DOI: 10.1590/abd1806-4841.20132311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Accepted: 01/15/2013] [Indexed: 12/27/2022] Open
Abstract
An 83 year-old man was observed for an 8 year-long pruritic, erythematous plaque of
the left axilla. He had been continuously medicated with topical antifungals and
steroids with occasional symptomatic relief, but with disease progression. After a
clinical and histological diagnosis of Extramammary Paget's Disease, a total excision
with wide margins was performed. He remains disease-free 12 months after surgery. We
report this rare presentation of Extramammary Paget's Disease on a male patient.
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Affiliation(s)
- André Lencastre
- Dermatology Department, Hospital de Santo António dos Capuchos, Central Lisbon Hospital Center, Lisbon, Portugal
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Sandoval-Leon AC, Drews-Elger K, Gomez-Fernandez CR, Yepes MM, Lippman ME. Paget’s disease of the nipple. Breast Cancer Res Treat 2013; 141:1-12. [DOI: 10.1007/s10549-013-2661-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 08/02/2013] [Indexed: 11/24/2022]
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16
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Mengjun B, Zheng-Qiang W, Tasleem MM. Extramammary Paget's Disease of the Perianal Region: A Review of the Literature Emphasizing Management. Dermatol Surg 2013; 39:69-75. [DOI: 10.1111/dsu.12019] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Delport ES. Extramammary Paget's disease of the vulva: An annotated review of the current literature. Australas J Dermatol 2012; 54:9-21. [PMID: 22671146 DOI: 10.1111/j.1440-0960.2012.00898.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Extramammary Paget's disease is a rare and unusual neoplastic entity that presents mainly on apocrine gland-bearing skin. The vulva is the most common site of involvement but any area of the anogenital skin can be affected. Due to its rarity, variable clinical course and deceptive histological appearance it has a high misdiagnosis rate and both gynaecologists and dermatologists have limited experience in its management. The significance of the disease lies in its association with underlying malignancy as well as its inherent ability to invade the dermis and metastasise. The management is notoriously complicated and recurrence rates are high despite aggressive surgeries. Several alternative modalities are being explored, with results that are often variable and unpredictable. This review summarises the histopathological, clinical and therapeutic features of extramammary Paget's disease of the vulva reported in recent years.
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Sánchez-Sánchez J, Molinero-Caturla J, Ferreres-Riera J, Masferrer-i-Niubò E. Enfermedad de Paget extramamaria. Semergen 2011. [DOI: 10.1016/j.semerg.2011.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nardelli AA, Stafinski T, Menon D. Effectiveness of photodynamic therapy for mammary and extra-mammary Paget's disease: a state of the science review. BMC DERMATOLOGY 2011; 11:13. [PMID: 21676258 PMCID: PMC3141658 DOI: 10.1186/1471-5945-11-13] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 06/15/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Paget's disease is a rare skin disorder occurring in the breast (mammary) or in the groin, genital, peri-anal and axillary regions (extra-mammary). Typical treatment involves surgical excision, which in the case of extra-mammary Paget's disease, can lead to significant morbidity. Photodynamic therapy (PDT) which uses a topical or intravenous photosensitizing agent that is activated by a light source to ablate abnormal tissue, offers a minimally invasive alternative. The purpose of this study was to assess the effectiveness of photodynamic therapy in the treatment of Paget's disease. METHODS Following Cochrane guidelines, a comprehensive systematic review of all clinical studies and reports examining the use of PDT for mammary and extra-mammary Paget's disease was conducted. Study quality was assessed using the Oxford Levels of Evidence Scale. RESULTS 21 retrospective and 2 prospective non-comparative studies were identified and included in the review: 9 case reports with 1-2 patients and 14 case series with 1-16 patients. These reports totalled 99 patients with 133 extra-mammary Paget's lesions and 3 patients (with 3 lesions) with mammary Paget's disease. Follow-up periods were typically one year or less, with 77/133 extra-mammary lesions exhibiting complete response to PDT. One recurrent mammary skin lesion and two mammary lesions treated concomitantly with surgery also exhibited complete responses. CONCLUSIONS Evidence of the effectiveness of PDT for Paget's disease is promising, but limited. This may, in part, be explained by the rarity of the condition, making controlled comparative clinical trials challenging.
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Affiliation(s)
- Alexa A Nardelli
- Department of Public Health Sciences, University of Alberta, Room 3021, Research Transition Facility, 8308 114 Street, Edmonton, Alberta, T6G 2V2, Canada
| | - Tania Stafinski
- Department of Public Health Sciences, University of Alberta, Room 3021, Research Transition Facility, 8308 114 Street, Edmonton, Alberta, T6G 2V2, Canada
| | - Devidas Menon
- Department of Public Health Sciences, University of Alberta, Room 3021, Research Transition Facility, 8308 114 Street, Edmonton, Alberta, T6G 2V2, Canada
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Anton C, Luiz AVDC, Carvalho FM, Baracat EC, Carvalho JP. Clinical treatment of vulvar Paget's disease: a case report. Clinics (Sao Paulo) 2011; 66:1109-11. [PMID: 21808885 PMCID: PMC3129957 DOI: 10.1590/s1807-59322011000600033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Cristina Anton
- Faculdade de Medicina, Universidade de São Paulo São Paulo, São Paulo, SP, Brazil
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