1
|
Lim BY, Guo Z, Lim JQ, Ko TK, Lee ECY, Kannan B, Lee JY, Lim AH, Li Z, Ng CCY, Busmanis I, Chan JY. Whole genome sequencing of HER2-positive metastatic extramammary Paget's disease: a case report. Orphanet J Rare Dis 2024; 19:223. [PMID: 38831459 PMCID: PMC11149212 DOI: 10.1186/s13023-024-03169-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/30/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Extramammary Paget's disease (EMPD) is a rare cancer that occurs within the epithelium of the skin, arising predominantly in areas with high apocrine gland concentration such as the vulva, scrotum, penis and perianal regions. Here, we aim to integrate clinicopathological data with genomic analysis of aggressive, rapidly-progressing de novo metastatic EMPD responding to HER2-directed treatment in combination with other agents, to attain a more comprehensive understanding of the disease landscape. METHODS Immunohistochemical staining on the scrotal wall tumor and bone marrow metastasis demonstrated HER2 overexpression. Whole genome sequencing of the tumor and matched blood was performed. RESULTS Notable copy number gains (log2FC > 0.9) on chromosomes 7 and 8 were detected (n = 81), with 92.6% of these unique genes specifically located on chromosome 8. Prominent cancer-associated genes include ZNF703, HOOK3, DDHD2, LSM1, NSD3, ADAM9, BRF2, KAT6A and FGFR1. Interestingly, ERBB2 gene did not exhibit high copy number gain (log2FC = 0.4) although 90% of tumor cells stained HER2-positive. Enrichment in pathways associated with transforming growth factor-beta (TGFβ) (FDR = 0.0376, Enrichment Ratio = 8.12) and fibroblast growth factor receptor (FGFR1) signaling (FDR = 0.0082, Enrichment Ratio = 2.3) was detected. Amplicon structure analysis revealed that this was a simple-linear amplification event. CONCLUSION Whole genome sequencing revealed the underlying copy number variation landscape in HER2-positive metastatic EMPD. The presence of alternative signalling pathways and genetic variants suggests potential interactions with HER2 signalling, which possibly contributed to the HER2 overexpression and observed response to HER2-directed therapy combined with other agents in a comprehensive treatment regimen.
Collapse
Affiliation(s)
- Boon Yee Lim
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore, Singapore
| | - Zexi Guo
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore, Singapore
| | - Jing Quan Lim
- Division of Cellular and Molecular Research, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Tun Kiat Ko
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Bavani Kannan
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore, Singapore
| | - Jing Yi Lee
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore, Singapore
| | - Abner Herbert Lim
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore, Singapore
| | - Zhimei Li
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Inny Busmanis
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Jason Yongsheng Chan
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
- Divison of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
| |
Collapse
|
2
|
Extramammary Paget Disease of the Scrotum: A Contemporary Clinicopathologic Analysis of 20 Cases in the United States. Appl Immunohistochem Mol Morphol 2019; 28:524-531. [PMID: 31290785 DOI: 10.1097/pai.0000000000000789] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Extramammary Paget disease (EMPD) often involves apocrine gland-bearing locations including vulva and perianal area. EMPD of the scrotum is rare. Twenty patients were identified from the pathology files of 4 institutions between 2000 and 2018. Patients were 63- to 87-year-old (mean: 73 y) with a history of symptoms of between 4 months and 10 years. Two patients had a history of prostate cancer. Follow-up was available in 11 patients for a median of 71 months (range: 8 to 126 mo). Nine of 11 patients (82%) had positive margins, and 73% required reexcisions. Three patients had a focal dermal invasion, 1 of whom reportedly died of another etiology 25 months post diagnosis and 2 were disease-free at 24 and 68 months. No patient had inguinal lymphadenopathy. Two patients were alive with disease. Immunohistochemically, GATA3 and GCDFP15 were expressed in 6/6 cases, CK7 in 8/8 cases, and androgen receptor in 13/13 cases. HER2 was positive in 5/12 cases. PSA was positive in 1 patient who had a history of prostate cancer, whereas other prostate markers (NKX3.1 and prostein) were negative, and CK7 and GCDFP15 were positive, rendering primary EMPD diagnosis. Twelve other cases were negative for PSA and NKX3.1. In conclusion, EMPD of the scrotum has an insidious onset and its nonspecific symptoms can be misdiagnosed as dermatitis or fungal infection. Although localized EMPD has a favorable prognosis, the invasive disease is rare and did not predict metastasis or progression. Margins are frequently positive requiring reexcision. Occasionally, cases can be positive for PSA leading to diagnostic pitfalls.
Collapse
|
3
|
Zhang YN, Chen Y, Gao F, Chen N, Liu JY. Advanced Scrotal Extramammary Paget's Disease Treated With Apatinib: A Case Report. Clin Genitourin Cancer 2017; 16:e339-e342. [PMID: 29113769 DOI: 10.1016/j.clgc.2017.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 09/25/2017] [Accepted: 10/09/2017] [Indexed: 02/05/2023]
Affiliation(s)
- Yun-Ni Zhang
- Department of Medical Oncology, Cancer Center, The State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China
| | - Ye Chen
- Department of Medical Oncology, Cancer Center, The State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China
| | - Feng Gao
- Department of Oncology, Mianyang Central Hospital, Mianyang, Sichuan Province, China
| | - Ni Chen
- Department of Pathology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China
| | - Ji-Yan Liu
- Department of Medical Oncology, Cancer Center, The State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China.
| |
Collapse
|
4
|
Ahmed AK, Goodwin CR, Abu-Bonsrah N, Nguyen D, Sciubba DM. A rare case of metastatic extramammary Paget disease of the spine and review of the literature. J Clin Neurosci 2017; 45:161-165. [PMID: 28887080 DOI: 10.1016/j.jocn.2017.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 08/10/2017] [Indexed: 11/30/2022]
Abstract
Extramammary Paget disease is an intraepithelial neoplasm affecting cells rich in apocrine glands-often located in the vulvar, scrotal, or perianal region. It typically affects older patients, between the ages of 50 and 80years old, and is most often limited to the epidermis. A 47-year-old Asian male first presented with enlargement of the right inguinal lymph node. A subsequent biopsy revealed extrammamary Paget disease of the scrotum. The patient eventually developed significant worsening back pain with bilateral lower extremity numbness and weakness three months later. Imaging demonstrated a pathologic compression fracture of the L4 vertebral body with metastatic epidural spinal cord compression. The patient underwent surgical decompression of the spine with bilateral L4 laminectomy, resection of epidural tumor, and pedicle screw fixation from L2 to S1. Surgical pathology demonstrated metastatic adenocarcinoma consistent with extramammary Paget disease. Although two other case reports have described spinal metastases from extramammary Paget disease, to the author's knowledge, this represents the first report of surgical decompression and fusion for extramammary Paget disease of the spine.
Collapse
Affiliation(s)
- A Karim Ahmed
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C Rory Goodwin
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nancy Abu-Bonsrah
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Doreen Nguyen
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
5
|
Devaji Rao S, Govindarajan M. Extramammary Paget's Disease of the Perianal Region. Indian J Surg 2017; 79:360-362. [PMID: 28827914 DOI: 10.1007/s12262-017-1590-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 01/02/2017] [Indexed: 11/25/2022] Open
Abstract
Extramammary Paget's disease (EMPD) is uncommon and only a few cases have been reported in the literature. They are identical to the Mammary Paget's disease. This can occur where the apocrine glands are in abundance, more commonly in the genitalia and perianal area. We report here a case of Extramammary Paget's disease in the perianal region. The colourful background of this ulcer is analysed and the literature reviewed.
Collapse
Affiliation(s)
- S Devaji Rao
- Dhanwanthri Surgical Clinic and St. Isabel's Hospital, 15, Vinayagam Street, Somu Colony, Chennai, 600 028 India
| | | |
Collapse
|
6
|
Little JT, Lehman VT, Morris JM, Lehman JS, Diehn FE. Spinal Metastases of Extramammary Paget Disease with Radiologic-Pathologic Correlation. J Radiol Case Rep 2016; 10:1-8. [PMID: 27761174 DOI: 10.3941/jrcr.v10i5.2577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Extramammary Paget disease (EMPD) is an uncommon malignancy. It manifests either in the primary form in the skin as an intraepithelial neoplasm, or in secondary form as pagetoid (intraepithelial) spread of an underlying internal carcinoma to the skin. Although local invasion and recurrence of primary extramammary Paget disease are relatively frequent, widespread metastases are rare. As such, there are very few reports and little characterization of the radiologic features of widespread spinal metastases. To our knowledge, there are no prior reports of a metastatic extramammary Paget disease presenting as a painful pathologic vertebral body compression fracture. We report the radiological features of a case of primary extramammary Paget disease with subsequent spinal metastases presenting as a painful compression fracture.
Collapse
Affiliation(s)
- Jason T Little
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Vance T Lehman
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Julia S Lehman
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Felix E Diehn
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
7
|
Christodoulidou M, Khetrapal P, Mitra A, Muneer A. A case of metastatic adenocarcinoma on a background of penoscrotal extramammary Paget's disease. BMJ Case Rep 2015; 2015:bcr-2015-211350. [PMID: 26424821 DOI: 10.1136/bcr-2015-211350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 77-year-old man presented with a chronic lesion located in the left penoscrotal area. Apart from pruritus, bleeding and an occasional discharge from this area, he also reported reduced appetite and weight loss. Examination revealed an ulcerated skin lesion attached to a firm subcutaneous mass. Wide local excision of the lesion revealed invasive adenocarcinoma on a background of extramammary Paget's disease. Staging studies showed disseminated metastatic disease within the lymph nodes, and liver and bone metastases. He was treated with carboplatin and paclitaxel chemotherapy initially, but then continued only on Carboplatin chemotherapy due to side effects from Paclitaxel. Eleven weeks after the start of his chemotherapy, his restaging imaging showed reduced lymphadenopathy, unchanged liver metastasis and sclerosis of bone metastasis. With completion of chemotherapy, repeat imaging showed stable disease. The patient is currently on follow-up.
Collapse
Affiliation(s)
| | - Pramit Khetrapal
- Department of Histopathology, University College London Hospital, London, UK
| | - Anita Mitra
- Department of Oncology, University College London Hospital, London, UK
| | - Asif Muneer
- Department of Urology, University College London Hospital, London, UK
| |
Collapse
|
8
|
Phuoc V, Grothey A. Metastatic extramammary Paget's disease responding to weekly paclitaxel. BMJ Case Rep 2015; 2015:bcr-2014-208653. [PMID: 25903204 DOI: 10.1136/bcr-2014-208653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Metastatic extramammary Paget's disease (EMPD) is a rare cancer with no validated systemic treatment. Regimens including FECOM 5-fluorouracil (5-FU, epirubicin, carboplatin, vincristine and mitomycin C), 5-FU/cisplatin and single agent docetaxel exhibited varying levels of efficacy in case reports. A 58-year-old man with EMPD diffusely metastatic to bone presented with worsening shortness of breath, significant pancytopenia and disseminated intravascular coagulation (DIC). He was started on low-dose heparin for the DIC and weekly paclitaxel. Initially requiring almost daily transfusions, his shortness of breath improved after two doses of paclitaxel, and he became transfusion-independent after only three doses. Correlating with his disease course, the patient's prepaclitaxel carcinoembryonic antigen level of 62.1 ng/mL decreased to 7.4 ng/mL on 3-month follow-up, and he showed no progression of disease on imaging. With no validated chemotherapy regimen currently, this case can help guide consideration of paclitaxel in future treatment of metastatic EMPD.
Collapse
Affiliation(s)
- Vania Phuoc
- Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Axel Grothey
- Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
9
|
Choi Y, Park W, Lee J, Cho EY, Moon GH. Aggressive clinical course of extramammary Paget disease after radiotherapy. Radiat Oncol J 2014; 32:95-8. [PMID: 25061578 PMCID: PMC4104225 DOI: 10.3857/roj.2014.32.2.95] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 04/23/2014] [Accepted: 05/07/2014] [Indexed: 11/03/2022] Open
Abstract
Extramammary Paget disease (EMPD) is a rare disease, especially in Asian populations. Surgical resection is considered the primary treatment option. Recently, radiotherapy has been suggested as an EMPD treatment, either as an alternative to surgical resection or in combination with surgical resection. This report reviewed a patient with EMPD who was treated with wide excision of the EMPD site followed by radiotherapy for remaining gross lymph node metastases. The aim of this report was to determine the optimal treatment for advanced EMPD.
Collapse
Affiliation(s)
- Yunseon Choi
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeeyun Lee
- Department of Hematology and Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Yoon Cho
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Goo-Hyun Moon
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
10
|
Fernandes BF, Nikolitch K, Coates J, Novais G, Odashiro A, Odashiro PP, Belfort RN, Burnier MN. Local chemotherapeutic agents for the treatment of ocular malignancies. Surv Ophthalmol 2013; 59:97-114. [PMID: 24112549 DOI: 10.1016/j.survophthal.2013.01.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 01/24/2013] [Accepted: 01/29/2013] [Indexed: 11/30/2022]
Abstract
We critically analyze available peer-reviewed literature, including clinical trials and case reports, on local ocular cancer treatments. Recent innovations in many areas of ocular oncology have introduced promising new therapies, but, for the most part, the optimal treatment of ocular malignancies remains elusive.
Collapse
Affiliation(s)
- Bruno F Fernandes
- Department of Ophthalmology and Pathology, The McGill University Health Center, and Henry C. Witelson Ocular Pathology Laboratory, Montreal, Canada.
| | - Katerina Nikolitch
- Department of Ophthalmology and Pathology, The McGill University Health Center, and Henry C. Witelson Ocular Pathology Laboratory, Montreal, Canada
| | - James Coates
- Department of Ophthalmology and Pathology, The McGill University Health Center, and Henry C. Witelson Ocular Pathology Laboratory, Montreal, Canada
| | - Gustavo Novais
- Department of Ophthalmology and Pathology, The McGill University Health Center, and Henry C. Witelson Ocular Pathology Laboratory, Montreal, Canada
| | - Alexandre Odashiro
- Department of Ophthalmology and Pathology, The McGill University Health Center, and Henry C. Witelson Ocular Pathology Laboratory, Montreal, Canada
| | - Patricia P Odashiro
- Department of Ophthalmology and Pathology, The McGill University Health Center, and Henry C. Witelson Ocular Pathology Laboratory, Montreal, Canada
| | - Rubens N Belfort
- Department of Ophthalmology and Pathology, The McGill University Health Center, and Henry C. Witelson Ocular Pathology Laboratory, Montreal, Canada
| | - Miguel N Burnier
- Department of Ophthalmology and Pathology, The McGill University Health Center, and Henry C. Witelson Ocular Pathology Laboratory, Montreal, Canada
| |
Collapse
|
11
|
|
12
|
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]
|
13
|
|
14
|
Karam A, Dorigo O. Treatment outcomes in a large cohort of patients with invasive Extramammary Paget's disease. Gynecol Oncol 2012; 125:346-51. [DOI: 10.1016/j.ygyno.2012.01.032] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 12/28/2011] [Accepted: 01/19/2012] [Indexed: 11/16/2022]
|
15
|
|