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Quaquarini E, Grillo F, Gervaso L, Arpa G, Fazio N, Vanoli A, Parente P. Prognostic and Predictive Roles of HER2 Status in Non-Breast and Non-Gastroesophageal Carcinomas. Cancers (Basel) 2024; 16:3145. [PMID: 39335117 PMCID: PMC11430748 DOI: 10.3390/cancers16183145] [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: 07/27/2024] [Revised: 09/01/2024] [Accepted: 09/07/2024] [Indexed: 09/30/2024] Open
Abstract
The oncogene ERBB2, also known as HER2 or c-ERB2, is located on chromosome 17 (q12). It encodes a tyrosine kinase receptor, the human epidermal growth factor receptor 2 (HER2), involved in neoplastic proliferation, tumor angiogenesis, and invasiveness. Over the past years, the introduction of various anti-HER2 therapies has significantly improved outcomes for patients with HER2-positive breast and gastroesophageal carcinomas. More recently, the introduction of a new antibody-drug conjugate, that is trastuzumab deruxtecan, expanded the therapeutic options to low-HER2 breast and gastroesophageal tumors. HER2 protein overexpression is investigated using immunohistochemistry, gene amplification using fluorescence in situ hybridization, and gene mutation using next-generation sequencing. This review evaluated the predictive and prognostic role of HER2 status in various types of epithelial malignant cancers beyond breast and gastroesophageal cancers. We critically analyzed the key published studies, focusing on utilized scoring systems and assays used, and analyzed clinical parameters and therapeutic approaches. Although the evidence about prognostic and predictive roles of HER2 in carcinomas other than breast and gastroesophageal has been widely increasing over the last decade, it still remains investigational, revealing a tumor site-related prognostic and predictive value of the different types of HER2 alterations. However, standardized and validated scoring system assays have not been well-established for many organs.
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Affiliation(s)
- Erica Quaquarini
- Medical Oncology Unit of Pavia Institute, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy;
| | - Federica Grillo
- Anatomic Pathology Unit, University of Genova and Policlinico San Martino Hospital, 16132 Genova, Italy;
| | - Lorenzo Gervaso
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.G.); (N.F.)
| | - Giovanni Arpa
- Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy;
- Anatomic Pathology Unit of Pavia Institute, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy
| | - Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.G.); (N.F.)
| | - Alessandro Vanoli
- Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy;
- Anatomic Pathology Unit, Fondazione IRCCS San Matteo Hospital, 27100 Pavia, Italy
| | - Paola Parente
- Pathology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy;
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Zhu L, Wang H, Cheng D, Wang W, Lei Y, Yang N, Peng L, Liu P, Zhou J, Xie B. Case report: Pyrotinib in the treatment of advanced scrotal EMPD combined with sweat gland carcinoma. Front Oncol 2024; 14:1382376. [PMID: 39045556 PMCID: PMC11263006 DOI: 10.3389/fonc.2024.1382376] [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: 02/05/2024] [Accepted: 06/18/2024] [Indexed: 07/25/2024] Open
Abstract
Extramammary Paget disease (EMPD) is a rare cutaneous intraepithelial adenocarcinoma, which is mostly distributed in areas with sweat gland cells and mainly occurs in the anogenital skin of women. The male genital tract involvement is extremely rare and often occurs with other malignant tumors. Paget's disease in the scrotum with sweat gland carcinoma is even rarer. In the first report of scrotal endocrine sweat gland carcinoma associated with Paget disease by Saidi et al. in 1997, no more than 50 cases have been reported in the relevant research worldwide. Early EMPD combined with sweat gland carcinoma is mainly surgical treatment, and there is no standard treatment plan for advanced EMPD with sweat gland carcinoma. Previous article has reported that chemotherapy such as paclitaxel, fluorouracil, platinum, and vinblastine and molecular targeted therapy based on the genetic test results of patients have certain efficacy. Here, we report a 79-year-old male case diagnosed with human epidermal growth factor receptor 2 (HER-2) overexpression, which was effectively controlled by chemotherapy and anti-HER-2 treatment such as pyrotinib.
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Affiliation(s)
- Liquan Zhu
- Department of Oncology, General Hospital of Southern Theater Command, Guangzhou, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Haoqiang Wang
- Department of Oncology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Donghai Cheng
- Department of Oncology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Wei Wang
- Department of Pathology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Yue Lei
- Department of Oncology, General Hospital of Southern Theater Command, Guangzhou, China
- Graduate School, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Ning Yang
- Department of Oncology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Lijun Peng
- Department of Oncology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Peng Liu
- Department of Oncology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Juan Zhou
- Department of Oncology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Bo Xie
- Department of Oncology, General Hospital of Southern Theater Command, Guangzhou, China
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3
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Zhang H, Finkelman BS, Ettel MG, Velez MJ, Turner BM, Hicks DG. HER2 evaluation for clinical decision making in human solid tumours: pearls and pitfalls. Histopathology 2024; 85:3-19. [PMID: 38443321 DOI: 10.1111/his.15170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/23/2024] [Accepted: 02/17/2024] [Indexed: 03/07/2024]
Abstract
The significant clinical benefits of human epidermal growth factor receptor 2 (HER2)-targeted therapeutic agents have revolutionized the clinical treatment landscape in a variety of human solid tumours. Accordingly, accurate evaluation of HER2 status in these different tumour types is critical for clinical decision making to select appropriate patients who may benefit from life-saving HER2-targeted therapies. HER2 biomarker scoring criteria is different in different organ systems, and close adherence to the corresponding HER2 biomarker testing guidelines and their updates, if available, is essential for accurate evaluation. In addition, knowing the unusual patterns of HER2 expression is also important to avoid inaccurate evaluation. In this review, we discuss the key considerations when evaluating HER2 status in solid tumours for clinical decision making, including tissue handling and preparation for HER2 biomarker testing, as well as pathologist's readout of HER2 testing results in breast carcinomas, gastroesophageal adenocarcinomas, colorectal adenocarcinomas, gynaecologic carcinomas, and non-small cell lung carcinomas.
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Affiliation(s)
- Huina Zhang
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA
| | - Brian S Finkelman
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA
| | - Mark G Ettel
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA
| | - Moises J Velez
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA
| | - Bradley M Turner
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA
| | - David G Hicks
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA
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Wang JL, Meng WJ, Hu N, Liu JY. Case report: Disitamab vedotin combined with immunotherapy demonstrated excellent efficacy in scrotal Paget's disease with Her-2 overexpression. Front Immunol 2024; 15:1349033. [PMID: 38989283 PMCID: PMC11233530 DOI: 10.3389/fimmu.2024.1349033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/28/2024] [Indexed: 07/12/2024] Open
Abstract
Background Extramammary Paget's disease (EMPD) is a rare epithelial malignancy, and approximately 30%-40% of EMPD patients overexpress human epidermal growth factor receptor 2 (Her-2). Currently, there are no established standard treatments for advanced EMPD while anti-Her-2 therapy is recommended for Her-2-positive cases. Case presentation Here, we report a 51-year-old male diagnosed with advanced Her-2-positive EMPD, presenting with numerous lymph node metastases. This patient received disitamab vedotin (an antibody-drug conjugate, targeting Her-2) combined with serplulimab as first-line treatment. After seven cycles of combination therapy, the patient tolerated the treatment well and the lymph node lesions continued to shrink. However, the patient developed immunotherapy-related pneumonia following the eighth treatment. Hormone therapy was administered while all the anti-tumor therapies were halted. After the pneumonia improved, the patient underwent positron emission tomography-computed tomography, revealing a complete response to his tumor. To consolidate the effect, he received another five cycles of disitamab vedotin monotherapy as maintenance therapy, without experiencing any adverse events. To date, the patient has remained in good health without any recurrence 10 months after drug discontinuance. Conclusion Disitamab vedotin combined with immunotherapy demonstrated a long-term clinical benefit in advanced Her-2-positive EMPD. For rare solid tumors with Her-2 overexpression, disitamab vedotin combined with immunotherapy might offer a viable therapeutic choice.
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Affiliation(s)
- Jia-Ling Wang
- Department of Biotherapy, Cancer Center, West China Hospital of Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Wen-Jun Meng
- Department of Biotherapy, Cancer Center, West China Hospital of Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Nian Hu
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Ji-Yan Liu
- Department of Biotherapy, Cancer Center, West China Hospital of Sichuan University, Chengdu, China
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Kawaguchi A, Akiba J, Ogasawara S, Kondo R, Naito Y, Kusano H, Sanada S, Muto I, Nakama T, Yano H. Transcription factor activating enhancer-binding protein 2B expression correlates with invasiveness and prognosis of extramammary Paget's disease. Pathol Res Pract 2023; 242:154309. [PMID: 36689838 DOI: 10.1016/j.prp.2023.154309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/06/2023] [Accepted: 01/14/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND Extramammary Paget's disease (EMPD) is a slowly advancing malignancy that sometimes progresses to the invasion of the dermis, systemic metastases, and death. Although there have been reports that dermal invasion is associated with poor prognosis, no molecular markers of this invasion have been identified thus far. The aim of this study was to identify key molecules for predicting the risk of EMPD dermis invasion. METHOD We performed microarray screening for three cases of in-situ EMPDs, three cases of invasive EMPDs, and three cases of normal epidermis. We identified a molecule that exhibited a stepwise increase in expression. Further, we analyzed 47 cases of EMPD using immunohistochemical staining (IHC) and examined the correlated clinicopathological findings, including prognosis. RESULT We examined molecules that showed stepwise differences with invasion. We focused on transcription factor activating enhancer-binding protein 2 B (TFAP2B). Of the 47 EMPD patients, 38 (80.9 %) and 9 (19.1 %) had low and high TFAP2B expression, respectively. TFAP2B expression was significantly correlated with invasion into the dermis, mass formation, and preoperative lymph node metastasis (p = 0.001, 0.042, and 0.033, respectively). The cumulative postoperative recurrence-free rate in the TFAP2B-high expression group was significantly lower than that in the TFAP2B-low expression group (P < 0.001). In univariate analysis of recurrence-free survival, TFAP2B expression was found to be a significant factor (p = 0.006). CONCLUSION The expression of TFAP2B, which was comprehensively found by microarray screening, may correlate with the invasiveness of EMPD and may be an unfavorable prognostic factor.
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Affiliation(s)
- Aya Kawaguchi
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan; Department of Dermatology, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
| | - Jun Akiba
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Fukuoka, Japan
| | - Sachiko Ogasawara
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Reiichiro Kondo
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Yoshiki Naito
- Department of Clinical Laboratory Medicine, Kurume University Hospital, Kurume, Fukuoka, Japan
| | - Hironori Kusano
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan; Department of Clinical Laboratory, National Hospital Organization Kokura Medical Center, Kitakyushu, Fukuoka, Japan
| | - Sakiko Sanada
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Ikko Muto
- Department of Dermatology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Takekuni Nakama
- Department of Dermatology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Hirohisa Yano
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
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The role of HER2 as a therapeutic biomarker in gynaecological malignancy: potential for use beyond uterine serous carcinoma. Pathology 2023; 55:8-18. [PMID: 36503635 DOI: 10.1016/j.pathol.2022.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 11/20/2022] [Indexed: 11/25/2022]
Abstract
Human epidermal growth factor receptor 2 (HER2) is a prognostic biomarker and therapeutic target in carcinomas of the breast, stomach and colon. In 2018, clinical trial data confirmed the prognostic and predictive role of HER2 in uterine serous carcinoma, with a demonstrated survival benefit from combined chemotherapy and anti-HER2 targeted therapy in patients with advanced or recurrent disease. Approximately one-third of uterine serous carcinomas demonstrate HER2 protein overexpression and/or gene amplification and HER2 immunohistochemistry, supplemented by in situ hybridisation in equivocal cases, is fast becoming a reflex ancillary test at time of diagnosis. The potential role of HER2 in gynaecological tumours other than uterine serous carcinoma is yet to be firmly established. With the advent of personalised medicine, routine tumour sequencing and pursuit of targeted therapies, this is a field currently under active investigation. Emerging data suggest triaging endometrial carcinomas for HER2 analysis based on molecular classification may be superior to histotype-based testing, with copy-number high/p53 mutant tumours enriched for HER2 overexpression or amplification. Accordingly, many carcinosarcomas and a subset of clear cell and high-grade endometrioid carcinomas may be eligible for HER2 targeted therapy, although any clinical benefit in this context is currently undefined. For ovarian carcinomas, combined data support the role of HER2 as a prognostic biomarker, however its use as a therapeutic target is yet to be elucidated through clinical trials. In the cervix, reported rates of HER2 overexpression vary and are generally low, and currently there is insufficient evidence to justify routine HER2 testing in this context. Limited data suggest HER2 holds promise as a prognostic and predictive biomarker in vulvar Paget disease. Future clinical trials, with pathologist input to develop and refine site-specific scoring criteria, are required to establish what role HER2 might play more broadly in gynaecological cancer care.
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Tokuchi K, Maeda T, Kitamura S, Yanagi T, Ujiie H. HER2-Targeted Antibody–Drug Conjugates Display Potent Antitumor Activities in Preclinical Extramammary Paget’s Disease Models: In Vivo and Immunohistochemical Analyses. Cancers (Basel) 2022; 14:cancers14143519. [PMID: 35884581 PMCID: PMC9322551 DOI: 10.3390/cancers14143519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 11/20/2022] Open
Abstract
Simple Summary The prognosis for advanced Extramammary Paget’s disease (EMPD) is almost always poor. HER2-targeted antibody–drug conjugates (ADCs) such as trastuzumab emtansine and trastuzumab deruxtecan have proven to be effective against HER2-positive breast cancers; however, no studies have addressed HER2-targeted ADCs as treatments for EMPD. We examine the efficacy of ADCs against an EMPD patient-derived xenograft (PDX) model harboring pathogenic ERBB2 mutations. Treatment with trastuzumab emtansine or trastuzumab deruxtecan was found to significantly regress EMPD-PDX tumors in only seven days, with no recurrence observed for 10 weeks. Our results suggest that HER2-targeted ADCs could be novel and promising treatment options for patients with EMPD, especially in cases with the ERBB2-mutation or ERBB2-overexpression. Abstract Extramammary Paget’s disease (EMPD) is an adenocarcinoma that develops mainly in the genital region of older adults. The prognosis for advanced EMPD is almost always poor; thus, novel therapeutic strategies need to be developed. HER2-targeted antibody–drug conjugates (ADCs) such as trastuzumab emtansine and trastuzumab deruxtecan have proven effective against HER2-positive breast cancers; however, no studies have addressed HER2-targeted ADCs as treatments for EMPD. We examine the efficacy of ADCs against an EMPD patient-derived xenograft (PDX) model harboring pathogenic ERBB2 mutations and investigate the expression levels of HER2 using EMPD clinical samples. Trastuzumab emtansine or trastuzumab deruxtecan was administered intravenously to tumor-bearing NOD/Scid mice. Treatment with trastuzumab emtansine or trastuzumab deruxtecan was found to significantly regress EMPD-PDX tumors in only seven days, with no recurrence observed for 10 weeks. EMPD tumors extracted 48 h after drug administration revealed the TUNEL-positive ratio to be significantly higher for the HER2-targeted ADC-treated tumors than for the control tumors. EMPD patients’ clinical samples revealed a significant correlation between HER2 positivity and invasion, suggesting that HER2 status is associated with tumor progression. Our results suggest that HER2-targeted ADCs could be novel and promising treatment options for patients with EMPD, especially in ERBB2-mutant or ERBB2-overexpressed cases.
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Zhu H, Lewis DJ. Efficacy of trastuzumab in HER-2-positive advanced extramammary Paget's disease. Expert Opin Biol Ther 2022; 22:673-674. [PMID: 35414305 DOI: 10.1080/14712598.2022.2066472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Harrison Zhu
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Daniel J Lewis
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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9
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Kibbi N, Owen JL, Worley B, Wang JX, Harikumar V, Downing MB, Aasi SZ, Aung PP, Barker CA, Bolotin D, Bordeaux JS, Cartee TV, Chandra S, Cho NL, Choi JN, Chung KY, Cliby WA, Dorigo O, Eisen DB, Fujisawa Y, Golda N, Halfdanarson TR, Iavazzo C, Jiang SIB, Kanitakis J, Khan A, Kim JYS, Kuzel TM, Lawrence N, Leitao MM, MacLean AB, Maher IA, Mittal BB, Nehal KS, Ozog DM, Pettaway CA, Ross JS, Rossi AM, Servaes S, Solomon MJ, Thomas VD, Tolia M, Voelzke BB, Waldman A, Wong MK, Zhou Y, Arai N, Brackett A, Ibrahim SA, Kang BY, Poon E, Alam M. Evidence-Based Clinical Practice Guidelines for Extramammary Paget Disease. JAMA Oncol 2022; 8:618-628. [PMID: 35050310 DOI: 10.1001/jamaoncol.2021.7148] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE Extramammary Paget disease (EMPD) is a frequently recurring malignant neoplasm with metastatic potential that presents in older adults on the genital, perianal, and axillary skin. Extramammary Paget disease can precede or occur along with internal malignant neoplasms. OBJECTIVE To develop recommendations for the care of adults with EMPD. EVIDENCE REVIEW A systematic review of the literature on EMPD from January 1990 to September 18, 2019, was conducted using MEDLINE, Embase, Web of Science Core Collection, and Cochrane Libraries. Analysis included 483 studies. A multidisciplinary expert panel evaluation of the findings led to the development of clinical care recommendations for EMPD. FINDINGS The key findings were as follows: (1) Multiple skin biopsies, including those of any nodular areas, are critical for diagnosis. (2) Malignant neoplasm screening appropriate for age and anatomical site should be performed at baseline to distinguish between primary and secondary EMPD. (3) Routine use of sentinel lymph node biopsy or lymph node dissection is not recommended. (4) For intraepidermal EMPD, surgical and nonsurgical treatments may be used depending on patient and tumor characteristics, although cure rates may be superior with surgical approaches. For invasive EMPD, surgical resection with curative intent is preferred. (5) Patients with unresectable intraepidermal EMPD or patients who are medically unable to undergo surgery may receive nonsurgical treatments, including radiotherapy, imiquimod, photodynamic therapy, carbon dioxide laser therapy, or other modalities. (6) Distant metastatic disease may be treated with chemotherapy or individualized targeted approaches. (7) Close follow-up to monitor for recurrence is recommended for at least the first 5 years. CONCLUSIONS AND RELEVANCE Clinical practice guidelines for EMPD provide guidance regarding recommended diagnostic approaches, differentiation between invasive and noninvasive disease, and use of surgical vs nonsurgical treatments. Prospective registries may further improve our understanding of the natural history of the disease in primary vs secondary EMPD, clarify features of high-risk tumors, and identify superior management approaches.
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Affiliation(s)
- Nour Kibbi
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Joshua L Owen
- Dermatology Service, South Texas Veterans Health Care System, San Antonio
| | | | - Jake X Wang
- Department of Dermatology, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Vishnu Harikumar
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Sumaira Z Aasi
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Phyu P Aung
- Department of Pathology (Dermatopathology), The University of Texas MD Anderson Cancer Center, Houston
| | - Christopher A Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Diana Bolotin
- Section of Dermatology, University of Chicago, Chicago, Illinois
| | - Jeremy S Bordeaux
- University Hospitals Cleveland Medical Center, Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - Todd V Cartee
- Division of Dermatology, Pennsylvania State College of Medicine, Hershey
| | - Sunandana Chandra
- Division of Oncology, Department of Medicine, Northwestern University Medical Center, Chicago, Illinois
| | - Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts
| | - Jennifer N Choi
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kee Yang Chung
- Department of Dermatology, Yonsei University College of Medicine, Seoul, South Korea
| | - William A Cliby
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Oliver Dorigo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford Women's Cancer Center, Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Daniel B Eisen
- Department of Dermatology, University of California Davis, Sacramento
| | | | - Nicholas Golda
- Department of Dermatology, University of Missouri School of Medicine, Columbia
| | | | - Christos Iavazzo
- Department of Gynecologic Oncology, Metaxa Cancer Hospital, Piraeus, Greece
| | | | - Jean Kanitakis
- Department of Dermatology, Ed. Herriot Hospital Group (Pav. R), Lyon, France
| | - Ashraf Khan
- Department of Pathology, University of Massachusetts Medical School-Baystate, Baystate Health, Springfield
| | - John Y S Kim
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Timothy M Kuzel
- Division of Hematology, Oncology and Cell Therapy, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Naomi Lawrence
- Division of Dermatology, Cooper Hospital, Rowan University, Camden, New Jersey
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York
| | - Allan B MacLean
- Department of Gynaecology, University College, London, United Kingdom
| | - Ian A Maher
- Department of Dermatology, University of Minnesota, Minneapolis
| | - Bharat B Mittal
- Department of Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kishwer S Nehal
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David M Ozog
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Curtis A Pettaway
- Division of Surgery, Department of Urology, The University of Texas MD Anderson Cancer Center, Houston
| | - Jeffrey S Ross
- Department of Pathology, Upstate Medical University, Syracuse, New York
- Department of Urology, Upstate Medical University, Syracuse, New York
| | - Anthony M Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sabah Servaes
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia
| | - Michael J Solomon
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Valencia D Thomas
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston
| | - Maria Tolia
- Department of Radiotherapy, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | | | - Abigail Waldman
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael K Wong
- Division of Cancer Medicine, Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Youwen Zhou
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nobuo Arai
- Electrical Engineering, Kanagawa University, Kanagawa-ku, Yokohama, Japan
| | - Alexandria Brackett
- Cushing/Whitney Medical Library, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Sarah A Ibrahim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bianca Y Kang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Otolaryngology-Head and Neck Surgery and Surgery (Organ Transplantation), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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10
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Hristu R, Eftimie LG, Stanciu SG, Glogojeanu RR, Gheorghita P, Stanciu GA. Assessment of Extramammary Paget Disease by Two-Photon Microscopy. Front Med (Lausanne) 2022; 9:839786. [PMID: 35280872 PMCID: PMC8913931 DOI: 10.3389/fmed.2022.839786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/24/2022] [Indexed: 12/29/2022] Open
Abstract
Two-photon microscopy techniques are non-linear optical imaging methods which are gaining momentum in the investigation of fixed tissue sections, fresh tissue or even for in vivo experiments. Two-photon excited fluorescence and second harmonic generation are two non-linear optical contrast mechanisms which can be simultaneously used for offering complementary information on the tissue architecture. While the former can originate from endogenous autofluorescence sources (e.g., NADH, FAD, elastin, keratin, lipofuscins, or melanin), or exogenous eosin, the latter is generated in fibrillar structures within living organisms (e.g., collagen and myosin). Here we test the ability of both these contrast mechanisms to highlight features of the extramammary Paget disease on fixed tissue sections prepared for standard histological examination using immunohistochemical markers and hematoxylin and eosin staining. We also demonstrate the label-free abilities of both imaging techniques to highlight histological features on unstained fixed tissue sections. The study demonstrated that two-photon microscopy can detect specific cellular features of the extramammary Paget disease in good correlation with histopathological results.
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Affiliation(s)
- Radu Hristu
- Center for Microscopy-Microanalysis and Information Processing, University Politehnica of Bucharest, Bucharest, Romania
| | - Lucian G. Eftimie
- Center for Microscopy-Microanalysis and Information Processing, University Politehnica of Bucharest, Bucharest, Romania
- Pathology Department, Central University Emergency Military Hospital, Bucharest, Romania
| | - Stefan G. Stanciu
- Center for Microscopy-Microanalysis and Information Processing, University Politehnica of Bucharest, Bucharest, Romania
| | - Remus R. Glogojeanu
- Department of Special Motricity and Medical Recovery, The National University of Physical Education and Sports, Bucharest, Romania
| | - Pavel Gheorghita
- Center for Microscopy-Microanalysis and Information Processing, University Politehnica of Bucharest, Bucharest, Romania
- Faculty of Energetics, University Politehnica of Bucharest, Bucharest, Romania
| | - George A. Stanciu
- Center for Microscopy-Microanalysis and Information Processing, University Politehnica of Bucharest, Bucharest, Romania
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11
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Gao X, Zhong X, Chen HN, Singh D, Yang L, Huang LB, Wang C, Zhou ZG. Nomograms for predicting cancer-specific and overall survival in patients with invasive extramammary Paget's disease. Future Oncol 2021; 17:2785-2801. [PMID: 33988031 DOI: 10.2217/fon-2021-0372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Aim: To develop nomograms for predicting cancer-specific survival (CSS) and overall survival (OS) in patients with invasive extramammary Paget's disease (iEMPD). Patients & methods: Retrospective data of 1955 patients with iEMPD were collected from the Surveillance, Epidemiology, and End Results database. Nomograms for predicting CSS and OS were established using competing risk regression and Cox regression, respectively, and were internally validated. Results: Five (age, surgery, tumor location, stage and concurrent malignancy) and eight (gender, age, race, marital status, surgery, tumor location, stage and lymph node metastasis) clinicopathological factors were utilized to construct nomograms for predicting CSS and OS, respectively. The concordance indices of the nomograms for predicting CSS and OS were 0.78 and 0.73, respectively. The validation of the nomograms showed good calibration and discrimination. The decision curve analyses confirmed the clinical utility of these nomograms. Conclusion: The nomograms can be a reliable tool for treatment design and prognostic evaluation of iEMPD.
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Affiliation(s)
- Xiang Gao
- Department of Gastrointestinal Surgery, West China Hospital, West China School of Medicine, Sichuan University, & Institute of Digestive Surgery, Sichuan University, Chengdu, 610041, PR China
| | - Xi Zhong
- Department of Intensive Care Unit, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, 610041, PR China
| | - Hai-Ning Chen
- Department of Gastrointestinal Surgery, West China Hospital, West China School of Medicine, Sichuan University, & Institute of Digestive Surgery, Sichuan University, Chengdu, 610041, PR China
| | - Dujanand Singh
- Department of Gastrointestinal Surgery, West China Hospital, West China School of Medicine, Sichuan University, & Institute of Digestive Surgery, Sichuan University, Chengdu, 610041, PR China
| | - Lie Yang
- Department of Gastrointestinal Surgery, West China Hospital, West China School of Medicine, Sichuan University, & Institute of Digestive Surgery, Sichuan University, Chengdu, 610041, PR China
| | - Li-Bin Huang
- Department of Gastrointestinal Surgery, West China Hospital, West China School of Medicine, Sichuan University, & Institute of Digestive Surgery, Sichuan University, Chengdu, 610041, PR China
| | - Cun Wang
- Department of Gastrointestinal Surgery, West China Hospital, West China School of Medicine, Sichuan University, & Institute of Digestive Surgery, Sichuan University, Chengdu, 610041, PR China
| | - Zong-Guang Zhou
- Department of Gastrointestinal Surgery, West China Hospital, West China School of Medicine, Sichuan University, & Institute of Digestive Surgery, Sichuan University, Chengdu, 610041, PR China
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12
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Hormonal Environment and HER2 Status in Extra-Mammary Paget's Disease (eMPD): A Systematic Literature Review and Meta-Analysis with Clinical Considerations. Diagnostics (Basel) 2020; 10:diagnostics10121040. [PMID: 33287150 PMCID: PMC7761697 DOI: 10.3390/diagnostics10121040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 11/29/2020] [Accepted: 12/02/2020] [Indexed: 12/13/2022] Open
Abstract
Background. Extra-mammary Paget’s disease (EMPD) is a rare neoplasm of epithelial origin, whose precise incidence is not clear. Starting from what is already known, we performed a systematic review and meta-analysis to investigate in male and female patients the immunohistochemical expression of biological markers that could serve as potential prognostic/therapeutic factors, including only human epidermal growth factor receptor 2 (HER2/neu), Estrogen Receptor (ER), Progesterone Receptor (PR), and Androgen Receptor (AR). Methods. A literature search was performed of the PubMed, Scopus, and Web of Science databases for English-language studies published from January 2000 to June 2020. Results. A total of 27 studies with 713 patients assessed the role of HER2/neu, AR, ER, and PR expression in male and female with EMPD. The overall rate of HER2/neu expression was 30%, the expression’s rate for ER and AR was 13% and 40%, respectively, and the overall rate for PR was 8%. The subgroup analysis revealed that there is a different expression of molecular markers between male and female patients. Conclusions. This study revealed that AR status and HER2/neu overexpression/amplification have been shown as two fundamental pathogenetic pathways in both female and male patients affected by EMPD.
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13
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Stasenko M, Jayakumaran G, Cowan R, Broach V, Chi DS, Rossi A, Hollman TJ, Zehir A, Abu-Rustum NR, Leitao MM. Genomic Alterations as Potential Therapeutic Targets in Extramammary Paget's Disease of the Vulva. JCO Precis Oncol 2020; 4:PO.20.00073. [PMID: 33015527 PMCID: PMC7529529 DOI: 10.1200/po.20.00073] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To identify genomic alterations as potential therapeutic targets in extramammary Paget disease (EMPD) of the vulva. METHODS We identified all patients with primary vulvar EMPD who were treated at our institution and underwent paired tumor-normal massively parallel sequencing of 410-468 cancer-related genes (MSK-IMPACT assay). EMPD of the vulva samples sequenced from 2014 to 2019 were reviewed and somatic mutations identified, with specific focus on mutations of potential therapeutic targets. Clinical data were abstracted from electronic medical records. Microsatellite instability (MSI) was assessed by MSIscore. RESULTS Tumors of 26 patients with EMPD underwent genomic sequencing. At diagnosis, all patients had noninvasive or microinvasive (< 1 mm) disease; invasive disease eventually developed in 2 patients. Primary treatment was surgery for 19 patients (73%) and imiquimod topical therapy for 7 (27%). Seven patients had ≥ 2 surgeries as part of clinical course (1 patient had 5 vulvar resections). Samples had a median of 2 coding mutations in the genes analyzed (range, 0-29). The most common mutations were in PIK3CA (n = 9; 35%), ERBB2 (4 mutations and 3 copy number alterations; 27%), and TP53 (n = 7; 27%). MSIscore was available for 23 samples; all were microsatellite stable. After tumor genomic profiling, a patient who was initially treated with multiple resections and imiquimod was found to have a PIK3CA p.E542K mutation. She underwent PI3K-inhibitor treatment for 18 months before disease progression. CONCLUSION EMPD of the vulva has a chronic and relapsing course, often requiring multiple surgical resections. Effective topical treatments are lacking. We identified targetable mutations (PIK3CA or ERBB2) in > 25% of a real-world clinical cohort. Additional prospective research implementing targetable therapies for EMPD treatment is warranted.
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Affiliation(s)
- Marina Stasenko
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gowtham Jayakumaran
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Renee Cowan
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vance Broach
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Dennis S. Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anthony Rossi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Travis J. Hollman
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ahmet Zehir
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nadeem R. Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mario M. Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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14
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Chow CY, Namuduri RP, Yeo YC, Mihir G. The diagnostic challenge of primary adenocarcinoma of the vulva: a case report. PROCEEDINGS OF SINGAPORE HEALTHCARE 2020. [DOI: 10.1177/2010105819877895] [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
The diagnosis and classification of primary adenocarcinoma of the vulva is a complicated and understudied area, as this is a rare histological subtype of vulvar cancers. The differential diagnoses include extramammary Paget disease with invasion, adenocarcinoma arising from mammary-like glands, skin adnexal structures as well as Bartholin’s glands in the vicinity. We report a case of extramammary Paget disease which first presented as primary vulvar adenocarcinoma. The patient was a 71-year-old woman who presented with a swelling at the external genitalia. Clinical examination revealed a right vulvar lump, with eczematous features on the overlying skin. The lump was biopsied and was called Paget disease with underlying adenocarcinoma. Subsequently, the patient underwent radical vulvectomy and bilateral groin and pelvis dissection. The resection specimen was reported as extramammary Paget disease, with dermal invasion forming a poorly differentiated adenocarcinoma showing strong HER-2 expression on immunohistochemistry. This case illustrates the diagnostic challenge in the classification of primary vulvar adenocarcinoma. Positivity for HER-2 has been reported in Paget-associated vulvar adenocarcinoma and might offer potentially actionable targets on the selection of therapy, especially in advanced metastatic disease.
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Affiliation(s)
- Chun Yuen Chow
- Department of Pathology, Singapore General Hospital, Singapore
| | - Rama P Namuduri
- Department of Pathology and Laboratory Medicine, KK Women’s and Children’s Hospital, Singapore
| | - Yen Chin Yeo
- Department of Gynecological Oncology, KK Women’s and Children’s Hospital, Singapore
| | - Gudi Mihir
- Department of Pathology and Laboratory Medicine, KK Women’s and Children’s Hospital, Singapore
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15
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Primo WQSP, Primo GRP, Basilio DB, Machado KK, Carvalho JP, Carvalho FM. Vulvar Paget disease secondary to high-grade urothelial carcinoma with underlying massive vascular embolization and cervical involvement: case report of unusual presentation. Diagn Pathol 2019; 14:125. [PMID: 31699107 PMCID: PMC6836446 DOI: 10.1186/s13000-019-0895-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/25/2019] [Indexed: 12/17/2022] Open
Abstract
Background Vulvar extramammary Paget disease is a rare chronic condition, that presents with non-specific symptoms such as pruritus and eczematous lesions. Because most of these lesions are noninvasive, the distinction between primary and secondary Paget disease is crucial to management. Case presentation We report an unusual case of vulvar Paget disease associated with massive dermal vascular embolization, cervicovaginal involvement and metastasis to inguinal and retroperitoneal lymph nodes. The intraepithelial vulvar lesion had a classical appearance and was accompanied by extensive component of dermal lymphovascular tumor emboli, similar to those observed in inflammatory breast carcinoma. Immunohistochemical analysis revealed that the lesion was secondary to high-grade urothelial cell carcinoma. The patient had a history of superficial low-grade papillary urothelial carcinoma of the bladder, which had appeared 2 years before the onset of vulvar symptoms. Conclusions Eczematoid vulvar lesions merit careful clinical examination and biopsy, including vulva mapping and immunohistochemistry. The information obtained may help to define and classify a particular presentation of Paget disease. Noninvasive primary lesions do not require the same aggressive approaches required for the treatment of invasive and secondary disease.
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Affiliation(s)
| | | | - Dunya Bachour Basilio
- Department of Pathology, Instituto Hospital de Base do Distrito Federal IHBDF, Secretaria de Estado da Saude, Brasilia, DF, Brazil
| | | | - Jesus Paula Carvalho
- Instituto do Cancer do Estado de São Paulo ICESP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Filomena M Carvalho
- Department of Pathology, Faculdade de Medicina FMUSP, Universidade de São Paulo, Av. Dr. Arnaldo, 455 - room 1149, Sao Paulo, SP, 01246-903, Brazil.
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16
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Urata K, Kajihara I, Myangat TM, Tasaki Y, Otsuka‐Maeda S, Sawamura S, Kanazawa‐Yamada S, Sakamoto R, Makino K, Aoi J, Igata T, Makino T, Masuguchi S, Fukushima S, Jinnin M, Ihn H. Overexpression of cyclin‐dependent kinase 4 protein in extramammary Paget's disease. J Dermatol 2019; 46:444-448. [DOI: 10.1111/1346-8138.14858] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 02/20/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Kazumi Urata
- Department of Dermatology and Plastic Surgery Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Ikko Kajihara
- Department of Dermatology and Plastic Surgery Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Tselmeg Mijiddorj Myangat
- Department of Dermatology and Plastic Surgery Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Yukino Tasaki
- Department of Dermatology and Plastic Surgery Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Saki Otsuka‐Maeda
- Department of Dermatology and Plastic Surgery Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Soichiro Sawamura
- Department of Dermatology and Plastic Surgery Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Saori Kanazawa‐Yamada
- Department of Dermatology and Plastic Surgery Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Ryoko Sakamoto
- Department of Dermatology and Plastic Surgery Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Katsunari Makino
- Department of Dermatology and Plastic Surgery Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Jun Aoi
- Department of Dermatology and Plastic Surgery Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Toshikatsu Igata
- Department of Dermatology and Plastic Surgery Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Takamitsu Makino
- Department of Dermatology and Plastic Surgery Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Shinichi Masuguchi
- Department of Dermatology and Plastic Surgery Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Satoshi Fukushima
- Department of Dermatology and Plastic Surgery Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Masatoshi Jinnin
- Department of Dermatology and Plastic Surgery Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Hironobu Ihn
- Department of Dermatology and Plastic Surgery Faculty of Life Sciences Kumamoto University Kumamoto Japan
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18
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Mantovani G, Fagotti A, Franchi M, Scambia G, Garganese G. Reviewing vulvar Paget's disease molecular bases. Looking forward to personalized target therapies: a matter of CHANGE. Int J Gynecol Cancer 2019; 29:ijgc-2018-000080. [PMID: 30674571 DOI: 10.1136/ijgc-2018-000080] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/25/2018] [Accepted: 12/04/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To review the published literature on vulvar Paget's disease (VPD) molecular bases, aiming to support the need for tailored treatment in women affected by this 'orphan' tumor. METHODS MEDLINE-PubMed and Scopus were interrogated using the following algorithm: (extramammary OR extra mammary OR vulvar) AND (paget OR pagets OR paget's) AND (molecular OR biological OR marker OR protein OR target OR expression). The inclusion criteria for papers were: peer-reviewed English-language journals, articles published in the last 30 years, studies focused on fixed research questions, quality assessment on the basis of the relevance and contribution to the selected topics. RESULTS A total of 42 studies were selected, providing the following results. Molecular markers implicated in cell cycle transitions seem to be related to prognosis and could help to tailor conventional treatments. Fragmented but consistent preliminary data exist on hormonal receptor expression, ERBB2 amplification/overexpression and abnormal vascular proliferation, offering a concrete possibility for target therapy trials. Conversely, other fields linked to the possible use of immunotherapy are currently relatively unexplored, such as the tumor 'immune contexture', programmed death ligand-1 (PD-L1) expression and defects in the mismatch repair system, which is involved in genomic instability and potentially promotes a consistent response to treatment. CONCLUSIONS Additional effort is needed to further characterize these aspects. Centralization of patients in dedicated units would be beneficial for concentrating patient numbers, collecting valuable clinical data and conducting clinical trials. Interdisciplinary study platforms should be developed and integrated into wider multicentric networks.
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Affiliation(s)
- Giulia Mantovani
- Department of Obstetrics and Gynecology, Università degli Studi di Verona, Verona, Italy
| | - Anna Fagotti
- Division of Gynecologic Oncology, Vul.Can MDT, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Department of Women's and Children's Health, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Massimo Franchi
- Department of Obstetrics and Gynecology, Università degli Studi di Verona, Verona, Italy
| | - Giovanni Scambia
- Division of Gynecologic Oncology, Vul.Can MDT, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Department of Women's and Children's Health, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giorgia Garganese
- Division of Gynecologic Oncology, Vul.Can MDT, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
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19
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Hsieh GL, English DP, Tu P, Folkins AK, Karam AK. Case of Metastatic Extramammary Paget Disease of the Vulva Treated Successfully With Trastuzumab Emtansine. JCO Precis Oncol 2018; 2:1-8. [DOI: 10.1200/po.17.00204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Gillian L. Hsieh
- All authors: Stanford University School of Medicine, Stanford CA
| | - Diana P. English
- All authors: Stanford University School of Medicine, Stanford CA
| | - Powen Tu
- All authors: Stanford University School of Medicine, Stanford CA
| | - Ann K. Folkins
- All authors: Stanford University School of Medicine, Stanford CA
| | - Amer K. Karam
- All authors: Stanford University School of Medicine, Stanford CA
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20
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Hirai I, Tanese K, Nakamura Y, Otsuka A, Fujisawa Y, Yamamoto Y, Hata H, Fujimura T, Matsushita S, Yoshino K, Kameyama K, Amagai M, Funakoshi T. Assessment of the methods used to detect HER2-positive advanced extramammary Paget's disease. Med Oncol 2018; 35:92. [PMID: 29744813 DOI: 10.1007/s12032-018-1154-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/03/2018] [Indexed: 12/29/2022]
Abstract
The human epidermal growth factor receptor 2 (HER2) is recognized as an oncogene as well as a therapeutic target in various cancers. Certain patients with advanced extramammary Paget's disease (EMPD) have also been reported to express HER2, which is therefore considered a therapeutic target for EMPD. However, an accurate methodology to determine HER2-positive EMPD has not been established. To assess the optimal methods for detection of HER2-positive EMPD, 73 EMPD samples were analyzed by immunohistochemical (IHC) staining, fluorescence in situ hybridization (FISH), and the HER2 testing algorithm for breast cancer of the American Society of Clinical Oncology/College of American Pathologists, which combined the results of IHC staining and FISH. The results showed discordance in the rate of positive IHC staining and FISH results. While 68.6% (24/35) of the metastatic samples showed equivocal or positive IHC staining, only 37.1% (13/35) were positive by FISH. To assess the accuracy of these methods, the degree of HER2 expression detected by each method was correlated with the staining profiles of activated downstream signaling pathways involving phosphorylated p44/42 MAPK (Thr202/Tyr204) (p-ERK1/2) and phosphorylated AKT (Ser473) (p-AKT). Among 16 lymph node metastasis samples, all HER2-positive samples as determined by the testing algorithm stained positively for both p-ERK1/2 and p-AKT. On the other hand, 10-14.3% of the samples determined by FISH or IHC showed negative staining for p-ERK1/2 and p-AKT. The results showed that combining the results of IHC and FISH according to the HER2 testing algorithm is a useful method for accurately evaluating HER2-positive EMPD.
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Affiliation(s)
- Ikuko Hirai
- Department of Dermatology, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Keiji Tanese
- Department of Dermatology, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Yoshio Nakamura
- Department of Dermatology, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Atsushi Otsuka
- Department of Dermatology, Kyoto University School of Medicine, Kyoto, Japan
| | - Yasuhiro Fujisawa
- Department of Dermatology, University of Tsukuba School of Medicine, Tsukuba, Japan
| | - Yuki Yamamoto
- Department of Dermatology, Wakayama Medical University School of Medicine, Wakayama, Japan
| | - Hiroo Hata
- Department of Dermatology, Hokkaido University School of Medicine, Sapporo, Japan
| | - Taku Fujimura
- Department of Dermatology, Tohoku University School of Medicine, Sendai, Japan
| | - Shigeto Matsushita
- Department of Dermato-Oncology/Dermatology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Koji Yoshino
- Department of Dermatology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Kaori Kameyama
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Masayuki Amagai
- Department of Dermatology, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takeru Funakoshi
- Department of Dermatology, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
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21
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Fukuda K, Funakoshi T. Metastatic Extramammary Paget's Disease: Pathogenesis and Novel Therapeutic Approach. Front Oncol 2018; 8:38. [PMID: 29503810 PMCID: PMC5820294 DOI: 10.3389/fonc.2018.00038] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 02/02/2018] [Indexed: 12/13/2022] Open
Abstract
Extramammary Paget’s disease (EMPD) is a rare, slow-growing, cutaneous adenocarcinoma that usually originates in the anogenital area and axillae outside the mammary glands. EMPD mostly progresses slowly and is often diagnosed as carcinoma in situ; however, upon becoming invasive, it promptly and frequently metastasizes to regional lymph nodes, leading to subsequent distant metastasis. To date, several chemotherapy regimens have been used to treat metastatic EMPD; however, they present limited effect and patients with distant metastasis exhibit a poor prognosis. Recently, basic and translational investigative research has elucidated factors and molecular mechanisms underlying the promotion of metastasis, which can lead to targeted therapy-based emerging treatment strategies. Here, we aim to discuss current therapies and their limitations; advancements in illustrating mechanisms promoting invasion, migration, and proliferation of EMPD tumor cells; and future therapeutic approaches for metastatic EMPD that may enhance clinical outcomes.
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Affiliation(s)
- Keitaro Fukuda
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, United States.,Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Takeru Funakoshi
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, United States
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22
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Tessier-Cloutier B, Asleh-Aburaya K, Shah V, McCluggage WG, Tinker A, Gilks CB. Molecular subtyping of mammary-like adenocarcinoma of the vulva shows molecular similarity to breast carcinomas. Histopathology 2017; 71:446-452. [DOI: 10.1111/his.13239] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 04/11/2017] [Accepted: 04/12/2017] [Indexed: 01/28/2023]
Affiliation(s)
- Basile Tessier-Cloutier
- Division of Anatomical Pathology; Vancouver General Hospital; University of British Columbia; Vancouver Canada
- Department of Pathology and Laboratory Medicine; University of British Columbia; Vancouver Canada
| | - Karama Asleh-Aburaya
- Department of Pathology and Laboratory Medicine; University of British Columbia; Vancouver Canada
- Genetic Pathology Evaluation Centre; University of British Columbia; Vancouver Canada
| | - Varsha Shah
- Department of Pathology; Royal Gwent Hospital; Newport UK
| | - W Glenn McCluggage
- Department of Pathology; Belfast Health and Social Care Trust; Belfast UK
| | - Anna Tinker
- Division of Medical Oncology; British Columbia Cancer Agency; Vancouver Canada
| | - C Blake Gilks
- Division of Anatomical Pathology; Vancouver General Hospital; University of British Columbia; Vancouver Canada
- Department of Pathology and Laboratory Medicine; University of British Columbia; Vancouver Canada
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23
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Tang Q, Song P, Mei L, Xu L, Tang W. Epidemiological research, scientific research, and applied research on rare diseases in China: current challenges and prospects for the future. Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2017.1259065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Qi Tang
- School of Public Health, Shandong University, Shandong, China
- Department of Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Peipei Song
- Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa-shi, Chiba, Japan
| | - Lin Mei
- School of Public Health, Shandong University, Shandong, China
| | - Lingzhong Xu
- School of Public Health, Shandong University, Shandong, China
| | - Wei Tang
- School of Public Health, Shandong University, Shandong, China
- Department of Surgery, The University of Tokyo Hospital, Tokyo, Japan
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Peña-Romero AG, Domínguez-Cherit J, Saeb-Lima M. Recurrent extramammary Paget's disease with an unusual histopathological finding. Int J Dermatol 2015; 54:e267-9. [PMID: 25784537 DOI: 10.1111/ijd.12794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 04/12/2014] [Accepted: 06/05/2014] [Indexed: 11/26/2022]
Affiliation(s)
| | - Judith Domínguez-Cherit
- Department of Dermatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México D.F, México
| | - Marcela Saeb-Lima
- Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México D.F, México
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Abstract
Extramammary Paget's disease is uncommon. Diagnosis has to be confirmed by histopathology. Treatment is a challenge in cases with extended tumors. We present a 70-year-old male patient with extensive genitoanal Paget's disease. Mohs surgery is the gold standard in such cases. Details of the surgical planning are discussed including wound bed preparation. Radiotherapy may be an alternative.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital, Friedrichstadt, Dresden, Germany
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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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