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Li HM, Huang TY, Chang TH, Wen TN. Paget's disease of the nipple with underlying occult invasive carcinoma detected by magnetic resonance imaging and second-look ultrasound: Case report. Int J Surg Case Rep 2024; 114:109139. [PMID: 38100925 PMCID: PMC10762364 DOI: 10.1016/j.ijscr.2023.109139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Paget's disease of the nipple (PDN) is a rare and often misdiagnosed condition characterized by the infiltration of adenocarcinoma cells into the nipple epidermis. It poses substantial diagnostic and therapeutic challenges due to its similarity to benign dermatological conditions and its association with in situ or invasive carcinoma. CASE PRESENTATION This report details the case of a 47-year-old woman with persistent nipple itching, rash, and occasional bloody discharge. No abnormalities were seen on the mammogram and ultrasound scans; punch biopsy was performed to confirm PDN. A small lesion missed by other imaging methods was detected via breast magnetic resonance imaging (MRI). A second-look ultrasound with needle localization enabled precise surgery. The pathology report after breast-conserving surgery (BCS) revealed invasive ductal carcinoma with no metastasis in the sentinel lymph node biopsy. DISCUSSION PDN often mimics benign skin conditions, leading to delayed diagnosis. Furthermore, timely identification is crucial as PDN is frequently associated with underlying breast malignancies. Additional imaging, such as breast MRI, is essential for comprehensive evaluation, as it can reveal hidden lesions previously undetected by conventional mammography and ultrasound. A second-look ultrasound guided needle placement for tumor localization, enhancing surgical precision, aesthetics, and reducing patient harm. Surgical management, including mastectomy, BCS with radiotherapy, and oncoplastic surgery, offers suitable options without affecting recurrence or survival in selected patients. CONCLUSION This case emphasizes the importance of employing additional imaging tools, such as breast MRI and second-look ultrasound for the early detection and surgical management of PDN.
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Affiliation(s)
- Hao-Ming Li
- Department of Surgery, Taoyuan Armed Forced General Hospital, Taoyuan City, Taiwan; Department of Surgery, Hsinchu Branch, Taipei Veterans General Hospital, Hsinchu County, Taiwan
| | - Tzu-Yu Huang
- Department of Pathology, Hsinchu Branch, Taipei Veterans General Hospital, Hsinchu County, Taiwan
| | - Tsun-Hou Chang
- Department of Radiology, Hsinchu Branch, Taipei Veterans General Hospital, Hsinchu County, Taiwan
| | - Tzu-Ning Wen
- Department of Nursing, Fu Jen Catholic University, New Taipei City, Taiwan.
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Younes B, Zakaria B, Meriem N, Benhessou M, Ennachit S, El Karroumi M. Extensive Paget's disease of the nipple: Case report. Int J Surg Case Rep 2023; 109:108586. [PMID: 37531879 PMCID: PMC10400464 DOI: 10.1016/j.ijscr.2023.108586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 08/04/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Paget's disease of the nipple is a rare form of ductal carcinoma in situ. It is often associated with an underlying breast cancer or, more rarely, may be isolated with no associated breast neoplasm. PRESENTATION OF CASE We report the case of a patient with extensive Paget's disease of the nipple without associated breast lesions, treated by mastectomy with coverage by a dorsalis major flap. CLINICAL DISCUSSION The association of Paget's disease of the nipple with breast cancer is the most frequent situation, requiring a complete radiological work-up of the breast. The diagnosis is confirmed by anatomopathological examination combined with immunohistochemistry, the treatment of Paget's disease of the nipple remains controversial, with conservative or radical treatment depending on the extent of the disease and the presence or absence of associated breast cancer. CONCLUSION Paget's disease of the nipple is a rare form of breast cancer. Treatment relies mainly on surgery, which can be either conservative or radical.
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Affiliation(s)
- Bencherifi Younes
- Onco-gynecological Surgery Center, University Hospital Center Ibn Rochd Casablanca, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco.
| | - Bousada Zakaria
- Onco-gynecological Surgery Center, University Hospital Center Ibn Rochd Casablanca, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco
| | - Nouri Meriem
- Onco-gynecological Surgery Center, University Hospital Center Ibn Rochd Casablanca, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco
| | - Mustapha Benhessou
- Onco-gynecological Surgery Center, University Hospital Center Ibn Rochd Casablanca, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco
| | - Simohamed Ennachit
- Onco-gynecological Surgery Center, University Hospital Center Ibn Rochd Casablanca, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco
| | - Mohammed El Karroumi
- Onco-gynecological Surgery Center, University Hospital Center Ibn Rochd Casablanca, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco
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Donval L, Thibault L, Langer A, Oufkir N, Rouzier R, Bonneau C. Borrelial lymphocytoma of the breast: A rare differential diagnosis of breast cancer. J Gynecol Obstet Hum Reprod 2023; 52:102502. [PMID: 36379351 DOI: 10.1016/j.jogoh.2022.102502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/30/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Lou Donval
- Department of Surgery, Institut Curie, 35, rue Dailly, Saint-Cloud 92210, France
| | - Lucie Thibault
- Pathology department, Institut Curie, 26 Rue d'Ulm, Paris 75005, France
| | - Adriana Langer
- Department of Radiology, Institut Curie, 35, rue Dailly, Saint-Cloud 92210, France
| | - Nina Oufkir
- Department of Surgery, Institut Curie, 35, rue Dailly, Saint-Cloud 92210, France; INSERM U900, Biostatistics for Personalized Medicine, Institut Curie, Saint-Cloud, France
| | - Roman Rouzier
- Department of Surgery, Institut Curie, 35, rue Dailly, Saint-Cloud 92210, France
| | - Claire Bonneau
- Department of Surgery, Institut Curie, 35, rue Dailly, Saint-Cloud 92210, France; INSERM U900, Biostatistics for Personalized Medicine, Institut Curie, Saint-Cloud, France.
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Wani S, Daroszewska A, Salter DM, van ‘t Hof RJ, Ralston SH, Albagha OME. The Paget's disease of bone risk gene PML is a negative regulator of osteoclast differentiation and bone resorption. Dis Model Mech 2022; 15:dmm049318. [PMID: 35229101 PMCID: PMC9066519 DOI: 10.1242/dmm.049318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/21/2022] [Indexed: 01/08/2023] Open
Abstract
Paget's disease of bone (PDB) is characterized by focal increases in bone remodelling. Genome-wide association studies identified a susceptibility locus for PDB tagged by rs5742915, which is located within the PML gene. Here, we have assessed the candidacy of PML as the predisposing gene for PDB at this locus. We found that the PDB-risk allele of rs5742915 was associated with lower PML expression and that PML expression in blood cells from individuals with PDB was lower than in controls. The differentiation, survival and resorptive activity of osteoclasts prepared from Pml-/- mice was increased compared with wild type. Furthermore, the inhibitory effect of IFN-γ on osteoclast formation from Pml-/- was significantly blunted compared with wild type. Bone nodule formation was also increased in osteoblasts from Pml-/- mice when compared with wild type. Although microCT analysis of trabecular bone showed no differences between Pml-/- mice and wild type, bone histomorphometry showed that Pml-/- mice had high bone turnover with increased indices of bone resorption and increased mineral apposition rate. These data indicate that reduced expression of PML predisposes an individual to PDB and identify PML as a novel regulator of bone metabolism. This article has an associated First Person interview with the first author of the paper.
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Affiliation(s)
- Sachin Wani
- Rheumatology and Bone Disease Unit, Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Anna Daroszewska
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK
| | - Donald M. Salter
- Rheumatology and Bone Disease Unit, Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Rob J. van ‘t Hof
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK
- Vanthof Scientific, Torun 87-100, Poland
| | - Stuart H. Ralston
- Rheumatology and Bone Disease Unit, Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Omar M. E. Albagha
- Rheumatology and Bone Disease Unit, Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, P.O. Box 34110, Qatar
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Shin DW, Bae J, Ha J, Lee WM, Jung KW. Trends in incidence and survival of patients with vulvar cancer in an Asian country: Analysis of the Korean Central Cancer Registry 1999-2018. Gynecol Oncol 2021; 164:386-392. [PMID: 34893346 DOI: 10.1016/j.ygyno.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To report 20-year trends in incidence and survival of vulvar cancer in Korea. METHODS Using data from the Korean Central Cancer Registry, age-standardized incidence rates (ASRs) and annual percentage changes (APCs) were calculated. Net survival (NS) was estimated by the Pohar-Perme method, and conditional net survival (CNS) was calculated. RESULTS A total of 2221 patients was diagnosed with vulvar cancer during the 1999-2018 period, with an ASR of 0.32 per 100,000 person-years. Among the cases, 51.4% were squamous cell carcinoma (SqCC), 21.3% were Paget disease, and 8.6% were basal cell carcinoma (BCC). There was an increase in incidence for all vulvar cancer (APC 2.4%, 95% CI 1.8-3.0). However, although BCC (APC 7.0%, 95% CI 3.3-10.8) and Paget disease (APC 5.9%, 95% CI 4.2-7.6) increased, SqCC did not (APC 0.2%, 95% CI -0.8-1.2). There was an increase in incidence in all age groups. The 5Y NS was 74.0% overall, and it did not improve significantly during the study period. The 5Y CNS of vulvar cancer increased continuously with time survived: from 74.0% (71.4-76.4) at baseline to 98.1% (95% CI, 85.4-99.8) at 5 years after diagnosis. CONCLUSIONS The incidence of vulvar cancer in Korea showed a different pattern from those in the US and Europe: SqCC incidence was relatively low and remained stable, but the incidence of BCC and Paget's disease increased. Survival did not improve in the past two decades. Patients can be considered cured after surviving for 5 years.
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Affiliation(s)
- Dong Wook Shin
- Supportive Care Center/Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jaeman Bae
- Department of Obstetrics and Gynecology, Hanyang University, College of Medicine, Seoul, Republic of Korea
| | - Johyun Ha
- The Korea Central Cancer Registry, National Cancer Center, Goyang, Republic of Korea; Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Won Moo Lee
- Department of Obstetrics and Gynecology, Hanyang University, College of Medicine, Seoul, Republic of Korea.
| | - Kyu-Won Jung
- The Korea Central Cancer Registry, National Cancer Center, Goyang, Republic of Korea; Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea.
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Salih AM, Hammood ZD, Kakamad FH, Othman S, Ali RK, Latif S. Paget's disease of the breast in male with underlying invasive ductal carcinoma: A case report with review of literature. Ann Med Surg (Lond) 2021; 72:103035. [PMID: 34820122 PMCID: PMC8599100 DOI: 10.1016/j.amsu.2021.103035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 11/14/2022] Open
Abstract
Introduction Paget's disease of the breast is a rare cutaneous eczema-like condition that occurs in the nipple-areolar complex of the breast. The current study aims to report a rare case of Paget's disease of the breast associated with invasive ductal carcinoma in a male breast. Case report A 54-year-old male presented with ulceration of the left nipple-areolar complex that has been progressing over the last 6 months. On examination; there was a palpable axillary lymph node. On ultrasound, a small hypoechoic heterogenous mass was seen beneath the areola (8*4 mm) with surrounding vascularity, and a few axillary lymph nodes with normal morphology and cortical thickness. The mammography revealed some points of calcification arranged in clusters. The patient underwent left side mastectomy and sentinel lymph node biopsy. The result of histopathological examination showed left side unifocal invasive ductal carcinoma. Discussion There are two main theories that explain the histogenesis of Paget's disease of the breast with and without underlying malignancy: epidermotropic theory, which suggests an epidermal infiltration of the nipple with Paget cells, and transformative theory, which proposes a malignant transformation of normal glandular cells of the epidermis. Conclusion The clinical presentation of Paget's disease of the breast is characteristic and should always warn the surgeon of the possibility of underlying malignancy. Paget's disease of the breast (or nipple) is a very rare cutaneous entity. Paget's disease of the male breast is an extremely rare clinicopathologic condition. Breast cancer in male is likewise very rare.
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Affiliation(s)
- Abdulwahid M Salih
- Department of Surgery, College of Medicine, University of Sulaimani, Sulaimani, Iraq.,Smart Health Tower, Madam Mittarand Str., Sulaimani, Iraq
| | | | - Fahmi H Kakamad
- Department of Surgery, College of Medicine, University of Sulaimani, Sulaimani, Iraq.,Smart Health Tower, Madam Mittarand Str., Sulaimani, Iraq.,Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Iraq
| | - Snur Othman
- Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Iraq
| | - Razhan K Ali
- Department of Cardiothoracic Surgery, Shar Hospital, Sulaimani, Iraq
| | - Shaban Latif
- Smart Health Tower, Madam Mittarand Str., Sulaimani, Iraq
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Goto W, Kashiwagi S, Kawano Y, Komoda A, Ishihara S, Asano Y, Morisaki T, Hirakawa K, Ohira M. Pathological Complete Response following Neoadjuvant Chemotherapy in Invasive Ductal Carcinoma with Mammary Paget's Disease: A Case Report. Case Rep Oncol 2021; 14:1242-1247. [PMID: 34703442 PMCID: PMC8460882 DOI: 10.1159/000516762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/14/2021] [Indexed: 11/19/2022] Open
Abstract
Mammary Paget's disease is a rare malignancy. Mastectomy or breast-conserving surgery has been considered as the standard treatment, while there have been few reports of neoadjuvant chemotherapy (NAC). A 53-year-old woman with erythema and skin ulceration of the left breast was admitted to our institution. Breast examinations revealed left invasive ductal carcinoma (cT1bN0M0, cStage I), and a punch biopsy of the left mammary erythema indicated Paget's disease (cTisN0M0, cStage0). The patient received NAC because of multiple lesions. Consequently, the breast tumor clinically disappeared, and the erythema improved. These outcomes made it easier to perform surgery (left mastectomy and sentinel node biopsy). Histopathological examination revealed no residual cancer cells in either the mammary gland or breast skin, and no metastasis was found in the sentinel lymph node. Therefore, NAC may be a useful treatment for mammary Paget's disease.
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Affiliation(s)
- Wataru Goto
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinichiro Kashiwagi
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yuko Kawano
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Asuka Komoda
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Sae Ishihara
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yuka Asano
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tamami Morisaki
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kosei Hirakawa
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.,Department of Gastrointestinal Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masaichi Ohira
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.,Department of Gastrointestinal Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Gnangnon FHR, Souaibou YI, Gbessi DG, Agbo TMG, Dossou FM, Méhinto DK. Surgical management of erosive adenomatosis of the nipple: A case report. Int J Surg Case Rep 2021; 86:106234. [PMID: 34500249 PMCID: PMC8430389 DOI: 10.1016/j.ijscr.2021.106234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/17/2021] [Accepted: 07/20/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction and importance Known as a very uncommon disease, erosive adenomatosis of the nipple is a benign neoplasm of the breast. However, its destructive process can have a considerably negative impact on patient's quality of life. Case presentation We report the case of a 45-year-old woman who presented at the visceral surgery department of the National Teaching Hospital of Cotonou-Benin (CNHU-HKM) for a burgeoning mass of the left nipple. She was diagnosed an erosive adenomatosis of the nipple and underwent a nipple resection with reconstruction. Clinical discussion Erosive adenomatosis is one differential diagnosis for lesion of the nipple. Clinically, it should be discussed with malignant nipple tumours including Paget's disease. Conclusion Surgery is the cornerstone of the treatment, and the prognosis is excellent. Erosive adenomatosis of the nipple (EAN) is a rare benign neoplasm of the breast. Clinically, it should always be discussed with malignant nipple tumours including Paget's disease Surgery (nipple resection) is the cornerstone of the management Tissue sparing techniques are advocated for women of childbearing age The prognosis is excellent.
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Affiliation(s)
| | - Yacoubou Imorou Souaibou
- Department of Visceral Surgery, National Teaching Hospital-Hubert Koutoukou Maga, Cotonou, Benin
| | - Dansou Gaspard Gbessi
- Department of Visceral Surgery, National Teaching Hospital-Hubert Koutoukou Maga, Cotonou, Benin
| | - Tiani Marie Gaston Agbo
- Department of Visceral Surgery, National Teaching Hospital-Hubert Koutoukou Maga, Cotonou, Benin
| | - Francis Moïse Dossou
- Department of General Surgery, University Regional Hospital of Ouémé-Plateau, Porto-Novo, Benin
| | - Delphin Kuassi Méhinto
- Department of Visceral Surgery, National Teaching Hospital-Hubert Koutoukou Maga, Cotonou, Benin
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D'Ambrosi R, Ballini L, Valli F, Guarino S, Rubino M, Ursino N. Bilateral Cemented Custom-Made Total Hip Arthroplasty in Paget's Disease with Femoral Cortical Thickening and Canal Narrowing. Joints 2021; 7:222-227. [PMID: 34235390 PMCID: PMC8253607 DOI: 10.1055/s-0041-1730381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 04/19/2021] [Indexed: 11/09/2022]
Abstract
In this report, we present a case of a 57-year-old man complaining of pain in both his hips. Clinically, the patient reported lameness and reduction in the range of motion of the hips. Radiographic imaging showed a very narrow medullary femoral canal, confirmed by a computed tomography scan. In consideration of the narrowness of the femoral canal and cortex thickening, and due to the rarity of the clinical case, we opted to use a custom-made prosthesis. We performed total hip arthroplasty, initially on the right side. One year later, we repeated the procedure on the left side. One year after the last surgery, the patient reported well-being and continuous improvement in walking, with no complications. This case report highlights the features and the critical issues related to this kind of surgery in patients affected by Paget's disease of the bone and the importance of custom-made implants in challenging cases.
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Affiliation(s)
| | - Luca Ballini
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
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10
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Li FZ, Ye Q, Ran LW, Fang S. Adipophilin expression in skin lesions with clear cell histology. J Clin Pathol 2021; 75:627-631. [PMID: 33952590 DOI: 10.1136/jclinpath-2021-207443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/02/2021] [Accepted: 04/22/2021] [Indexed: 12/11/2022]
Abstract
AIMS Clear cells formed due to depositions of glycogen or lipids in the cytoplasm commonly occur in various tissues. Adipophilin (ADP), a lipid regulatory protein, is closely related to lipid droplets. This study aims to examine adipophilin expression in clear cells of various skin lesions. METHODS ADP expression was examined using immunohistochemistry in 108 sections from 15 skin lesion types with clear cell histology, namely, sebaceoma (n=16), sebaceous adenoma (n=3), sebaceous carcinoma (n=12), xanthomata cutis (n=10), xanthogranuloma (n=8), Paget's disease (n=10), Bowen disease (n=10), hidradenoma (n=9), atypical lipoma (n=5), superficial lipomatous nevus (n=5), metastatic renal cell carcinoma (n=5), squamous cell carcinoma (n=4), seborrheic keratosis (n=4), dermatofibroma (n=4) and clear cell sarcoma (n=3). RESULTS ADP was not expressed in Bowen disease, hidradenoma or seborrheic keratosis. Four expression patterns, foamy, reticular, granular and punctate, were summarised based on their expression in clear cells. Different expression patterns were related to tissue origin and differentiation degree. Foamy expression was commonly observed in lesions with mature sebaceous glands and xanthomas; reticular expression in adipocytes; granular expression in xanthoma, xanthogranuloma and metastatic renal carcinoma and punctate expression in sebaceoma, sebaceous carcinoma, Paget's disease, squamous cell carcinoma and clear cell sarcoma. Furthermore, stronger staining with focal vesicular labelling was noted in sebaceoma than in sebaceous carcinoma. Characteristic labelling was noted, including the circular distribution in Touton giant cells of xanthogranulomas and focal distribution in the clear cells along the edge of necrotic tissue in clear cell sarcoma. CONCLUSIONS ADP is useful in identifying intracytoplasmic lipids and can be used to diagnose skin lesions with clear cell histology, especially in some lesions with characteristic labelling.
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Affiliation(s)
- Feng-Zeng Li
- Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qian Ye
- Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li-Wei Ran
- Dermatology, Beijing Chaoyang Hospital Jingxi Branch, Beijing, China
| | - Sheng Fang
- Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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11
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Griepp DW, Sajan A, Sighary M. Diffuse Paget's Disease of the Skull with Intense Uptake of Technetium-99m-Labeled Diphosphonate Tracer in Bone Scintigraphy. World Neurosurg 2021; 151:89-90. [PMID: 33940269 DOI: 10.1016/j.wneu.2021.04.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/21/2021] [Indexed: 11/17/2022]
Abstract
Imaging in patients with Paget's disease of bone is very important clinically to show the presence of Pagetic abnormalities, assess disease progression, and identify adversely affected structures throughout disease course. Abnormalities and progression may be seen on radiographs, computed tomography, magnetic resonance imaging, and nuclear imaging. Herein, we report a case Paget's disease of bone showing diffuse characteristic pathology using technetium-99m-labelled diphosphonate tracer in bone scintigraphy (nuclear imaging). This case emphasizes the ability of nuclear imaging to rapidly visualize and assess progressive distribution of Pagetic involvement in a patient previously diagnosed with pituitary adenoma and mild Paget's disease of the skull.
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Affiliation(s)
- Daniel W Griepp
- College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, New York, USA; Department of Radiology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Abin Sajan
- Department of Surgery, NYU Langone Hospital-Long Island, Mineola, New York, USA.
| | - Maziar Sighary
- Department of Radiology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
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12
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Abstract
Two early observations about the first generation bisphosphonate, clodronate, suggested that it would likely have clinical utility; specifically, it was a more potent anti-resorptive but a less potent inhibitor of mineralisation than its predecessor etidronate. The known mechanism of action differs from that of the later nitrogen-containing bisphosphonates, as clodronate is metabolised intracellularly to a toxic analog of adenosine triphosphate, AppCCl2p, which causes mitochondrial dysfunction, impaired cellular energy metabolism and osteoclast apoptosis. For pre-clinical studies in a variety of disease models, liposomal clodronate has become the agent of choice for macrophage depletion, for example in a recent study to enhance haematopoietic chimerism and donor-specific skin allograft tolerance in a mouse model. For clinical use, clodronate was developed in oral and injectable formulations; while poorly absorbed from the gastro-intestinal tract, its absorption at 1-3% of the administered dose is approximately three-fold higher than for nitrogen-containing bisphosphonates. Following an early setback due to an erroneous association with toxic adverse events, a number of successful clinical studies have established clodronate, predominantly in its oral formulations, as a highly successful treatment in Paget's disease, hypercalcaemia (benign and malignant), multiple myeloma, and early or metastatic breast cancer. Novel uses in other disease areas, including veterinary use, continue to be explored.
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Affiliation(s)
- Eugene McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK; Centre for Integrated Research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK.
| | | | - Trevor Powles
- Cancer Centre London, 49 Parkside, Wimbledon, London SW19 5NB, UK
| | - John A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK; Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
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13
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Dauendorffer JN, Herms F, Baroudjian B, Basset-Seguin N, Cavelier-Balloy B, Fouéré S, Bagot M, Lebbé C. Penoscrotal Paget's disease. Ann Dermatol Venereol 2021; 148:71-76. [PMID: 33461789 DOI: 10.1016/j.annder.2020.08.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/12/2020] [Accepted: 08/31/2020] [Indexed: 10/22/2022]
Abstract
Paget's disease (PD) denotes an initially intra-epidermal adenocarcinoma that can later invade the dermis and metastasise. Among the extramammary forms of PD (EMPD), penoscrotal presentations are rarer than the vulvar and perianal forms. Once diagnosis has been confirmed by histopathological examination, a search for associated neoplasia must be conducted, although penoscrotal EMPD is less frequently associated with underlying neoplasia than mammary PD (MPD). The associated cancer most often involves a neighbouring organ, with prostate cancer being the most common, or in some cases consists of underlying cutaneous adnexal tumours. First-line therapy consists of surgical excision. Alternatives to surgery (imiquimod, CO2 laser vaporisation, dynamic phototherapy) may be considered in certain cases.
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Affiliation(s)
| | - F Herms
- Department of Dermatology, Hôpital Saint-Louis, Paris, France
| | - B Baroudjian
- Department of Dermatology, Hôpital Saint-Louis, Paris, France
| | - N Basset-Seguin
- Department of Dermatology, Hôpital Saint-Louis, Paris, France
| | | | - S Fouéré
- Department of Dermatology, Hôpital Saint-Louis, Paris, France
| | - M Bagot
- Department of Dermatology, Hôpital Saint-Louis, Paris, France
| | - C Lebbé
- Department of Dermatology, Hôpital Saint-Louis, Paris, France
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14
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Chiorean A, Pintican RM, Szep M, Feier D, Rogojan L, Fetica B, Dindelegan G, Vlad B, Duma M. Nipple Ultrasound: A Pictorial Essay. Korean J Radiol 2020; 21:955-966. [PMID: 32677380 PMCID: PMC7369201 DOI: 10.3348/kjr.2019.0831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/07/2020] [Accepted: 03/09/2020] [Indexed: 11/15/2022] Open
Abstract
Ultrasound (US) is an attractive diagnostic approach to identify both common and uncommon nipple pathologies, such as duct ectasia, nipple abscess, nipple leiomyoma, nipple adenoma, fibroepithelial polyp, ductal carcinoma in situ (restricted to nipple), invasive carcinoma, and Paget's disease. US is the reliable first-line imaging technique to assess nipple pathologies. It is useful to identify and characterize nipple lesions. Additionally, we have presented the mammography and MRI outcomes correlated with histopathologic features for the relevant cases.
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Affiliation(s)
- Angelica Chiorean
- Department of Radiology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Medimages Breast Center, Cluj-Napoca, Romania
| | - Roxana Maria Pintican
- Department of Radiology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Radiology and Medical Imaging, County Clinical Emergency Hospital, Cluj-Napoca, Romania.
| | - Madalina Szep
- Department of Radiology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Medimages Breast Center, Cluj-Napoca, Romania
| | - Diana Feier
- Department of Radiology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Medimages Breast Center, Cluj-Napoca, Romania
| | - Liliana Rogojan
- Department of Pathology, County Clinical Emergency Hospital, Cluj-Napoca, Romania
| | - Bogdan Fetica
- Department of Pathology, County Clinical Emergency Hospital, Cluj-Napoca, Romania.,Department of Pathology, Ion Chiricuţă, Oncology Institute, Cluj-Napoca, Romania
| | - George Dindelegan
- Department of Surgery, County Clinical Emergency Hospital, Cluj-Napoca, Romania
| | - Bura Vlad
- Department of Radiology and Medical Imaging, County Clinical Emergency Hospital, Cluj-Napoca, Romania
| | - Magdalena Duma
- Department of Radiology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Medimages Breast Center, Cluj-Napoca, Romania.,Department of Radiology, Micromedica Clinic, Piatra Neamt, Romania
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15
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Senthil R, Gangadharan VP, Ramachandran Nair AV, Mahadevan P, Pratap T. 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography in Malignant Transformation of Paget's Disease of Bone. Indian J Nucl Med 2020; 35:362-363. [PMID: 33642771 PMCID: PMC7905288 DOI: 10.4103/ijnm.ijnm_99_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 11/04/2022] Open
Abstract
Malignant transformation Paget's disease of bone to sarcoma is relatively rare, occurring in approximately 1% of these patients. Although few clinical and imaging findings may help in prediction of malignant transformation, most of them are nonspecific. We describe a case of carcinoma vocal cord and Paget's disease of bone with sarcomatous transformation, where 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography was helpful in accurate diagnosis by demonstrating differential intense FDG uptake in transformed areas of pagetic bone and also FDG-avid osteoblastic pulmonary metastasis.
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Affiliation(s)
- Raja Senthil
- Department of Nuclear Medicine and PET/CT, VPS Lakeshore Hospital, Kochi, Kerala, India
| | | | | | - Pushpa Mahadevan
- Department of Pathology, VPS Lakeshore Hospital, Kochi, Kerala, India
| | - Thara Pratap
- Department of Radiology, VPS Lakeshore Hospital, Kochi, Kerala, India
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16
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Abstract
The first clinical use of bisphosphonates was in Paget's disease of bone (PDB) when disodium etidronate was found to be effective at suppressing metabolic activity of the disease. Subsequently, PDB became a testing ground for many bisphosphonates using changes in alkaline phosphatase (ALP) as the primary outcome measure in clinical trials. Bisphosphonates are now considered to be the treatment of choice for PDB since they are highly effective at suppressing the elevations in bone turnover that are characteristic of the disease. Short term studies have shown that treatment with alendronate and risedronate can promote formation of lamellar bone in affected sites and improve x-ray appearances in some patients. Bisphosphonates have also been shown to improve bone pain in PDB and within the bisphosphonates, zoledronic acid (ZA) is most likely to give a favourable pain response. Many patients with PDB do not have pain however, even when there is increased metabolic activity and more research is needed to find out why this is the case. The effects of bisphosphonates on complications of PDB such as deformity, pathological fractures and deafness have not been adequately studied since most clinical trials have been short term and have not collected information on these important outcomes. The PRISM and PRISM-EZ studies investigated the long-term effects of bisphosphonates in patients with established PDB using a treat-to-target approach and showed that intensive bisphosphonate therapy aimed at normalising ALP was no more effective than symptom directed treatment with bisphosphonates at preventing complications of PDB. The Zoledronate in the Prevention of Paget's Disease (ZiPP) trial, which is currently in progress, seeks to determine whether early intervention with this potent bisphosphonate might be effective in preventing disease progression. Should the ZiPP study yield positive results, genetic testing coupled to prophylactic bisphosphonate therapy might represent a new indication for these highly effective inhibitors of bone resorption in future years.
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Affiliation(s)
- Stuart H Ralston
- Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh EH4 2XU, UK.
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17
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Carton I, Lebreton M, Tesson C, Henno S, Lavoué V, Levêque J, Nyangoh-Timoh K. Paget's disease of the vulva: A challenge for the gynaecologist. J Gynecol Obstet Hum Reprod 2020; 50:101896. [PMID: 32828871 DOI: 10.1016/j.jogoh.2020.101896] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/11/2020] [Accepted: 08/17/2020] [Indexed: 01/09/2023]
Abstract
Paget's disease of the vulva is a rare form of extramammary Paget's disease mainly affecting postmenopausal women. Its pathophysiology remains largely unknown. Up to fairly recently, the only treatment for this disease was surgery, often mutilating the vulva, with significant psychosexual repercussions without the assurance of complete therapeutic efficacy. New therapeutic approaches -topical treatments, radiotherapy or chemotherapy- have emerged in recent years but lack consensual guidelines. We present a literature review of the recent results published in this field.
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Affiliation(s)
- I Carton
- Department of Obstetrics, Gynecology and Human Reproduction, CHU Anne De Bretagne, Rennes, France
| | - M Lebreton
- Department of Obstetrics, Gynecology and Human Reproduction, CHU Anne De Bretagne, Rennes, France
| | - C Tesson
- Department of Obstetrics, Gynecology and Human Reproduction, CHU Anne De Bretagne, Rennes, France
| | - S Henno
- Department of Pathological Anatomy and Cytology, CHU Pontchaillou, Rennes, France
| | - V Lavoué
- Department of Obstetrics, Gynecology and Human Reproduction, CHU Anne De Bretagne, Rennes, France
| | - J Levêque
- Department of Obstetrics, Gynecology and Human Reproduction, CHU Anne De Bretagne, Rennes, France.
| | - K Nyangoh-Timoh
- Department of Obstetrics, Gynecology and Human Reproduction, CHU Anne De Bretagne, Rennes, France
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18
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Reid IR, Green JR, Lyles KW, Reid DM, Trechsel U, Hosking DJ, Black DM, Cummings SR, Russell RGG, Eriksen EF. Zoledronate. Bone 2020; 137:115390. [PMID: 32353565 DOI: 10.1016/j.bone.2020.115390] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/16/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023]
Abstract
Zoledronate is the most potent and most long-acting bisphosphonate in clinical use, and is administered as an intravenous infusion. Its major uses are in osteoporosis, Paget's disease, and in myeloma and cancers to reduce adverse skeletal related events (SREs). In benign disease, it is a first- or second-line treatment for osteoporosis, achieving anti-fracture efficacy comparable to that of the RANKL blocker, denosumab, over 3 years, and it reduces fracture risk in osteopenic older women. It is the preferred treatment for Paget's disease, achieving higher rates of remissions which are much more prolonged than with any other agent. Some trials have suggested that it reduces mortality, cardiovascular disease and cancer, but these findings are not consistent across all studies. It is nephrotoxic, so should not be given to those with significant renal impairment, and, like other potent anti-resorptive agents, can cause hypocalcemia in patients with severe vitamin D deficiency, which should be corrected before administration. Its most common adverse effect is the acute phase response, seen in 30-40% of patients after their first dose, and much less commonly subsequently. Clinical trials in osteoporosis have not demonstrated increases in osteonecrosis of the jaw or in atypical femoral fractures. Observational databases are currently inadequate to determine whether these problems are increased in zoledronate users. Now available as a generic, zoledronate is a cost-effective agent for fracture prevention and for management of Paget's disease, but wider provision of infusion facilities is important to increase patient access. There is a need to further explore its potential for reducing cancer, cardiovascular disease and mortality, since these effects could be substantially more important than its skeletal actions.
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Affiliation(s)
- Ian R Reid
- Department of Medicine, University of Auckland, Auckland, New Zealand.
| | | | | | - David M Reid
- School of Medicine, Dentistry and Nutrition, University of Aberdeen, UK
| | | | | | - Dennis M Black
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Steven R Cummings
- San Francisco Coordinating Center, Sutter Health Research, San Francisco, CA, USA; Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - R Graham G Russell
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK; Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - Erik F Eriksen
- Department of Clinical Medicine, University of Oslo, Oslo, Norway
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19
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Abstract
Herein we review the discovery, development, commercial history and legacy of risedronate or NE-58095, a potent N-containing bisphosphonate developed by scientists at the Cincinnati Miami Valley Laboratories and the Norwich Eaton Laboratories of Procter and Gamble. It is characterized by a hydroxyl substituent (R1) and a pyridyl-methylene substituent (R2) at the carbon bridging two phosphonate moieties. It was shown to have greater potency than alendronate in cell-based systems while binding affinity to bone matrix was lower than alendronate, accounting for the relatively rapid offset of bone turnover inhibition when therapy is discontinued. Risedronate was shown to significantly reduce serum alkaline phosphatase and clinical features in patients with Paget's disease and was approved for this indication, at a dose of 30 mg daily for 2 months, in 1998. Formal dose response testing for treatment of osteoporosis was not performed. In large Phase 3 studies, 5 mg risedronate daily increased bone mineral density more than did the 2.5 mg dose. As a result, the 2.5 mg dose was dropped from most of the Phase 3 studies after 12 months. The 5 mg daily dose was approved for treating and preventing postmenopausal osteoporosis and glucocorticoid-induced osteoporosis in 2000. The drug was subsequently approved for treating men with osteoporosis. Following the leads of other companies, weekly and monthly preparations were developed and approved, based on non-inferiority BMD studies vs the 5 mg daily oral dose as was a unique dosing regimen of 75 mg given on 2 consecutive days each month. Finally, to overcome the effect of food on limiting the already poor gastrointestinal absorption of the drug, a once-weekly oral preparation containing the chelating agent EDTA and with an enteric coating delaying dissolution until the tablet was in the small intestine was approved in 2010 to be administered after breakfast. The Alliance for Better Bone Health, a collaboration between Procter & Gamble Pharmaceuticals and sanofi-aventis U.S. was formed to market risedronate as Actonel® and, subsequently, Actonel-EC® or Atelvia®. These drugs are still marketed by sanofi-aventis in some countries. The sale of the pharmaceutical division of Procter & Gamble to Warner Chilcott (US) was based, in large part, on the perceived value and marketability of the risedronate drugs. When marketing targets of Warner-Chilcott were not met, the rights of risedronate were sold to Allergan USA, Inc. which never actively promoted the drug. Generic forms of risedronate were introduced into the United States in 2015 but are rarely used, although several generic forms are actively marketed in other countries.
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Affiliation(s)
- Michael R McClung
- Oregon Osteoporosis Center, Portland, OR, United States of America; Mary MacKillop Center for Health Research, Australian Catholic University, Melbourne, VIC, Australia.
| | - Frank H Ebetino
- Chemistry Department, University of Rochester, Rochester, NY, United States of America; BioVinc, Pasadena, CA, United States of America
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20
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Watts NB, Chesnut CH, Genant HK, Harris ST, Jackson RD, Licata AA, Miller PD, Mysiw WJ, Richmond B, Valent D. History of etidronate. Bone 2020; 134:115222. [PMID: 31911206 DOI: 10.1016/j.bone.2020.115222] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 12/19/2019] [Accepted: 01/02/2020] [Indexed: 11/20/2022]
Abstract
Etidronate is a non-nitrogen-containing bisphosphonate. Because it binds with calcium and inhibits crystal formation and dissolution, it was considered by Procter & Gamble as an additive to toothpaste (to prevent build-up of tartar) and detergent (to bind calcium and increase sudsing in "hard" water). The first clinical use (1968) was for fibrodysplasia ossificans progressiva. The first approved clinical use (1977) was for treatment of Paget's disease of bone. Other approved indications are hypercalcemia of malignancy and heterotopic ossification, with a host of off-label uses (including fibrous dysplasia, periodontal disease, multiple myeloma, neuropathic arthropathy, pulmonary microlithiasis, diabetic retinopathy, bone metastases, melorheostosis, urinary stone disease, periodontal disease, etc.). Unique among bisphosphonates, etidronate (oral therapy) results in hyperphosphatemia, increased tubular reabsorption of phosphorus and increased levels of 1,25-dihydroxyvitamin D. The dose that reduces bone resorption is close to the dose that impairs mineralization; prolonged high-dose use can result in osteomalacia and bone fractures. Intermittent cyclic etidronate for osteoporosis resulted in favorable changes in bone density and histomorphometry (no mineralization defect) as well as a decrease in vertebral fracture rates in postmenopausal women with osteoporosis. Later studies showed similar effects in men with osteoporosis and patients with glucocorticoid-induced osteoporosis. Although its use for osteoporosis has given way to newer bisphosphonates and other agents, because of its unique properties, it remains the bisphosphonate of choice for treatment of heterotopic ossification.
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Affiliation(s)
- Nelson B Watts
- Mercy Health Osteoporosis and Bone Health Services, 4760 E. Galbraith Rd, Suite 212, Cincinnati, OH 45236, USA.
| | - Charles H Chesnut
- Departments of Radiology and Medicine, University of Washington Medical Center, Seattle, Washington USA 98195; Department of Medicine, University of Washington Medical Center, Seattle, WA 98195, USA.
| | - Harry K Genant
- Departments of Radiology, Medicine and Orthopedic Surgery, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA; Department of Medicine, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA; Department of Orthopedic Surgery, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Steven T Harris
- Department of Medicine, University of California, San Francisco, 1635 Divisadero St., Suite 525, San Francisco, CA 94115-3044, USA.
| | - Rebecca D Jackson
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, The Ohio State University, 376 West Tenth Ave, Suite 260 Prior Hall, Columbus, OH 43210, USA.
| | - Angelo A Licata
- Department of Endocrinology, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA.
| | | | - W Jerry Mysiw
- Department of Physical Medicine and Rehabilitation, 480 Medical Center Drive, 1018 Dodd Hall, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
| | - Bradford Richmond
- Department of Radiology, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44194, USA.
| | - David Valent
- Procter & Gamble Pharmaceuticals, 8700 Mason Montgomery Road, Mason, OH 45040, USA.
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21
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Papapoulos SE. Pamidronate: A model compound of the pharmacology of nitrogen-containing bisphosphonates; A Leiden historical perspective. Bone 2020; 134:115244. [PMID: 31958532 DOI: 10.1016/j.bone.2020.115244] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 11/30/2022]
Abstract
Pamidronate [3-amino-1-hydroxypropylidene-1,1-bisphosphonate (APD)] was the first nitrogen-containing bisphosphonate (N-BP) investigated in clinical studies. In contrast to other clinically used bisphosphonates, pamidronate was discovered and its properties were initially studied in an Academic Institution. On the occasion of the 50th Anniversary of the first publications on the biological effects of bisphosphonates, I review in this article the contribution of Leiden investigators to the development of pamidronate that led to the recognition of the significance of the Nitrogen atom in the side chain of bisphosphonates for their action on bone resorption and to the formulation of principles for the use of N-BPs in the management of patients with different skeletal disorders.
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Affiliation(s)
- Socrates E Papapoulos
- Center for Bone Quality, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, the Netherlands.
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22
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Kuźnik A, Październiok-Holewa A, Jewula P, Kuźnik N. Bisphosphonates-much more than only drugs for bone diseases. Eur J Pharmacol 2019; 866:172773. [PMID: 31705903 DOI: 10.1016/j.ejphar.2019.172773] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/23/2019] [Accepted: 11/01/2019] [Indexed: 12/22/2022]
Abstract
α,α-Bisphosphonates (BPs) are well established in the treatment of bone diseases such as osteoporosis and Paget's disease. Their successful application originates from their high affinity to hydroxyapatite. While the initially appreciated features of BPs are already beneficial to many patients, recent developments have further expanded their pleiotropic applications. This review describes the background of the interactions of BPs with bone cells that form the basis of the classical treatment. A better understanding of the mechanism behind their interactions allows for the parallel application of BPs against bone cancer and metastases followed by palliative pain relief. Targeted therapy with bone-seeking BPs coupled with a diagnostic agent in one particle resulted in theranostics which is also described here. For example, in such a system, BP moieties are bound to contrast agents used in magnetic resonance imaging or radionuclides used in positron emission tomography. In addition, another example of the pleiotropic function of BPs which involves targeting the imaging agents to bone tissues accompanied by pain reduction is presented in this work.
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Affiliation(s)
- Anna Kuźnik
- Department of Organic and Bioorganic Chemistry and Biotechnology, Silesian University of Technology, B. Krzywoustego 4, 44-100, Gliwice, Poland; Biotechnology Center of Silesian University of Technology, B. Krzywoustego 8, 44-100, Gliwice, Poland.
| | - Agnieszka Październiok-Holewa
- Department of Organic and Bioorganic Chemistry and Biotechnology, Silesian University of Technology, B. Krzywoustego 4, 44-100, Gliwice, Poland; Biotechnology Center of Silesian University of Technology, B. Krzywoustego 8, 44-100, Gliwice, Poland
| | - Pawel Jewula
- Central European Institute of Technology, Brno University of Technology, Purkyňova 656/123, 612-00, Brno, Czech Republic
| | - Nikodem Kuźnik
- Department of Organic and Bioorganic Chemistry and Biotechnology, Silesian University of Technology, B. Krzywoustego 4, 44-100, Gliwice, Poland
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23
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Abstract
Paget’s disease is a condition which continues to challenge and surprise. The dramatic fall in its incidence over the last three decades has been an enormous surprise, as is the capacity of a single infusion of the potent bisphosphonate, zoledronate, to produce biochemical remission in 90% of patients, remissions which usually persist for many years and raise the possibility of a cure in some patients. However, challenges in its management remain. The trials carried out in Paget’s disease have almost always had biochemical indices as their primary endpoints. From these studies, we also know that bone pain is relieved, quality of life improved, bone histology normalised, and radiological lesions healed. Thus, disease progression is halted. Studies have not been powered to assess whether clinically important endpoints such as fracture and the need for joint replacement surgery are diminished, although these complications are well established as part of the natural history of the condition. Since disease progression is prevented by potent bisphosphonates, it is likely that disease complications will also be prevented. Zoledronate also reduces the frequency of follow-up needed and therefore provides a very cost-effective intervention in those who have symptomatic disease or are at risk of complications.
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Affiliation(s)
- Ian R Reid
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, 1142, New Zealand.,Auckland District Health Board, Auckland, 1142, New Zealand
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24
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Hamzah JL, Ong KW, Tan BY. Isolated invasive ductal carcinoma of the nipple-areolar complex: A rare occurrence yet to be reported in current literature. Breast J 2019; 25:706-708. [PMID: 31172621 DOI: 10.1111/tbj.13308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 10/24/2018] [Indexed: 11/27/2022]
Abstract
Invasive ductal carcinoma of the nipple-areolar complex is exceedingly rare. Patients who present with bloody nipple discharge with or without the presence of Paget's disease constitute one-third of all symptomatic in situ patients. Only rarely does an invasive cancer cause nipple discharge in the absence of a clinical mass. Even more obscure is the case of the invasive cancer involving solely the nipple-areolar complex. Sir James Paget first described 'an eczematous change in the skin of the nipple preceding an underlying mammary cancer' in 1874, which is now known as Paget's disease, considered to be ductal carcinoma in situ of the nipple-areolar region. There are two competing theories as to the pathogenesis of Paget's disease of the breast-one suggests that Pagetoid cells are keratinocytes that have undergone malignant transformation. According to this theory, Paget's disease of the breast represents an in situ carcinoma of the skin-and that overlying skin changes and underlying malignancy are discontinuous. The second theory suggests that cells migrate along basement membranes and enter the epidermis and dermis of the nipple-areola complex. Pagetoid cells and underlying carcinomas demonstrate similar immunohistochemical staining patterns.
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Affiliation(s)
- Julie Liana Hamzah
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Kong Wee Ong
- Department of Surgical Oncology, National Cancer Centre, Singapore, Singapore
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25
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Wang W, Feng W, Li D, Liu S, Gao Y, Zhao Z, Fu Q, Yan L, Zheng W, Li M, Zheng X. Fusion and hemagglutinin proteins of canine distemper virus promote osteoclast formation through NF-κB dependent and independent mechanisms. Exp Cell Res 2019; 378:171-181. [PMID: 30880029 DOI: 10.1016/j.yexcr.2019.03.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/25/2019] [Accepted: 03/11/2019] [Indexed: 11/24/2022]
Abstract
Paget's disease (PD) features abnormal osteoclasts (OC) which sharply increase in number and size and then intensely induce bone resorption. The purpose of this study was to determine the direct effects of canine distemper virus (CDV) and its fusion protein and hemagglutinin protein (F + H) on receptor activator of nuclear factor kappa-B ligand (RANKL) induced OC formation in vitro. Immunofluorescence assay, OC morphological and functional detection, intracellular signaling pathway detection, Real-time PCR analysis and ELISA were applied in this study. Immunofluorescence assay provided the conclusive proof that CDV can infect and replicate in RAW264.7 mouse monocyte cell line, primary human peripheral blood mononuclear cells (PBMC) and their further fused OC. Both CDV and F + H significantly promoted OC formation and bone resorption ability induced by RANKL. Meanwhile, intracellular signaling transduction analysis revealed CDV and F + H specifically upregulated the phosphorylation of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) and mitogen-activated protein kinase (MAPK) induced by RANKL, respectively. Furthermore, without RANKL stimulation, both CDV and F + H slightly induced OC-like cells formation in RAW264.7 cell line even in the presence of NF-κB inhibitor. F + H upregulate OC differentiation and activity through modulation of NF-κB signaling pathway, and induce OC precursor cells merging dependent on the function of glycoproteins themselves. These results meant that F and H proteins play a pivotal role in CDV supporting OC formation. Moreover, this work further provide a new research direction that F and H proteins in CDV should be considered as a trigger during the pathogenesis of PD.
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Affiliation(s)
- Wei Wang
- Department of Bone Metabolism, School of Stomatology Shandong University, Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Jinan, China
| | - Wei Feng
- Department of Endodontics, Jinan Stomatological Hospital, Jinan, China
| | - Dongfang Li
- Department of Bone Metabolism, School of Stomatology Shandong University, Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Jinan, China
| | - Shanshan Liu
- Department of Bone Metabolism, School of Stomatology Shandong University, Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Jinan, China
| | - Yuan Gao
- Department of Bone Metabolism, School of Stomatology Shandong University, Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Jinan, China
| | - Zhongxin Zhao
- School of Public Health, Shandong University, Jinan, China
| | - Qianyun Fu
- School of Public Health, Shandong University, Jinan, China
| | - Lina Yan
- School of Public Health, Shandong University, Jinan, China
| | - Wenwen Zheng
- School of Public Health, Shandong University, Jinan, China
| | - Minqi Li
- Department of Bone Metabolism, School of Stomatology Shandong University, Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Jinan, China.
| | - Xuexing Zheng
- School of Public Health, Shandong University, Jinan, China.
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26
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Abstract
Paget's disease of the vulva is a rare intraepithelial neoplasm, accounting for <5% of all vulvar lesions. The underlying mechanisms of this disease are still poorly understood, however, diagnosing a Pagetoid lesion early is of prime importance as it may forewarn an underlying systemic malignancy. We discuss the case of an elderly female who was being conservatively treated for infectious lesion of the lower urinary tract and vulva for months. She was subsequently confirmed on histopathology with vulvar Paget's and underlying urothelial carcinoma, with the help of an extensive panel of immunohistochemistry.
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Affiliation(s)
- Anurag Mehta
- Departments of Laboratory Services, Rajiv Gandhi Cancer Institute and Research Center, New Delhi, India
| | - Poojan Agarwal
- Departments of Laboratory Services, Rajiv Gandhi Cancer Institute and Research Center, New Delhi, India
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27
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Abstract
Paget's disease of bone is a focal disorder of bone remodelling that progresses slowly and leads to changes in the shape and size of affected bones and to skeletal, articular and vascular complications. In some parts of the world it is the second most common bone disorder after osteoporosis though in recent years its prevalence and severity appear to decrease. The disease is easily diagnosed and effectively treated but its pathogenesis remains incompletely understood.
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28
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Mai R, Zhou S, Zhou S, Zhong W, Hong L, Wang Y, Lu S, Pan J, Huang Y, Su M, Crawford R, Zhou Y, Zhang G. Transcriptome analyses reveal FOXA1 dysregulation in mammary and extramammary Paget's disease. Hum Pathol 2018; 77:152-158. [PMID: 29630912 DOI: 10.1016/j.humpath.2017.12.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 12/10/2017] [Accepted: 12/15/2017] [Indexed: 02/05/2023]
Abstract
Paget's disease (PD) is an uncommon intraepithelial adenocarcinoma with unknown pathogenesis. There are two anatomic subtypes: mammary (MPD) and extramammary (EMPD). Little is known about their molecular characteristics. Our objective was to discover novel molecular markers for PD and its subtypes. In the discovery phase, we used transcriptome analyses to uncover the most differentially expressed genes and pathways in EMPD biopsies compared with normal skin. In the validation phase, we performed immunohistochemistry analyses on the most promising marker (FOXA1) and other markers selected from a literature review (GATA3, estrogen receptor [ER], and androgen receptor [AR]) on independent biopsies of MPD (n = 86), EMPD (n = 59), and normal skin (n = 21). Transcriptome analyses revealed 210 genes differentially expressed more than 10-fold between EMPD and normal skin. These genes are involved in mammary and sweat gland development (FOXA1) and immune regulation, as well as epidermal differentiation. Immunohistochemistry staining revealed that FOXA1 was positive in 88% of both MPD and EMPD, whereas GATA3 was positive in 67% of MPD and 77% of EMPD, and ER was positive in 9% of MPD and 19% of EMPD. Finally, AR was positive in 33% of PD and 54% of EMPD. Mammary Paget's disease and EMPD share dysregulation of the glandular developmental regulator gene FOXA1, suggesting similarity in cell-specific transcriptional regulation. Further, FOXA1 may be a useful molecular target for developing PD therapies.
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Affiliation(s)
- Ruiqin Mai
- Department of Laboratory Medicine, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515031, China
| | - Songxia Zhou
- Department of Pathology, Shantou University Medical College, Shantou, Guangdong, 515041
| | - Shuqin Zhou
- Department of Anesthesiology, the First People's Hospital of Kashi, Kashi, Xinjiang, 844000, China
| | - Weixiang Zhong
- Department of Pathology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310006, China
| | - Liangli Hong
- Department of Pathology, the First Affiliated Hospital of Shantou University Medical College, 515031
| | - Yuanyuan Wang
- Department of Pathology, Shantou Central Hospital and the Affiliated Shantou Hospital of Sun Yat-Sen University, Shantou, Guangdong, 515041
| | - Shanming Lu
- Department of Pathology, Meizhou Central Hospital, Meizhou, Guangdong, 514786
| | - Jikai Pan
- Department of Pathology, Shantou Hospital of Dermatology, Shantou, Guangdong, 515031
| | - Yuansheng Huang
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, V5Z 1L8, Canada
| | - Mingwan Su
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, V5Z 1L8, Canada
| | - Richard Crawford
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, V5Z 1L8, Canada
| | - Youwen Zhou
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, V5Z 1L8, Canada
| | - Guohong Zhang
- Department of Pathology, Shantou University Medical College, Shantou, Guangdong, 515041; Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, V5Z 1L8, Canada.
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29
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Campolongo MG, Cabras M, Bava L, Arduino PG, Carbone M. Paget's disease of jaw bones as primary manifestation: A case report of a proper diagnosis made by general dentist. Gerodontology 2018; 35:147-150. [PMID: 29733536 DOI: 10.1111/ger.12328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To present a case of early diagnosis mandibular Paget's disease of bone (PDB), recognised by a general dentist. BACKGROUND PDB is responsible of rapid bone resorption and disorganised bone formation. MATERIALS AND METHODS The patient was a 72-year-old female patient complaining of dental malposition and blatant prognathism. CONCLUSION Clinicians should consider PDB in differential diagnosis for an elderly patient undergoing unexplained alteration in face profile and occlusion.
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Affiliation(s)
- Martin G Campolongo
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
| | - Marco Cabras
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
| | | | - Paolo G Arduino
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
| | - Mario Carbone
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
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30
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Abstract
BACKGROUND Paget's disease of the breast is rare, even more so when it occurs in a supernumerary breast since diagnosis is delayed due to lack of exploration and ignorance of the pathology of ectopic breast. Based on an original clinical case, we provide a clinical update concerning ectopic breast and ectopic carcinoma, including Paget's disease. PATIENTS AND METHODS A 44-year-old woman had complained of pain in the area of her supernumerary breast for several months. The ultrasound examination was normal but the unexplained symptoms led to performance of an excision biopsy of the lesion. This showed strictly intra-epidermal Paget's disease measuring 2mm, without any underlying carcinoma. A wider excision was performed. Follow-up at one year showed no recurrence. DISCUSSION An ectopic breast, present in 6 % of the population, is often ignored, despite being subject to the same diseases as anatomical breasts: it is at the origin of 0.6 % of breast cancers. Paget's disease is a rare in situ adenocarcinoma comprising fewer than 3 % of cases of breast cancer. It is extremely rare in ectopic breast. Ours is only the fourth reported case in the literature. This case is original because of the lack of objective clinical signs. Subjective symptoms such as pain, tingling, burning sensation and pruritus related to the supernumerary breast must be taken into consideration in order to enable early diagnosis of Paget's disease. Exploration by ultrasound and mammography generally appears flawed. Breast MRI may be useful but is not performed routinely. A promising future approach may consist of confocal microscopy screening of all ectopic breasts with areola or nipple patches, since this method enables the visualization of Paget cells and their organization.
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Affiliation(s)
- M-H Jegou
- Cabinet de dermatologie, 8, rue Jules-Ferry, 33290 Blanquefort, France.
| | - E Lorier-Roy
- Cabinet de dermatologie, 16, rue Balard, 75015 Paris, France
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31
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Zach F, Polzer F, Mueller A, Gessner A. p62/sequestosome 1 deficiency accelerates osteoclastogenesis in vitro and leads to Paget's disease-like bone phenotypes in mice. J Biol Chem 2018; 293:9530-9541. [PMID: 29555685 DOI: 10.1074/jbc.ra118.002449] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 03/09/2018] [Indexed: 11/06/2022] Open
Abstract
The sequestosome 1 gene encodes the p62 protein and is the major genetic risk factor associated with Paget's disease of bone. In 2004, p62 was reported to up-regulate osteoclast differentiation by activating the transcription factors Nfatc1 and NF-κB. Here, we characterized the osteoclastogenic potential of murine p62-/--derived cells compared with WT cells. Our data confirmed previous findings indicating that p62 is induced during murine osteoclast differentiation. Surprisingly, an indispensable role for p62 in in vitro osteoclast differentiation was not reproducible because p62-deficient osteoclasts exhibited robust activation of Nfatc1, NF-κB, and osteoclast marker enzymes. Thus, we concluded that in vitro osteoclast differentiation is not negatively influenced by knocking out p62. On the contrary, our results revealed that p62 deficiency accelerates osteoclastogenesis. Differentiation potential, multinucleation status, and soluble receptor activator of NF-κB ligand (sRANKL) sensitivity were significantly elevated in p62-deficient, murine bone marrow-derived stem cells. Moreover, femur ultrastructures visualized by micro-computed tomography revealed pronounced accumulation of adipocytes and trabecular bone material in distal femora of obese p62-/- mice. Increased tartrate-resistant acid phosphatase activity, along with increased trabecular bone and accumulation of adipocytes, was confirmed in both paraffin-embedded decalcified and methyl methacrylate-embedded nondecalcified bones from p62-/- mice. Of note, Paget's disease-like osteolytic lesions and increased levels of the bone turnover markers CTX-I and PINP were also observed in the p62-/- mice. Our results indicate that p62 predominantly suppresses murine in vitro osteoclast differentiation and highlight previously undetected Paget's disease-like phenotypes in p62-/- mice in vivo.
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Affiliation(s)
- Frank Zach
- From the Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Franziska Polzer
- From the Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Alexandra Mueller
- From the Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, 93053 Regensburg, Germany
| | - André Gessner
- From the Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, 93053 Regensburg, Germany
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32
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Abstract
Paget's disease is a chronic focal high turnover bone disorder that is primarily present in middle-aged or older adults. It seems to be restricted to humans and has no clear parallels with other diseases. Although much has been learnt about its pathology and epidemiology, and treatment is now highly effective we still lack a complete understanding of its etiology and biology. This review focusses on the natural history of the disorder, in particular its changing epidemiology, recent discoveries about its genetic basis and current approaches to diagnosis and treatment. While there is strong evidence for genetic predisposition to Paget's disease, there is also compelling evidence that it is becoming less prevalent, the age of patients at presentation is increasing and that the extent of skeletal involvement is diminishing, implying that there is an important, but as yet unidentified, environmental factor in its etiology. Contemporary patients are typically elderly and have few bones involved. Treatment with potent intravenous bisphosphonates provides prolonged remission and many will require only once in a lifetime treatment.
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Affiliation(s)
- Tim Cundy
- Department of Medicine, Faculty of Medical & Health Sciences, University of Auckland, New Zealand.
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33
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Tanaka T, Slavin J, McLachlan SA, Choong P. Anti-osteoclastic agent, denosumab, for a giant cell tumor of the bone with concurrent Paget's disease: A case report. Oncol Lett 2017; 13:2105-2108. [PMID: 28454368 PMCID: PMC5403716 DOI: 10.3892/ol.2017.5693] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 11/30/2016] [Indexed: 12/22/2022] Open
Abstract
Paget's disease of the bone may predispose the development of malignant bone tumors such as osteosarcoma. Giant cell tumor (GCT) as a consequence of Paget's disease is rare. Bone GCT is characterized by rapid growth, the destruction of bone, extension to the surrounding soft tissue and abnormal bone turnover caused by an abnormality of the receptor activator of nuclear factor-κB (RANK)-RANK ligand (RANKL) pathway. Denosumab is a RANK-RANKL inhibitor, which is used to treat osteoporosis and bone GCT. In the current study, a 60-year-old male presented with severe pain located between the right thigh and the knee. The patient could not bear weight on the affected leg. The patient had suffered from Paget's disease for 15 years. The complications from Paget's disease included degenerative hip disease, for which the patient underwent a right total hip replacement. A right periacetabular lesion was identified and confirmed as Paget's disease-induced GCT by needle biopsy. A positron emission tomography (PET) scan revealed significant tumor metabolic activity. Subsequent to obtaining informed consent, the patient started treatment with denosumab. A total of 2.5 months after starting denosumab, a PET scan showed no residual pathological uptake at the site of the previously identified large PET avid tumor. After 1 year, the patient exhibited a satisfactory clinical improvement. In conclusion, treatment with denosumab markedly reduced the size of the hemi-pelvic GCT and led to a complete metabolic response.
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Affiliation(s)
- Takaaki Tanaka
- Department of Orthopedics, St. Vincent's Hospital Melbourne, Fitzroy, Victoria 3065, Australia.,Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - John Slavin
- Department of Pathology, St. Vincent's Hospital Melbourne, Fitzroy, Victoria 3065, Australia
| | - Sue-Anne McLachlan
- Department of Oncology, St. Vincent's Hospital Melbourne, Fitzroy, Victoria 3065, Australia
| | - Peter Choong
- Department of Orthopedics, St. Vincent's Hospital Melbourne, Fitzroy, Victoria 3065, Australia.,Department of Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria 3065, Australia.,Bone and Soft Tissue Sarcoma Unit, Peter MacCallum Cancer Centre, East Melbourne, Victoria 3002, Australia
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34
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Jelin G, Grados F, Fardellone P, Goëb V. [A rare complication of Paget's disease]. Rev Med Interne 2018; 39:832-3. [PMID: 28131441 DOI: 10.1016/j.revmed.2016.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/17/2016] [Indexed: 11/22/2022]
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35
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Humphrey J, Pervez A, Walker R, Abbasian A, Singh S. Management of Paget's Disease of the Calcaneum. J Foot Ankle Surg 2017; 56:401-403. [PMID: 28089128 DOI: 10.1053/j.jfas.2016.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Indexed: 02/03/2023]
Abstract
The calcaneum is not the most common site for Paget's disease of bone, with only a few reports of monostotic involvement. We present 2 cases of Paget's disease of bone affecting the calcaneus, present an overview of the published data, and describe our management of these interesting cases.
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Affiliation(s)
- Joel Humphrey
- Orthopaedic Registrar, Orthopaedic Department, Guys' and St Thomas' National Health Services Foundation Trust, London, United Kingdom.
| | - Anum Pervez
- Foundation Year Trainee, Orthopaedic Department, Guys' and St Thomas' National Health Services Foundation Trust, London, United Kingdom
| | - Roland Walker
- Consultant Orthopaedic Surgeon, Orthopaedic Department, Guys' and St Thomas' National Health Services Foundation Trust, London, United Kingdom
| | - Ali Abbasian
- Consultant Orthopaedic Surgeon, Orthopaedic Department, Guys' and St Thomas' National Health Services Foundation Trust, London, United Kingdom
| | - Sam Singh
- Consultant Orthopaedic Surgeon, Orthopaedic Department, Guys' and St Thomas' National Health Services Foundation Trust, London, United Kingdom
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36
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Abstract
Biochemical markers of bone turnover (BTM) are released during bone remodeling and can be measured in blood or urine as noninvasive surrogate markers for the bone remodeling rate. The C-terminal cross-linked telopeptide of type I collagen (βCTX) is released during bone resorption and is specific to bone tissue. Assays have been developed to measure βCTX in blood and in urine; most current use of βCTX measurement for research and in clinical practice is performed on a blood sample. Method-specific differences for serum and plasma βCTX have led to initiatives to standardize or harmonize βCTX commercial assays. βCTX demonstrates significant biological variation due to circadian rhythm and effect of food which can be minimized by standardized sample collection in the fasting state in the morning. While βCTX predicts fracture risk independent of bone mineral density, lack of data has precluded its inclusion in fracture risk calculators. The changes seen in βCTX with antiresorptive therapies have been well characterized and this has led to its widespread use for monitoring therapy in osteoporosis. However, more fracture-based data on appropriate treatment goals for monitoring need to be developed. Evidence is lacking for the use of βCTX in managing "drug holidays" of bisphosphonate treatment in osteoporosis or risk stratifying those at increased risk of developing osteonecrosis of the jaw. βCTX is useful as an adjunct to imaging techniques for the diagnosis of Paget's disease of bone and for monitoring therapy and detecting recurrence. βCTX also shows promise in the management of metastatic bone disease.
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37
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Onaiwu CO, Salcedo MP, Pessini SA, Munsell MF, Euscher EE, Reed KE, Schmeler KM. Paget's disease of the vulva: A review of 89 cases. Gynecol Oncol Rep 2016; 19:46-49. [PMID: 28124023 PMCID: PMC5220256 DOI: 10.1016/j.gore.2016.12.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 12/26/2016] [Accepted: 12/27/2016] [Indexed: 12/17/2022] Open
Abstract
The purpose of this study was to retrospectively review the clinical characteristics and outcomes of a series of women with Paget's disease of the vulva. A retrospective review was performed of 89 women with Paget's disease of the vulva evaluated at a single institution between 1966 and 2010. Medical records were reviewed for demographic information, clinical data, pathologic findings, treatment modalities and outcomes. We found that the primary treatment was surgery for 74 (83.1%) patients, with positive margins noted in 70.1% of cases. Five patients (5.6%) underwent topical treatment with imiquimod and/or 5-fluorouracil, one patient (1.1%) underwent laser ablation and treatment was unknown in 9 patients (10.1%). The majority of patients had multiple recurrences, with 18% having four or more recurrences. There were no significant differences in recurrence rates between patients who underwent surgery and those who did not. Furthermore, there was no association between positive margins following primary surgery and recurrence. Forty-one patients (46.1%) were diagnosed with 53 synchronous or metachronous cancers. Seven patients (7.9%) were found to have invasive vulvar cancer with 1 mm or more depth of invasion, but none of the patients died of Paget's disease or associated vulvar/vaginal cancer. Our findings suggest that the majority of patients with Paget's disease of the vulva develop multiple recurrences regardless of treatment modality or margin status. Alternatives to surgery are needed to better care for women with this disease. Many recurrences were noted regardless of margin status following surgery for Paget's disease. 46% of the patients with Paget's disease had synchronous or metachronous cancers. None of the patients in our study died of Paget's disease or associated vulvar cancer. Alternatives to surgery are needed to improve outcomes in these patients.
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Affiliation(s)
- Cherry O Onaiwu
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Mila Pontremoli Salcedo
- The Department of Obstetrics & Gynecology, Federal University of Health Sciences/Irmandade Santa Casa de Misericordia, Porto Alegre, Brazil
| | - Suzana A Pessini
- The Department of Obstetrics & Gynecology, Federal University of Health Sciences/Irmandade Santa Casa de Misericordia, Porto Alegre, Brazil
| | - Mark F Munsell
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Elizabeth E Euscher
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | | | - Kathleen M Schmeler
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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38
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Shetty S, Shetty S, Prabhu AJ, Kapoor N, Hepzibah J, Paul TV. An unusual presentation of metastatic bone disease in a subject with Paget's disease of bone. J Family Med Prim Care 2016; 5:488-490. [PMID: 27843872 PMCID: PMC5084592 DOI: 10.4103/2249-4863.192326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Solid organ malignancies involving breast, prostate, and lung frequently metastasize to the skeleton. However, the occurrence of Paget's disease and metastatic bone disease in the same patient is uncommon. We report a case of a 63-year-old man who presented with back pain and a lump in the right breast. He was earlier diagnosed to have Paget's disease of bone based on characteristic skeletal radiological features,99mTc methylene diphosphonate bone scan and elevated alkaline phosphatase, and treated with bisphosphonates, and his disease was in remission. Further evaluation revealed an underlying skeletal metastatic disease secondary to a breast malignancy. He underwent radical mastectomy with axillary node clearance, radiotherapy, and chemotherapy. In addition, he also received parenteral bisphosphonates for his skeletal metastatic bone disease.
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Affiliation(s)
- Shrinath Shetty
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sahana Shetty
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Annie Jennifer Prabhu
- Department of General Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nitin Kapoor
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Julie Hepzibah
- Department of Nuclear Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Thomas Vizhalil Paul
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
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39
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Fernandez-Flores A, Saeb-Lima M. Mucin as a diagnostic clue in dermatopathology. J Cutan Pathol 2016; 43:1005-1016. [PMID: 27500958 DOI: 10.1111/cup.12782] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 09/22/2015] [Accepted: 08/01/2016] [Indexed: 01/19/2023]
Abstract
Mucins are high-molecular weight glycoproteins typically found in normal skin in small amounts. There are several reports regarding different types of cutaneous mucinosis. In this report, we discuss mucins in dermatopathology as a diagnostic clue of some well-known entities and some less frequent cutaneous diseases. We also emphasize mucin as a sign in the differential diagnosis between conditions that show histopathological overlap. Lastly, we discuss the locations and circumstances in which mucin could be considered almost normal or physiological.
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Affiliation(s)
| | - Marcela Saeb-Lima
- Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, INER/CIENI, Hospital Angeles Lomas, Centro Medico ABC, Mexico City, Mexico
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40
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Leelavathi M, Norazirah MN, Nur Amirah AP. Multiple concurrent primary extramammary Paget's disease. Malays Fam Physician 2016; 11:18-21. [PMID: 28461844 PMCID: PMC5405328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Extramammary Paget's disease (EMPD) is a rare malignant disorder of the skin, which was described in as early as the nineteenth century. EMPD usually occurs as a single lesion in the apocrine sweat gland-bearing skin with abundant hair follicles. Here, we present an elderly man who suffered from a non-resolving chronic genital pruritus for 8 months. Initially, he was managed for recurrent fungal infection and eczema. Later, a diagnosis of the rare condition multiple primary EMPD was made based on the histopathology findings and appropriate treatment was given.
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Affiliation(s)
- M Leelavathi
- MMed (Fam Med) Department of Family Medicine, Faculty of Medicine, 14 th Floor, Pre-clinical Block, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia.
| | - M N Norazirah
- MBBCh(Cardiff) MRCP, ADVM Derm Dermatology Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - A P Nur Amirah
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center Kuala Lumpur, Malaysia
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Abstract
Pruritus ani is a common condition with many different potential causes. Because of this, it can be difficult to treat. It is important to identify and eliminate any inciting factors, which are often unintentional consequences of the patient's attempts to alleviate symptoms. If no reversible cause is found, simple measures with diet modification and perianal hygiene are tried before using topical medications or procedures.
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Affiliation(s)
- Parswa Ansari
- Hofstra North Shore-LIJ School of Medicine, Lenox Hill Hospital, New York
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42
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Wallace AN, Chang RO, Hsi AC, Jennings JW. Painful Pagetic vertebra palliated with percutaneous vertebral augmentation. Diagn Interv Imaging 2015; 97:269-72. [PMID: 26607735 DOI: 10.1016/j.diii.2015.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 09/15/2015] [Accepted: 09/16/2015] [Indexed: 10/22/2022]
Affiliation(s)
- A N Wallace
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, United States.
| | - R O Chang
- Washington University School of Medicine, Saint Louis, MO, United States
| | - A C Hsi
- Department of Pathology & Immunology, Division of Anatomic Pathology, Washington, University School of Medicine, Saint Louis, MO, United States
| | - J W Jennings
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, United States
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43
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Kamaleshwaran KK, Natarajan S, Shibu D, Malaikkal A, Shinto AS. Paget's disease of pelvis mimicking metastasis in a patient with lung cancer evaluated using staging and follow-up imaging with fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography. Indian J Nucl Med 2015; 30:151-3. [PMID: 25829736 PMCID: PMC4379677 DOI: 10.4103/0972-3919.152980] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Paget's disease of bone is a benign disease, of uncertain etiology, characterized by an accelerated turnover, that is, bone resorption and formation. Paget's disease may be present in up to 5% of the population, and the majority of cases are asymptomatic. We report the imaging findings of Paget's disease of pelvis discovered incidentally in patient with lung cancer evaluated by fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for staging. FDG PET-CT scan showed intense uptake in the right lung lower lobe primary and mediastinal lymph nodes. Furthermore, increased uptake noted in left hemipelvis suggestive of Paget's disease. He underwent follow-up FDG PET-CT after chemotherapy showed decrease in lung mass and mediastinal nodes. However, the uptake in left hemipelvis remains same confirming Paget's disease.
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Affiliation(s)
- Koramadai Karuppusamy Kamaleshwaran
- Department of Nuclear Medicine, PET/CT and Radionuclide Therapy, Comprehensive Cancer Care Centre, Kovai Medical Centre and Hospital Limited, Coimbatore, Tamil Nadu, India
| | - Sudhakar Natarajan
- Department of Medical Oncology, Comprehensive Cancer Care Centre, Kovai Medical Centre and Hospital Limited, Coimbatore, Tamil Nadu, India
| | - Deepu Shibu
- Department of Nuclear Medicine, PET/CT and Radionuclide Therapy, Comprehensive Cancer Care Centre, Kovai Medical Centre and Hospital Limited, Coimbatore, Tamil Nadu, India
| | - Anjali Malaikkal
- Department of Nuclear Medicine, PET/CT and Radionuclide Therapy, Comprehensive Cancer Care Centre, Kovai Medical Centre and Hospital Limited, Coimbatore, Tamil Nadu, India
| | - Ajit Sugunan Shinto
- Department of Nuclear Medicine, PET/CT and Radionuclide Therapy, Comprehensive Cancer Care Centre, Kovai Medical Centre and Hospital Limited, Coimbatore, Tamil Nadu, India
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44
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Abstract
Paget's disease of bone (PDB) is a progressive chronic disease of unknown etiology, manifested as initial increase in bone resorption, followed by a disorganized and excessive formation of bone, resulting in pain and skeletal deformities. Treatment of the disease primarily aims at reducing the altered bone turnover by pharmacotherapy, along with surgical intervention for deformed bones, to reduce morbidity and improve the quality of living. We present a case of PDB with craniofacial involvement in a 55-year-old female, diagnosed on the basis of clinical features, radiological assessment along with biochemical findings and histopathological report. Our management included medical treatment in the form of intravenous bisphosphonates which alleviated symptoms by reducing the abnormal bone activity, and normalized serum alkaline phosphatase. Patient morale, self-confidence and social acceptance were all boosted due to the surgical correction of the facial deformity.
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Affiliation(s)
- G Umamaheswari
- Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospital, Coimbatore, Tamil Nadu, India
| | - Anunay B Pangarikar
- Department of Dentistry, ESIC Medical College, Coimbatore, Tamil Nadu, India
| | - Vijay B Urade
- Consultant Oral and Maxillofacial Surgeon, Chandrapur, Maharashtra, India
| | - Prachi G Parab
- Consultant Periodontist and Oral Implantologist, Coimbatore, Tamil Nadu, India
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45
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Abstract
Paget's disease of bone is characterized by highly localized areas of increased bone resorption accompanied by exuberant, but aberrant new bone formation with the primary cellular abnormality in osteoclasts. Paget's disease provides an important paradigm for understanding the molecular mechanisms regulating both osteoclast formation and osteoclast-induced osteoblast activity. Both genetic and environmental etiologies have been implicated in Paget's disease, but their relative contributions are just beginning to be defined. To date, the only gene with mutations in the coding region linked to Paget's disease is sequestosome-1 (SQSTM1), which encodes the p62 protein, and these mutations lead to elevated cytokine activation of NF-B in osteoclasts but do not induce a "pagetic osteoclast" phenotype. Further, genetic mutations linked to Paget's appear insufficient to cause Paget's disease and additional susceptibility loci or environmental factors may be required. Among the environmental factors suggested to induce Paget's disease, chronic measles (MV) infection has been the most studied. Expression of the measles virus nucleocapsid gene (MVNP) in osteoclasts induces pagetic-like osteoclasts and bone lesions in mice. Further, mice expressing both MVNP in osteoclasts and germline mutant p62 develop dramatic pagetic bone lesions that were strikingly similar to those seen in patients with Paget's disease. Thus, interactions between environmental and genetic factors appear important to the development of Paget's disease. In this article we review the mechanisms responsible for the effects of mutant p62 gene expression and MVNP on osteoclast and osteoblast activity, and how they may contribute to the development of Paget's disease of bone.
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Affiliation(s)
- Deborah L Galson
- Department of Medicine/Hematology-Oncology, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
| | - G David Roodman
- Department of Medicine/Hematology-Oncology, Indiana University, Indianapolis IN, USA. ; Veterans Administration Medical Center, Indianapolis, IN, USA
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46
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Segers K, Glibert G, Callebaut J, Kevers L, Alcan I, Dachy B. Involvement of peripheral and central nervous systems in a valosin-containing protein mutation. J Clin Neurol 2014; 10:166-70. [PMID: 24829604 PMCID: PMC4017021 DOI: 10.3988/jcn.2014.10.2.166] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 04/09/2013] [Accepted: 04/10/2013] [Indexed: 12/12/2022] Open
Abstract
Background Inclusion-body myopathy with Paget's disease of the bone and frontotemporal dementia (IBMPFD) is a rare, late-onset autosomal disorder arising from missense mutations in a gene coding for valosin-containing protein. Case Report We report the case of a man carrying the previously described p.Arg159His mutation, who had an unusual axonal sensorimotor neuropathy as the first clinical manifestation of IBMPFD, and for whom diagnosis only became clear 8 years later when the patient developed frontotemporal dementia. Conclusions Peripheral neuropathy is a rare manifestation of IBMPFD. This underdiagnosed disorder should be considered when a patient develops dementia or has signs of Paget's disease.
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Affiliation(s)
- Kurt Segers
- Department of Neurology, The Brugmann University Hospital, Brussels, Belgium
| | - Gerald Glibert
- Department of Neurology, The Brugmann University Hospital, Brussels, Belgium
| | - Johan Callebaut
- Department of Neurology, Clinique Sainte-Anne Saint-Remi, Brussels, Belgium
| | - Luc Kevers
- Department of Neurology, Clinique Saint-Jean, Brussels, Belgium
| | - Ibrahim Alcan
- Department of Radiology, The Brugmann University Hospital, Brussels, Belgium
| | - Bernard Dachy
- Department of Neurology, The Brugmann University Hospital, Brussels, Belgium
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47
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Bachiller-Corral J, Díaz-Miguel C, Morales-Piga A. Monostotic Paget's disease of the femur: a diagnostic challenge and an overlooked risk. Bone 2013; 57:517-21. [PMID: 24001926 DOI: 10.1016/j.bone.2013.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 08/22/2013] [Accepted: 08/23/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Although radiological diagnosis of Paget's disease of bone (PD) is usually straightforward, monostotic cases may potentially raise specific problems which lead to performing invasive procedures. Therefore, the purpose of this study is to ascertain whether or not monostotic femoral Paget's disease (MFPD) presentation poses particular diagnostic difficulties which prompt excessive use of excisional biopsies. METHODS We retrospectively reviewed the medical records of 24 MFPD patients identified from a series of 412 patients; their clinical features were compared with those of the remaining 164 monostotic cases and the radiological images were systematically assessed. RESULTS When compared with the remaining monostotic cases, MFPD patients were more prone to having normal alkaline phosphatase levels (31.8% vs. 16.4%; 0.08) and a significantly higher percentage of patients have PD symptoms (75% vs. 51%; 0.02) and complain of bone pain (73.9% vs. 40.8%; 0.003). Six (25%) MFPD patients evidenced a fracture over the pagetic lesion. This incidence is higher than that of the monostotic cases of other locations (8.4%; p=0.02). The existence of PD lesion was not recognised initially in 10 cases and an excisional bone biopsy was performed in 7 (29%). One patient subsequently experienced a fracture through the biopsy site and another two experienced worsening of their previous bone pain. CONCLUSION The femur is a relatively common monostotic PD location which often causes diagnostic confusion, prompting a bone biopsy in many cases. Careful assessment of this lesion by X-ray examination may help attain an early appropriate diagnosis and avoidance of unnecessary surgical morbidity.
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48
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Abstract
Paget's disease of bone is a chronic bone remodeling disorder. Although most patients are asymptomatic, a variety of symptoms and complications may develop directly from bone involvement or secondarily due to compression by the expanded bone. It is usually diagnosed from radiological and biochemical abnormalities or in advanced cases it becomes clinically evident due to the expanded bone. We report a case of Paget's disease which was detected incidentally during evaluation of nephrolithiasis and polyarthritis but had normal radiographs and normal biochemical markers.
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Affiliation(s)
- Avs Anil Kumar
- Department of Nuclear Medicine, Command Hospital, Air Force, Bengaluru, India ; Department of Nuclear Medicine, Command Hospital, Kolkata, India
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49
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Abstract
Paget's disease is a rare form of breast cancer often associated with an underlying ductal carcinoma in situ or invasive cancer. A 47-year-old female patient presented with bleeding from the left nipple since 4 months. Imprint smears from the lesion showed pleomorphic malignant epithelial cells in singles and in small clusters, many of them containing dark brown cytoplasmic pigment granules. There was no palpable breast lump or axillary lymph node enlargement. Based on the physical examination and cytological features, a diagnosis of malignant melanoma with a differential of Paget's disease of the nipple was made. Biopsy showed features of Paget's disease and immunohistochemistry was positive for HER-2/neu, negative for HMB-45 and S-100, thus confirming the diagnosis. This case has been reported to emphasize the fact that Paget's cells can contain imbibed brown cytoplasmic pigment and should not be mistaken for melanoma cells on cytology smears.
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Affiliation(s)
- Br Vani
- Department of Pathology, ESIC Medical College and PGIMSR, Rajajinagar, Bangalore, India
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50
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Feldmeyer L, Kerl K, Kamarashev J, de Viragh P, French LE. Treatment of vulvar Paget disease with topical imiquimod: a case report and review of the literature. J Dermatol Case Rep 2012; 5:42-6. [PMID: 22187578 DOI: 10.3315/jdcr.2011.1073] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2011] [Accepted: 05/21/2011] [Indexed: 12/18/2022]
Abstract
BACKGROUND Extramammary Paget's disease is a cutaneous neoplasm that presents as erythematous crusted patches and plaques reminiscent of contact dermatitis or inverse psoriasis that can be a challenge to treat in a tissue-sparing manner. The most commonly involved site for this rare disorder is the anogenital region. Surgery is considered as the gold standard therapy. In the last years, the topical use of imiquimod cream in the treatment of this condition has been reported. MAIN OBSERVATIONS We present a case of a 59-year-old woman with primary extramammary Paget's disease of the vulva, in which a conservative approach to therapy was desired, and who underwent complete and stable remission with imiquimod cream. We also review the previous reports of patients with extramammary Paget's disease treated with imiquimod cream. CONCLUSIONS Imiquimod therapy may be an alternative for primary as well as recurring extramammary Paget's disease. Treatment-associated morbidity is minimal compared with other therapies, such as surgery which may be debilitating.
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Affiliation(s)
- Laurence Feldmeyer
- Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091 Zurich, Switzerland
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