1
|
Gearing PF, Devine M, Edmondson MJ, Concannon E, Sheikh R. Reconstruction of a Large Extramammary Paget Disease Pelvic Defect. Dermatol Surg 2024; 50:183-185. [PMID: 37669091 DOI: 10.1097/dss.0000000000003933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Affiliation(s)
- Peter F Gearing
- All authors are affiliated with the Department of Plastic & Reconstructive Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | | | | | | |
Collapse
|
2
|
Okumura M, Ogata D, Namikawa K, Takahashi A, Akiyama M, Yamazaki N. Functional preservation benefits of minimal surgery for extramammary Paget's disease. Exp Dermatol 2023; 32:1644-1650. [PMID: 37377183 DOI: 10.1111/exd.14866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/06/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023]
Abstract
As extramammary Paget's disease (EMPD) sometimes invades and metastasizes from the skin to the mucosa, radical surgical resection of these lesions is often difficult. The purpose of this study was to analyse the association between surgical margins and survival as well as the benefit of functional preservation over complete resection, in patients with EMPD. We retrospectively analysed 230 patients diagnosed with EMPD between 1969 and 2020. Patient and treatment characteristics were recorded. Since our centre is a specialized hospital and almost all patients were referred from other hospitals, we reviewed their referral letters. Prognostic factors and survival time were also analysed. Among 230 patients, 78 (33.9%) had positive margins. The presence of margin positive lesions increased the local recurrence rate but was not significantly correlated with survival. Of all the patients who had received a thorough explanation about the surgical procedure in the referring hospital, 43.8% were scheduled for surgeries that would result in functional impairment, and all of them had function-preserving surgeries at our hospital with a 10-year survival rate of 100%. Our result suggest that less invasive surgery preserves anogenital and urethral function may be an acceptable option for EMPD treatment.
Collapse
Affiliation(s)
- Mao Okumura
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Dai Ogata
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kenjiro Namikawa
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Akira Takahashi
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Masashi Akiyama
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoya Yamazaki
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| |
Collapse
|
3
|
Bencherifi Y, El Abbassi I, Amghar A, Ennachit M, Benhessou M, Elkarroumi M. Paget disease of de Vulva: About a rare case and a literature review. Int J Surg Case Rep 2023; 111:108870. [PMID: 37793235 PMCID: PMC10550582 DOI: 10.1016/j.ijscr.2023.108870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION Paget disease of de Vulva (PDV) is a rare neoplastic intraepithelial pathology. In the majority of cases, neoplastic proliferation remains intraepithelial and the prognosis is favorable. The standard treatment for Paget disease is surgical excision. We report the observation of a patient with extensive and recurrent vulvar Paget's disease which we treated with surgery. PRESENTATION OF CASE A 39-year-old single woman presented with itchy heterogeneous erythematous vulvar lesions suggestive of Paget disease. A biopsy confirmed the diagnosis of non-invasive Paget disease. Surgical excision of the lesions was realized, with the anatomopathological examination confirming the diagnosis. DISCUSSION MPV is often diagnosed late due to the absence of specific symptoms in its initial phase. Clinically, it manifests as an erythematous lesion or eczema. Immunohistochemistry plays a crucial role in the diagnosis of VPM, helping to distinguish the disease from other vulvar conditions. Vulvar MPV has recently been subdivided into two subtypes: type 1, which concerns primary vulvar lesions, and type 2, which concerns associated primary non-cutaneous adenocarcinomatous proliferations or pagetoid intraepithelial urothelial carcinomas. Surgery is considered the gold standard treatment for MPV. CONCLUSION PDV is a complex disease requiring appropriate diagnosis and management, with surgery as the main treatment, but other less invasive therapeutic options may be considered on a case-by-case basis. Prognostic factors play an important role in the choice of treatment and disease progression.
Collapse
Affiliation(s)
- Y Bencherifi
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Imane El Abbassi
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
| | - A Amghar
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - M Ennachit
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - M Benhessou
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - M Elkarroumi
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| |
Collapse
|
4
|
Cheng X, Zhang Q, Zhang W, Huang L, Sun J, Zhao L, Zhao Y, Tian C, Cheng W, Shao X, Wang Y, Gong X. Impact of combining photodynamic diagnosis with reflectance confocal microscopy, on tumor margin detection and surgical outcomes in patients with extramammary Paget disease. Indian J Dermatol Venereol Leprol 2023; 0:1-6. [PMID: 38031698 DOI: 10.25259/ijdvl_1011_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 06/29/2023] [Indexed: 12/01/2023]
Abstract
Background The recurrence rate of extramammary Paget disease after surgical resection is high due to the lesions' poorly delineated and unclear margins. Aims To evaluate the impact of non-invasive tumour margin detection via photodynamic diagnosis plus reflectance confocal microscopy on the surgical outcomes of patients with extramammary Paget disease. Methods Thirty-six patients with histopathologically confirmed primary extramammary Paget disease between January 2017 and June 2018 were included in this study. The skin lesion margins were preoperatively observed using the naked eye, photodynamic diagnosis, and reflectance confocal microscopy. An incision was made 0.5-2 cm from the outermost non-invasive detection marker line. The incision depth was more significant than the follicle level or the deepest level affected by the tumour in the biopsy specimens. After the skin lesions were removed, a pathological examination of the specimens was conducted to ensure clear margins to prevent tumour recurrence and metastases. Results A total of 166 good-quality tissue sections were selected from 36 patients. The tumour surfaces and deep margins were within the scope of resection. Six patients (6/36, 15.4%) experienced local recurrence 2-12 months postoperatively. One patient (1/36, 2.8%) had lymph node metastasis without local recurrence 36 months postoperatively and died 50 months postoperatively (1/36, 2.8%). Limitations This study is limited by the small patient population, especially the number of patients with mucous membrane involvement. Conclusion Using photodynamic diagnosis plus reflectance confocal microscopy to detect the margins of extramammary Paget disease lesions non-invasively reduces the postoperative tumour recurrence rate and is a valuable guide for tumour treatment.
Collapse
Affiliation(s)
- Xiaolei Cheng
- Department of Dermatology, Tianjin Union Medical Center, Hongqiao District, Tianjin, China
| | - Qian Zhang
- Departments of Dermatologic Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu Province, China
| | - Wei Zhang
- Dermatopathology, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu Province, China
| | - Liming Huang
- Departments of Dermatologic Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu Province, China
| | - Jia Sun
- Department of Dermatology, Xuecheng People's Hospital, Zaozhuang, Shandong Province, China
| | - Liang Zhao
- Departments of Dermatologic Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu Province, China
| | - Yan Zhao
- Department of Dermatology, Linyi People's Hospital, Linyi, Shandong Province, China
| | - Cuicui Tian
- Departments of Dermatologic Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu Province, China
| | - Wei Cheng
- Dermatopathology, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu Province, China
| | - Xuebao Shao
- Dermatopathology, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu Province, China
| | - Yan Wang
- Departments of Dermatologic Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu Province, China
| | - Xiangdong Gong
- Department of Epidemiology, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu Province, China
| |
Collapse
|
5
|
Müller CSL, Hauer N, Kofler K, Kofler L. [Micrographic controlled surgery in everyday dermatosurgery]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00105-023-05158-x. [PMID: 37249657 DOI: 10.1007/s00105-023-05158-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/31/2023]
Abstract
Micrographic controlled surgery (MCS) has become established in dermatosurgery in recent years and includes various methods to enable the histologically proven complete resection of malignant cutaneous tumors, while at the same time sparing tumor-free tissue in the immediate vicinity as much as possible. MCS is of great importance in the surgical treatment of cutaneous malignancies in so-called problem locations and aggressive tumor subtypes. Indications for MCS include basal cell carcinoma, cutaneous squamous cell carcinoma, Bowen's disease and Bowen's carcinoma, melanoma in chronic light-damaged skin with acral lentiginous melanoma, dermatofibrosarcoma protuberans (DFSP), and Merkel cell carcinoma. However, other tumor entities are also treated using MCS, such as extramammary Paget's disease and various cutaneous sarcomas. All procedures subsumed under MCS have in common the marking of the surgical specimen for topographical orientation, which provides assignment of remaining tumor remnants. Various methods of MCS (3D histology, the horizontal method or Mohs surgery) are presented in this article. Furthermore, this article aims to raise awareness of the possibilities and limitations of micrographically controlled surgery.
Collapse
Affiliation(s)
- Cornelia Sigrid Lissi Müller
- MVZ für Histologie, Zytologie und molekulare Diagnostik Trier GmbH, Wissenschaftspark Trier, Max-Planck-Str. 5 und 17, 54296, Trier, Deutschland.
- Medizinische Fakultät, Universität des Saarlandes, Kirrberger Str. 100, 66421, Homburg/Saar, Deutschland.
| | - Nina Hauer
- MVZ für Histologie, Zytologie und molekulare Diagnostik Trier GmbH, Wissenschaftspark Trier, Max-Planck-Str. 5 und 17, 54296, Trier, Deutschland
| | - Katrin Kofler
- Universitätshautklinik, Studienzentrum Operative Dermatologie, Eberhard-Karls-Universität Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
- skin + more MVZ GmbH, Holzmarkt 6, 88400, Biberach, Deutschland
| | - Lukas Kofler
- Universitätshautklinik, Studienzentrum Operative Dermatologie, Eberhard-Karls-Universität Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
- skin + more MVZ GmbH, Holzmarkt 6, 88400, Biberach, Deutschland
| |
Collapse
|
6
|
Clemente N, Ciavattini A, Valenti G, Zannier F, Di Giuseppe J, Delli Carpini G, Fichera M, Del Fabro A, Giorda G, Goteri G, Canzonieri V, Sopracordevole F. Extramammary Paget's Disease of the Vulva and Concomitant Premalignant/Malignant Vulvar Lesions: A Potential Challenge in Diagnosis and Treatment. Curr Oncol 2023; 30:959-966. [PMID: 36661722 PMCID: PMC9857742 DOI: 10.3390/curroncol30010073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
The aim of the present study was to evaluate the incidence of concomitant vulvar cancers or premalignant lesions in women surgically treated for extramammary Paget's disease of the vulva (EMPDV) through a multicenter case series. The medical records of all women diagnosed with and treated for EMPDV from January 2010 to December 2020 were retrospectively analyzed. Women with EMPDV and synchronous vulvar cancer, vulvar intraepithelial neoplasia (VIN) and/or lichen sclerosus (LS) at the histology report were included in the study. A total of 69 women eligible for the present study were considered. Concomitant vulvar lesions occurred in 22 cases (31.9%). A total of 11 cases of synchronous VIN (50%) and 14 cases (63.6%) of concomitant LS were observed. One patient (4.5%) had synchronous vulvar SCC (FIGO stage 1B). Women with EMPDV and concomitant premalignant/malignant vulvar lesions had a significantly higher rate of invasive EMPDV and wider lesions with an extravulvar involvement. The specific meaning of the association between EMPDV, VIN, SCC and LS remains unclear. The potential overlapping features between different vulvar lesions highlight the importance of dedicated gynecologists and pathologists in referral centers.
Collapse
Affiliation(s)
- Nicolò Clemente
- Gynecological Oncology Unit, Centro di Riferimento Oncologico—National Cancer Institute, IRCCS, 33081 Aviano, Italy
| | - Andrea Ciavattini
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, 60123 Ancona, Italy
| | - Gaetano Valenti
- Gynecological Oncology Unit, Centro di Riferimento Oncologico—National Cancer Institute, IRCCS, 33081 Aviano, Italy
- Unit of Gynecology and Obstetrics, Department of Women’s and Children’s Health, Umberto I Hospital, 94100 Enna, Italy
| | - Federica Zannier
- Pathology Unit, Centro di Riferimento Oncologico—National Cancer Institute, IRCCS, 33081 Aviano, Italy
- Pathology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Jacopo Di Giuseppe
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, 60123 Ancona, Italy
| | - Giovanni Delli Carpini
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, 60123 Ancona, Italy
| | - Mariasole Fichera
- Gynecological Oncology Unit, Centro di Riferimento Oncologico—National Cancer Institute, IRCCS, 33081 Aviano, Italy
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, 60123 Ancona, Italy
| | - Anna Del Fabro
- Gynecological Oncology Unit, Centro di Riferimento Oncologico—National Cancer Institute, IRCCS, 33081 Aviano, Italy
| | - Giorgio Giorda
- Gynecological Oncology Unit, Centro di Riferimento Oncologico—National Cancer Institute, IRCCS, 33081 Aviano, Italy
| | - Gaia Goteri
- Division of Pathological Anatomy, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, 60123 Ancona, Italy
| | - Vincenzo Canzonieri
- Pathology Unit, Centro di Riferimento Oncologico—National Cancer Institute, IRCCS, 33081 Aviano, Italy
- Department of Medical, Surgical, and Health Sciences, University of Trieste, 34127 Trieste, Italy
| | - Francesco Sopracordevole
- Gynecological Oncology Unit, Centro di Riferimento Oncologico—National Cancer Institute, IRCCS, 33081 Aviano, Italy
| |
Collapse
|
7
|
Kang I, Lee JH, Lee JI, Hong JS, Mo YW, Jung GY. Coexistence of condyloma acuminatum and extramammary Paget's disease on penis and scrotum: A rare case report. Medicine (Baltimore) 2022; 101:e31754. [PMID: 36397375 PMCID: PMC9666121 DOI: 10.1097/md.0000000000031754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
RATIONALE Extramammary Paget's disease (EMPD) is a rare skin cancer that commonly occurs in sites rich in apocrine glands, such as perineum, vulva, axilla, scrotum, and penis. On the other hand, condyloma acuminatum (CA; also referred to as anogenital warts) is a common benign neoplasm caused by human papillomavirus. Few cases of coexistent EMPD and CA have been reported because of the rarity of the condition. PATIENT CONCERNS AND DIAGNOSIS A 72-year-old man with a genital mass, which appeared to be composed of multiple papillomatous masses, was referred for surgical resection. The lesion was first noticed 6 months previously and grew rapidly. CO2 ablative laser therapy was performed twice at a primary clinic, but the mass recurred. INTERVENTION AND OUTCOMES Excisional biopsy revealed the presence of coexistent EMPD and CA. Additional wide excision was performed, and postoperative biopsy confirmed no residual tumor. Two years after surgery, no recurrence had occurred. LESSONS CA can co-occur with several types of skin malignancies, and a skin malignancy coexisting with CA is difficult to diagnose visually. Therefore, even if a skin lesion in the genital region is considered to be CA, we recommend punch biopsy before treatment because it can benefit prognosiss.
Collapse
Affiliation(s)
- Inho Kang
- Department of Plastic and Reconstructive Surgery, College of Medicine, Dongguk University, Gyeongju-si, Republic of Korea
| | - Joon Ho Lee
- Department of Plastic and Reconstructive Surgery, College of Medicine, Dongguk University, Gyeongju-si, Republic of Korea
| | - Jong Im Lee
- Pathology, College of Medicine, Dongguk University, Gyeongju-si, Republic of Korea
| | - Joon Shik Hong
- Department of Plastic and Reconstructive Surgery, College of Medicine, Dongguk University, Gyeongju-si, Republic of Korea
| | - Young Woong Mo
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gyu Yong Jung
- Department of Plastic and Reconstructive Surgery, College of Medicine, Dongguk University, Gyeongju-si, Republic of Korea
- * Correspondence: Gyu Yong Jung, Department of Plastic and Reconstructive Surgery, College of Medicine, Dongguk University, 87 Dongdae-ro, Gyeongju 38067, Republic of Korea (e-mail: )
| |
Collapse
|
8
|
Extramammary Paget's disease: Updates in the workup and management. Asian J Urol 2022; 9:451-459. [DOI: 10.1016/j.ajur.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/26/2022] [Accepted: 08/16/2022] [Indexed: 11/22/2022] Open
|
9
|
ZENG D, LONG H, MA D, ZENG X, SU X, HUANG Y, ZHU S, ZHU B. Extramammary Paget's disease: a clinical features analysis of 31 patients in China. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2022. [DOI: 10.23736/s0393-3660.19.04222-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
10
|
Abstract
PURPOSE OF REVIEW Extramammary Paget's Disease (EMPD) is an uncommon intra-epithelial malignancy, affecting primarily apocrine gland-bearing skin. EMPD is often considered an orphan diagnosis given its rarity. This review provides a contemporary overview of EMPD management. RECENT FINDINGS The mainstay of EMPD treatment centers around a high index of suspicion to allow for an early and accurate diagnosis, wide local or Mohs micrographic surgical excision with care paid toward the margin status, and thoughtful consideration for lymphadenectomy in patients with clinically positive regional disease. There is currently no consensus regarding adjuvant therapies or systemic therapies although with ongoing improvements in tumor biology and genomics, including molecular pathways and alterations specific to EMPD, targeted or combinatorial therapies may be on the horizon. SUMMARY Clinicians caring for patients with EMPD should seek consultation from or if feasible, consider referral to high-volume, experienced centers with patients counseled and provided with frequent and close follow-up for disease recurrence or progression. Collaboration with groups such as the Global Society for Rare Genitourinary Tumors, and especially patient groups will be vital to designing trials and collaborative databases.
Collapse
Affiliation(s)
- Vikram M Narayan
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | |
Collapse
|
11
|
Stage 3 perianal extra mammary Paget's disease: A case report of a non-operative approach. Int J Surg Case Rep 2022; 91:106796. [PMID: 35101718 PMCID: PMC8808074 DOI: 10.1016/j.ijscr.2022.106796] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 01/21/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction and importance Extra mammary Paget's disease (EMPD) is a rare disease characterised by intraepithelial involvement of the skin by non-squamous carcinoma cells in the vulva, perineum, and scrotum. Secondary EMPD is even rarer and accounts for roughly 25% of cases (Delport, 2012) [1]. Surgery (Mohs/wide local excision) is the standard treatment for primary non-invasive disease, but management of secondary invasive EMPD is less defined as there are no current treatment guidelines. Case presentation A 76-year-old lady had a 1-year history of a pruritic perianal rash that was refractory to multiple topical agents. A biopsy confirmed a diagnosis of EMPD in June 2020 and on staging imaging was found to have metastatic disease in her right inguinal lymph node. Upon discussion at a multi-disciplinary team (MDT) meeting, she proceeded chemo radiation therapy followed by systemic chemotherapy as she had such extensive perianal disease that would make surgery quite morbid. She had interval imaging 3 monthly to assess response to treatment. In June 2021, the patient had a complete clinical response and has ongoing 6 monthly surveillance. Clinical discussion EMPD is extremely rare and currently treatment options for secondary EMPD are still being navigated. Specifically, there are no current randomised control trials (RCTs) that compare outcomes in secondary EMPD between radiation therapy and surgery and in the context of stage III disease. This case report documents the treatment approach governed by MDT consensus and has a 1 year follow up. The case report has been reported in line with the SCARE 2020 criteria (Agha et al., 2020) [2]. Conclusion The patient has had a good outcome with treatment, however ongoing surveillance is required. EMPD is a rare disease. There are no treatment guidelines for invasive disease. Invasive disease confers high recurrence rates and lower survival rates. There are no RCTs comparing surgery versus radiation therapy in invasive disease. Combined radiation and chemotherapy can be a reasonable definitive treatment in stage 3 disease.
Collapse
|
12
|
|
13
|
Brough K, Carley SK, Vidal NY. The treatment of anogenital extramammary Paget's disease as part of a multidisciplinary approach: The use of Mohs surgery moat method with CK7. Int J Dermatol 2021; 61:238-245. [PMID: 34435670 DOI: 10.1111/ijd.15847] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 05/18/2021] [Accepted: 07/23/2021] [Indexed: 11/28/2022]
Abstract
Although most cases of extramammary Paget's disease (EMPD) are localized to the intraepidermal, the extensive subclinical extension can lead to high rates of marginal recurrence with wide local excisions and topically destructive treatments. Recurrence rates of EMPD treated with Mohs micrographic surgery (MMS) without immunohistochemical staining are better but variable. Here, we describe our multidisciplinary approach for treating large EMPD tumors of the anogenital region involving critical anatomy using MMS for peripheral margin clearance (moat method) and intraoperative CK7 immunostaining. Our clinical pearls for the management of anogenital EMPD are based on 53 multidisciplinary cases treated at the author's institution between 2014 and 2020.
Collapse
Affiliation(s)
- Kevin Brough
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Sama K Carley
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Nahid Y Vidal
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
14
|
Hondo N, Miyagawa Y, Kitazawa M, Muranaka F, Tokumaru S, Koyama M, Takahata S, Soejima Y. Laparoscopic abdominosacral resection for rectal and anal canal carcinoma with pagetoid spread. Asian J Endosc Surg 2021; 14:624-627. [PMID: 32875728 DOI: 10.1111/ases.12856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/09/2020] [Accepted: 08/10/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Perianal Paget's disease is associated with adenocarcinoma and can spread to the perianal skin. It often requires extensive resection of the perianal skin and rectum. Many studies have shown the efficacy of laparoscopic abdominoperineal resection for lower rectal cancer. However, extensive resection of the dorsal side of the perineal skin is difficult in the lithotomy position. We report a laparoscopic abdominosacral approach using the jackknife position for perianal Paget's disease. MATERIALS AND SURGICAL TECHNIQUE Surgery was started using the lithotomy position, and total mesorectal excision with central lymphadenectomy was performed laparoscopically. Pelvic floor muscles were divided 2 cm away from the rectum. The sigmoid colon was then divided with a linear stapler, and a terminal colostomy was made. The sacral approach was then followed with the patient placed in a jackknife position. A skin incision was made 1-2 cm from the negative margin confirmed by preoperative mapping biopsy and resected en-bloc. We used this approach in two patients with a mean operative time of 483 minutes, including 53.5 minutes for the position change. All tumor margins, including the skin, were cancer-free, and primary wound closure was possible in both of the cases. Both patients were doing well without any recurrence 10 and 13 months postoperatively. CONCLUSION Laparoscopic abdominosacral resection is safe and effective and facilitates extensive perineal skin resection, especially on the dorsal side, with a less invasive laparoscopic procedure.
Collapse
Affiliation(s)
- Nao Hondo
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yusuke Miyagawa
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masato Kitazawa
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Futoshi Muranaka
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shigeo Tokumaru
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Makoto Koyama
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shugo Takahata
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuji Soejima
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| |
Collapse
|
15
|
[Management of malignant adnexal neoplasms of the skin]. Hautarzt 2021; 72:619-632. [PMID: 34137901 DOI: 10.1007/s00105-021-04829-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
Malignant adnexal neoplasms of the skin are a heterogeneous group of rare malignancies with eccrine, apocrine, sebaceous and follicular differentiation. Essential clinical practice recommendations for the overall management of these cancers are presented. Moreover, specific evidence-based findings according to diagnosis, therapy and follow-up of porocarcinoma, sebaceous carcinoma and microcystic adnexcarcinoma will be explained.
Collapse
|
16
|
Konstantinova AM, Kazakov DV. Extramammary Paget disease of the vulva. Semin Diagn Pathol 2020; 38:50687. [PMID: 32921571 DOI: 10.1053/j.semdp.2020.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 02/03/2023]
Abstract
Extramammary Paget disease (EMPD) is a rare neoplasm with uncertain histogenesis, usually presenting in the anogenital area, most commonly in the vulva. The disease is characterized by slow grow and high recurrence rates. This article reviews the epidemiological, clinical, morphological, genetic and treatment features of EMPD of the vulva reported in recent years.
Collapse
Affiliation(s)
- Anastasia M Konstantinova
- Department of Pathology, Clinical Research and Practical Center for Specialized Oncological care, Saint-Petersburg, Russian Federation; Department of Pathology, Medical Faculty, Saint-Petersburg State University, Russian Federation; Department of Pathology, Saint-Petersburg Medico-Social Institute, St.-Petersburg, Russian Federation
| | - Dmitry V Kazakov
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic; Bioptical Laboratory, Pilsen, Czech Republic.
| |
Collapse
|
17
|
Maeda Y, Minagawa N, Koyama R, Kobayashi T, Saito A, Shinohara T. Recurrence of Noninvasive Perianal Extramammary Paget's Disease in the Lymph Nodes without Local Recurrence after Complete Excision. Case Rep Gastroenterol 2020; 14:402-408. [PMID: 32884517 PMCID: PMC7443629 DOI: 10.1159/000508859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/19/2020] [Indexed: 11/19/2022] Open
Abstract
Primary extramammary Paget's disease (EMPD) is a rare intraepithelial adenocarcinoma. Lymph node metastasis from noninvasive EMPD originating in the anorectal region is extremely rare, and the recurrence of noninvasive EMPD is commonly associated with local recurrence mainly due to an insufficient resection margin. We herein report a case of inguinal and para-aortic lymph node recurrence without local recurrence after complete margin-free surgical resection of noninvasive perianal EMPD. The patient was a man in his 40s who presented with an erythematous plaque of 7 × 5 cm in the perianal region, which had been present for 1 year. Biopsy from the perianal skin suggested EMPD; it was positive for cytokeratin (CK)7 and negative for CK20. Underlying malignancy was ruled out based on whole-body enhanced computed tomography (CT) and total colonoscopy. Surgery including complete wide resection of the lesion with preservation of the rectum was performed, and VY-advancement flap reconstruction and flap-rectum anastomosis were performed. A histological examination of the whole specimen with 5-mm slices confirmed noninvasive EMPD resected with all-negative surgical margins. At 2 years and 6 months after surgery, however, enlargement of the inguinal and para-aortic lymph nodes was detected by follow-up enhanced CT, and the recurrence of EMPD was diagnosed based on left inguinal lymph node biopsy. The patient underwent chemotherapy without a remarkable response. He died of the disease 53 months after the first surgery. This is the first case report of lymph node metastasis without local recurrence after complete margin-free resection of noninvasive perianal EMPD.
Collapse
Affiliation(s)
- Yoshiaki Maeda
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Shiroishi, Japan
| | - Nozomi Minagawa
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Shiroishi, Japan
| | - Ryota Koyama
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Shiroishi, Japan
| | - Tadayuki Kobayashi
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Shiroishi, Japan
| | - Akira Saito
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Shiroishi, Japan
| | - Toshiki Shinohara
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Shiroishi, Japan
| |
Collapse
|
18
|
Experiences with Surgical Reconstruction of Penoscrotal Extramammary Paget's Disease: A review of 21 cases. J Plast Reconstr Aesthet Surg 2020; 73:1700-1705. [DOI: 10.1016/j.bjps.2020.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 12/26/2022]
|
19
|
Abstract
Extramammary Paget's disease (EMPD) is a rare and lethal intraepithelial malignancy that remains poorly understood. No standardized guidelines or consensus statements exist with regards to the diagnostic evaluation, therapeutic approaches and follow-up management. Complete surgical excision with negative margins has been accepted as the mainstay of treatment for EMPD to decrease the risk of local recurrence and to maximize durable cure. Non-invasive therapies, such as laser therapy, photodynamic therapy, radiotherapy and topical chemotherapy have been utilized, but are best reserved for non-surgical candidates. While the debate on the surgical approach between wide local excision (WLE) and Mohs micrographic surgery (MMS) continues, several studies have demonstrated the ability of WLE to be performed safely and effectively and to yield equally satisfactory outcomes with similar rates of recurrence to MMS. Patients undergoing surgical excision often require complex closures with skin grafting or local flaps to close genital defects. We aim to provide an up-to-date review of the current knowledge of EMPD. In addition to discussing the clinical presentation and prognostic outcomes, we focus and elaborate on the diagnostic approaches and treatment alternatives available. This information may serve as a primer for the urologist who may be called upon to treat this malignancy primarily or to provide wound coverage secondarily.
Collapse
Affiliation(s)
- Joon Yau Leong
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia PA, USA
| | - Paul H Chung
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia PA, USA
| |
Collapse
|
20
|
Samiee-Rad F, Farajee S. Concurrence of Primary Cutaneous Extra Mammary Paget's Disease and Squamous Cell Carcinoma in situ of Vulva: A Case Report. IRANIAN JOURNAL OF PATHOLOGY 2020; 15:48-52. [PMID: 32095151 PMCID: PMC6995679 DOI: 10.30699/ijp.2019.93259.1906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Extramammary Paget's disease and vulvar intraepithelial neoplasia are common lesions of vulve, but synchronous occurrence is rare in a same location. Herein we describe a concurrence of primary cutaneous extra mammary Paget's disease and squamous cell carcinoma in situ of vulva in an Iranian women. A 59 year old woman, initially presented to Kosar teaching hospital gynecology clinic April 2017 with a single, well defined, scaly, white ulcerated mass, 2 cm in diameter on right minor labia, but other examinations were normal. She had no urinary or gastrointestinal symptoms. Incisional biopsies from the mass represented concurrence extramammary Paget's disease and VIN3. She underwent radical vulvectomy .No evidence of disease recurrence was noted after 16 months follow up. Participant consent was obtained before patient was enrolled in this study. There are lot of diseases that involve genitalia and lead to vulvar lesions. But in this rare case, we diagnosed concurrence of extramammary Paget's disease and vulvar intraepithelial neoplasia in a same location. Additionally, the clinical presentation as a vulvar mass was found unusual. Therefore, we report the case to sensitize gynecologists and pathologists for uncommon pathologies and their manifestations in vulva.
Collapse
Affiliation(s)
- Fatemeh Samiee-Rad
- Department of Pathology, School of Medicine, Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Sohayla Farajee
- School of Medicine, Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| |
Collapse
|
21
|
Abstract
BACKGROUND Extramammary Paget's disease is an uncommon intraepidermal adenocarcinoma with poorly defined clinical implications. OBJECTIVE The purpose of this research was to estimate the risk of second primary neoplasms in patients with extramammary Paget's disease. DESIGN This was a retrospective analysis of the Surveillance, Epidemiology, and End Results Registry (1973-2014). SETTINGS The study included population-based cancer registries from the United States. PATIENTS Patients who were diagnosed with anogenital Paget's disease were included. MAIN OUTCOME MEASURES Risk of second primary development was measured. RESULTS We identified 108 patients with anal Paget's disease, 421 patients with male genital (scrotum or penis) Paget's, and 1677 patients with female genital (vagina or vulva) Paget's. Median follow-up time was 5.9 years. The risk of developing colorectal adenocarcinoma was 18.5% for patients with anal Paget's disease. Eighty percent of colorectal adenocarcinoma diagnoses were synchronous (within 2 mo) to anal Paget's diagnoses, whereas metachronous tumors occurred at a median time of 2.4 years. Of patients with anal Paget's disease, 8.3% developed an anal adenocarcinoma or nonsmall cell cancer. In male patients with genital Paget's, the risk of proximal genitourinary malignancy was 9.7%, scrotal or testicular adenocarcinoma was 0.4%, and penile or scrotal squamous carcinoma was 1.7%. In female patients with genital Paget's, the risk of proximal genitourinary malignancy was 3.0%, vaginal or vulvar adenocarcinoma was 1.4%, and vaginal or vulvar squamous neoplasm was 1.0%. Five-year overall survival was 59.7%, 73.5%, and 80.7% in patients with anal, male genital, and female genital Paget's (p < 0.001). LIMITATIONS The registry did not record surveillance schedule, provider specialty, or nonprocedural therapies for extramammary Paget's disease. CONCLUSIONS In the largest published cohort of patients with extramammary Paget's disease, patients with anal Paget's had a much higher risk of both proximal and local neoplasms as compared with patients with genital Paget's. Patients with anal Paget's also experienced worse survival as compared with those with purely genital Paget's. See Video Abstract at http://links.lww.com/DCR/B20. ALTO RIESGO DE NEOPLASIAS PROXIMALES Y LOCALES EN 2206 PACIENTES CON ENFERMEDAD DE PAGET EXTRAMAMARIA ANOGENITAL:: La enfermedad de Paget extramamaria es un adenocarcinoma intraepidérmico poco frecuente con implicaciones clínicas poco definidas.Estimar el riesgo de segundas neoplasias primarias en pacientes con enfermedad de Paget extramamaria.Análisis retrospectivo del Registro de Vigilancia, Epidemiología y Resultados Finales (1973-2014).Registros de base poblacional en cáncer de los Estados Unidos.Pacientes que fueron diagnosticados con enfermedad de Paget anogenital.Riesgo de desarrollo un cáncer primario adicional.Se identificaron 108 pacientes con Paget anal, 421 pacientes con Paget genital masculino (escroto o pene) y 1677 pacientes con Paget genital femenino (vagina o vulva). Tiempo mediano de seguimiento fue de 5,9 años. El riesgo de desarrollar adenocarcinoma colorrectal fue del 18,5% para los pacientes con Paget anal. El ochenta por ciento de los diagnósticos de adenocarcinoma colorrectal fueron sincrónicos (dentro de los 2 meses) a los diagnósticos de Paget anal, mientras que los tumores metacrónicos ocurrieron en un tiempo promedio de 2,4 años. De los pacientes con Paget anal, el 8.3% desarrolló un adenocarcinoma anal o cáncer de células no pequeñas. En los pacientes masculinos con Paget genital, el riesgo de malignidad genitourinaria proximal fue del 9,7%, el adenocarcinoma escrotal o testicular fue del 0,4% y el carcinoma escamoso del pene o escroto fue del 1,7%. En pacientes femeninas con Paget genital, el riesgo de malignidad genitourinaria proximal fue de 3.0%, el adenocarcinoma vaginal o vulvar fue de 1.4% y la neoplasia escamosa vaginal o vulvar fue de 1.0%. La supervivencia general a cinco años fue del 59.7%, 73.5% y 80.7% en pacientes con anal, genital masculino y genital femenino, respectivamente (p <0.001).El registro no señalo el cronograma de vigilancia, la especialidad del proveedor o las terapias sin procedimiento para la enfermedad de Paget extramamaria.En la cohorte más grande publicada de pacientes con enfermedad de Paget extramamaria, los pacientes con Paget anal demostraron un riesgo mucho mayor de neoplasias proximales y locales en comparación con los pacientes con Paget genital. Los pacientes con Paget anal además demostraron una peor supervivencia en comparación con aquellos con Paget aislada genital. Vea el Resumen del Video en http://links.lww.com/DCR/B20.
Collapse
|
22
|
Loiacono RMR, Traversi P, Deliso MA, Gargano G, Kardhashi A, Francescato R, Loizzi V, Spinelli M, Lovascio S, Fiorito M, Resta L, Popescu O, Cicinelli E, Cormio G. Paget disease of the vulva an analysis of 24 cases. Medicine (Baltimore) 2019; 98:e17018. [PMID: 31593076 PMCID: PMC6799860 DOI: 10.1097/md.0000000000017018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Paget's disease can arise in the breast (mammary Paget disease) or in other locations (extramammary Paget disease) such as anogenital skin in both males and females (Paget disease of the vulva [PDV]). Underlying adenocarcinoma can be found in some cases. This study aims to report clinical aspects, surgical procedures, outcomes, and recurrences of patients with PDV.A retrospective chart review was conducted on patients with pathologically confirmed diagnosis of PDV managed at the Department of Obstetrics and Gynecology, University of Bari, and the "Giovanni Paolo II" National Cancer Institute in Bari, between 1998 and 2018.Records of 24 cases of PDV were examined. Median age of the patients at diagnosis was 69.3 (range 38-84), diagnosis of synchronous cancer was made in 2 cases and in 2 other cases of metachronous disease. Three patients had previously been diagnosed with other oncological diseases. All patients underwent surgery including wide local excision (6), simple vulvectomy (8), and extended vulvectomy (10). Lymphadenectomy was performed in 2 cases and reconstructions with advancement flaps in 7 cases. Four patients were found to have invasive disease and 1 had inguinal node involvement. Positive margins were found in 11 patients. Wound dehiscence and urethral stenosis were found in 4 and 1 case each. Eight recurrences (33.33%) were observed, regardless of positive surgical margins.PDV has a low rate of malignancy but a high rate of recurrence. It should be diagnosed early to avoid repeated surgery and to reduce symptoms and morbidity.
Collapse
Affiliation(s)
| | | | | | - Giulio Gargano
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”
| | - Anila Kardhashi
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”
| | | | | | | | | | | | | | - Ondina Popescu
- Department of Pathology, IRCCS Istituto Tumori “Giovanni Paolo II,” Bari, Italy
| | | | - Gennaro Cormio
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”
- Department of Obstetrics and Gynecology
| |
Collapse
|
23
|
Chen ST, Guo LH, Yan JN, Wang Q, Li XL, Li MX, Zhu RZ, Yang WP, Xu HX. Ultrasound Biomicroscopy and High-Frequency Ultrasound for Evaluating Extramammary Paget Disease With Pathologic Correlation. JOURNAL OF ULTRASOUND IN MEDICINE 2019; 38:3229-3237. [PMID: 31144340 DOI: 10.1002/jum.15033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/04/2019] [Accepted: 04/23/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the performance of ultrasound biomicroscopy (UBM) and high-frequency ultrasound (HFUS) in the assessment of extramammary Paget disease (EMPD) and to correlate the imaging features with pathologic findings. METHODS In this retrospective study, we described the imaging features from UBM and HFUS based on 17 pathologically proven EMPD cases. The performance for visualizing layer involvement by UBM and HFUS was compared. Additionally, we checked the consistency between layer involvement of the lesions on UBM images and the pathologic results. Additionally, blood flow and the status of lymph nodes were investigated with HFUS. RESULTS Ultrasound biomicroscopy revealed that all 17 lesions (100%) were hypoechoic and grew in a creeping form. The feature of layer involvement was shown in 10 lesions (58.8%) limited to the epidermis and 6 lesions (35.3%) involving the dermis, and the remaining lesion (5.9%) involved the full skin layers. Layer involvement was clearly displayed by UBM for all lesions (100%) but for only 5 lesions (29.4%) by HFUS (P < .001). Additionally, the layer involvement of 15 lesions (88.2%) on UBM was consistent with the pathologic results (κ = 0.746). High-frequency ultrasound revealed profuse blood flow in most lesions (64.7% [11 of 17]), and 1 case showed inguinal lymph node metastasis. CONCLUSIONS Combined use of UBM and HFUS can provide key information on EMPD based on ultrasound features. Comparatively, UBM provides clearer morphologic information, whereas HFUS provides information on lymph node metastasis and blood flow.
Collapse
Affiliation(s)
- Si-Tong Chen
- Department of Medical Ultrasound, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China.,Department of Medical Ultrasound, Shanghai Skin Disease Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Le-Hang Guo
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Tumor Minimally Invasive Treatment Center, Tongji University Cancer Center, Shanghai, China
| | - Jian-Na Yan
- Tumor Minimally Invasive Treatment Center, Tongji University Cancer Center, Shanghai, China.,Departments of Skin Surgery, Shanghai Skin Disease Hospital, Shanghai, China
| | - Qiao Wang
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Tumor Minimally Invasive Treatment Center, Tongji University Cancer Center, Shanghai, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Tumor Minimally Invasive Treatment Center, Tongji University Cancer Center, Shanghai, China
| | - Ming-Xu Li
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Tumor Minimally Invasive Treatment Center, Tongji University Cancer Center, Shanghai, China
| | - Rui-Zheng Zhu
- Tumor Minimally Invasive Treatment Center, Tongji University Cancer Center, Shanghai, China.,Departments of Pathology, Shanghai Skin Disease Hospital, Shanghai, China
| | - Wei-Ping Yang
- Department of Medical Ultrasound, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Tumor Minimally Invasive Treatment Center, Tongji University Cancer Center, Shanghai, China
| |
Collapse
|
24
|
Chung PH, Leong JY, Voelzke BB. Surgical Experience With Genital and Perineal Extramammary Paget's Disease. Urology 2019; 128:90-95. [PMID: 30902697 DOI: 10.1016/j.urology.2019.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/04/2019] [Accepted: 03/08/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe our surgical experience for the treatment and management of extramammary Paget's disease (EMPD). METHODS Our surgical approach involves excising a 2-cm margin of normal appearing skin around the EMPD-suspicious lesion. Prior to excision, the tissue is oriented and demarcated into predefined segments in coordination with a pathologist. Frozen sections are performed when necessary to guide additional excision. Xenograft or wet-to-dry dressings are applied depending on size and location of the wound while the specimen is expeditiously reviewed over the following 24-48 hours. If positive margins remain, further excision of the corresponding skin segment is performed. Delayed complex wound closure +/- split thickness skin grafting is performed once negative margins are confirmed. RESULTS Ten EMPD patients were referred to two academic centers between 2014 and 2018. Two patients had positive lymph nodes at diagnosis and underwent palliative surgery and died within 12 and 29 months. The remaining 8 patients underwent a median of 1 surgery (range 0-3) with referring providers before undergoing a median of 3 surgeries (range 2-5) at our institutions to achieve negative surgical margins and wound reconstruction (7 split thickness skin grafts, 1 secondary closure). At mean follow-up of 15 months, 1 patient recurred, required further excision, and remains disease free. CONCLUSION EMPD is a rare malignancy with poorly described treatment methodologies. Due to its multifocal distribution and asymmetric spread, obtaining negative margins can be challenging. Our systematic approach to obtaining wide margins and documenting excised skin has enabled us to achieve negative margins for this challenging malignancy.
Collapse
Affiliation(s)
- Paul H Chung
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
| | - Joon Yau Leong
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Bryan B Voelzke
- Department of Urology, University of Washington Medical Center, Seattle, WA
| |
Collapse
|
25
|
Yoshida Y, Goto H, Tsutsumi R, Yamamoto O. Use of an Anal Retractor Device for Excision in Patients with Perianal Extramammary Paget's Disease. Indian J Dermatol 2018; 63:435-437. [PMID: 30210173 PMCID: PMC6124241 DOI: 10.4103/ijd.ijd_251_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Yuichi Yoshida
- Department of Medicine of Sensory and Motor Organs, Division of Dermatology, Faculty of Medicine, Tottori University, Yonago, Japan. E-mail:
| | - Hiroyuki Goto
- Department of Medicine of Sensory and Motor Organs, Division of Dermatology, Faculty of Medicine, Tottori University, Yonago, Japan. E-mail:
| | - Reiko Tsutsumi
- Department of Medicine of Sensory and Motor Organs, Division of Dermatology, Faculty of Medicine, Tottori University, Yonago, Japan. E-mail:
| | - Osamu Yamamoto
- Department of Medicine of Sensory and Motor Organs, Division of Dermatology, Faculty of Medicine, Tottori University, Yonago, Japan. E-mail:
| |
Collapse
|