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Kibbi N, Owen JL, Worley B, Wang JX, Harikumar V, Aasi SZ, Chandra S, Choi JN, Fujisawa Y, Iavazzo C, Kim JYS, Lawrence N, Leitao MM, MacLean AB, Ross JS, Rossi AM, Servaes S, Solomon MJ, Alam M. Anatomic Subtype Differences in Extramammary Paget Disease: A Meta-Analysis. JAMA Dermatol 2024; 160:417-424. [PMID: 38446447 PMCID: PMC10918581 DOI: 10.1001/jamadermatol.2024.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/28/2023] [Indexed: 03/07/2024]
Abstract
Importance Extramammary Paget disease (EMPD) is a rare, highly recurrent cutaneous malignant neoplasm of unclear origin. EMPD arises most commonly on the vulvar and penoscrotal skin. It is not presently known how anatomic subtype of EMPD affects disease presentation and management. Objective To compare demographic and tumor characteristics and treatment approaches for different EMPD subtypes. Recommendations for diagnosis and treatment are presented. Data Sources MEDLINE, Embase, Web of Science Core Collection, and Cochrane Reviews CENTRAL from December 1, 1990, to October 24, 2022. Study Selection Articles were excluded if they were not in English, reported fewer than 3 patients, did not specify information by anatomic subtype, or contained no case-level data. Metastatic cases on presentation were also excluded. Data Extraction and Synthesis Abstracts of 1295 eligible articles were independently reviewed by 5 coauthors, and 135 articles retained. Reporting was in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. The analysis was cunducted in August 2019 and updated in November 2022. Findings Most vulvar EMPD cases were asymptomatic, and diagnosis was relatively delayed (mean, 25.1 months). Although most vulvar EMPD cases were intraepidermal (1247/1773 [70.3%]), radical surgeries were still performed in almost one-third of cases. Despite this aggressive surgical approach, 481 of 1423 (34%) recurred, commonly confined to the skin and mucosa (177/198 [89.4%]). By contrast, 152 of 1101 penoscrotal EMPD cases (14%) recurred, but more than one-third of these recurrences were regional or associated with distant metastases (54 of 152 [35.5%]). Perianal EMPD cases recurred in one-third of cases (74/218 [33.9%]), with one-third of these recurrences being regional or associated with distant metastasis (20 of 74 [27.0%]). Perianal EMPD also had the highest rate of invasive disease (50% of cases). Conclusions and Relevance The diagnosis and treatment of EMPD should differ based on anatomic subtypes. Considerations for updated practice may include less morbid treatments for vulvar EMPD, which is primarily epidermal, and close surveillance for local recurrence in vulvar EMPD and metastatic recurrence in perianal EMPD. Recurrences in penoscrotal subtype were less common, and selective surveillance in this subtype may be considered. Limitations of this study include the lack of replication cohorts and the exclusion of studies that did not stratify outcomes by anatomic subtype.
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Affiliation(s)
- Nour Kibbi
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Joshua L. Owen
- Dermatology Service, Audie L Murphy VA Medical Center, San Antonio, Texas
- Division of Dermatology, University of Texas Health San Antonio, San Antonio
| | | | - Jake X. Wang
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Vishnu Harikumar
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Sumaira Z. Aasi
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Sunandana Chandra
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jennifer N. Choi
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Christos Iavazzo
- Department of Gynecologic Oncology, Metaxa Cancer Hospital, Piraeus, Greece
| | - John Y. S. Kim
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Naomi Lawrence
- Division of Dermatology, Cooper Hospital, Rowan University, Camden, New Jersey
| | - Mario M. Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of OB/GYN, Weill Cornell Medical College, New York, New York
| | - Allan B. MacLean
- Department of Gynaecology, University College, London, United Kingdom
| | - Jeffrey S. Ross
- Departments of Pathology and Urology, Upstate Medical University, Syracuse, New York
- Medical Director, Foundation Medicine, Inc, Boston, Massachusetts
| | - Anthony M. Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sabah Servaes
- Department of Radiology, West Virginia University Children’s Hospital, Charleston, West Virginia
| | - Michael J. Solomon
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Murad Alam
- Department of Dermatology, Ehime University, To-on, Japan
- Department of Otolaryngology–Head and Neck Surgery and Surgery (Organ Transplantation), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Maloney NJ, Yao H, Aasi SZ, John EM, Linos E, Kibbi N. Elevated Risk of Visceral Malignant Neoplasms in Extramammary Paget Disease. JAMA Dermatol 2023; 159:1139-1141. [PMID: 37647047 PMCID: PMC10469282 DOI: 10.1001/jamadermatol.2023.2679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/16/2023] [Indexed: 09/01/2023]
Abstract
This cross-sectional study evaluates the incidence and types of cancers that develop years after an extramammary Paget disease (EMPD) diagnosis.
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Affiliation(s)
- Nolan J. Maloney
- Department of Dermatology, Stanford University School of Medicine, Palo Alto, California
| | - Hanqi Yao
- Department of Dermatology, Stanford University School of Medicine, Palo Alto, California
| | - Sumaira Z. Aasi
- Department of Dermatology, Stanford University School of Medicine, Palo Alto, California
| | - Esther M. John
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
- Department of Medicine (Oncology), Stanford University School of Medicine, Stanford, California
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Eleni Linos
- Department of Dermatology, Stanford University School of Medicine, Palo Alto, California
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Nour Kibbi
- Department of Dermatology, Stanford University School of Medicine, Palo Alto, California
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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.
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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
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Chelmow D, Cejtin H, Conageski C, Farid H, Gecsi K, Kesterson J, Khan MJ, Long M, O'Hara JS, Burke W. Executive Summary of the Lower Anogenital Tract Cancer Evidence Review Conference. Obstet Gynecol 2023; 142:708-724. [PMID: 37543740 PMCID: PMC10424818 DOI: 10.1097/aog.0000000000005283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/16/2023] [Accepted: 05/25/2023] [Indexed: 08/07/2023]
Abstract
The Centers for Disease Control and Prevention sponsored a project conducted by the American College of Obstetricians and Gynecologists to develop educational materials for clinicians on the prevention and early diagnosis of gynecologic cancers. For this final module, focusing on the cancers of the lower anogenital tract (vulva, vagina, and anus), a panel of experts in evidence assessment from the Society for Academic Specialists in General Obstetrics and Gynecology, ASCCP, and the Society of Gynecologic Oncology reviewed relevant literature and current guidelines. Panel members conducted structured literature reviews, which were then reviewed by other panel members. Representatives from stakeholder professional and patient advocacy organizations met virtually in September 2022 to review and provide comment. This article is the executive summary of the review. It covers prevention, early diagnosis, and special considerations of lower anogenital tract cancer. Knowledge gaps are summarized to provide guidance for future research.
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Affiliation(s)
- David Chelmow
- Departments of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, Feinberg School of Medicine Northwestern University, Stroger Hospital, Chicago, Illinois, University of Colorado School of Medicine, Aurora, Colorado, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, Medical College of Wisconsin, Milwaukee, Wisconsin, Stanford University School of Medicine, Palo Alto, California, Mayo Clinic Alix School of Medicine, Rochester, Minnesota, and Stony Brook University Hospital, Stony Brook, New York; the Division of Gynecologic Oncology, UPMC-Central PA, Mechanicsburg, Pennsylvania; and the American College of Obstetricians and Gynecologists, Washington, DC
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Ueda M, Omori M, Sakai A. Invasive extramammary Paget's disease with lymph node metastases and high-grade B-cell lymphoma. An Bras Dermatol 2023; 98:414-418. [PMID: 36803560 PMCID: PMC10173068 DOI: 10.1016/j.abd.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 02/19/2023] Open
Affiliation(s)
- Misato Ueda
- Department of Plastic Surgery, Yodogawa Christian Hospital, Kunijima, Osaka, Japan.
| | - Makoto Omori
- Department of Plastic Surgery, Yodogawa Christian Hospital, Kunijima, Osaka, Japan
| | - Ayumi Sakai
- Department of Plastic Surgery, Yodogawa Christian Hospital, Kunijima, Osaka, Japan
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6
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Özdemir Ü, Salış M, Özer İ, Ünal B. Perianal Paget’s Disease; Surgery and Non-surgical Interventions, Untreated Patient: a Report of Two Cases. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03376-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Hypopigmentation in Extramammary Paget Disease Is an Important Prognostic Factor for High Recurrence Rate and Poor Surgical Outcome. Dermatol Surg 2021; 47:613-617. [PMID: 33481430 DOI: 10.1097/dss.0000000000002950] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Several studies have reported the presence of hypopigmentation in extramammary Paget disease (EMPD). However, an in-depth analysis regarding its clinical implication is lacking. OBJECTIVE To evaluate the clinical characteristics of EMPD in the Korean population and to determine the implication of hypopigmentation on clinical outcomes. METHODS We retrospectively reviewed 124 cases of EMPD who underwent surgical treatment from a single tertiary hospital from December 2005 to March 2019. Baseline characteristics of the patients and hypopigmentation patterns were analyzed. Moreover, the number of stages of Mohs micrographic surgery (MMS) and recurrence rate were evaluated in relation to the hypopigmentation. RESULTS A total of 67.7% (n = 84) of the patients showed hypopigmentation. The adjusted odds ratio for recurrence in the hypopigmented group was 5.980, which was statistically significant (95% confidence interval = 1.347-26.553, p-value = 0.019). Furthermore, the average number of MMS stages was 2.92 in the hypopigmentation group, compared with 1.82 in the nonhypopigmentation group (p-value = .0016). CONCLUSION Hypopigmented lesions may disguise the tumor margin, thus raising the recurrence rate after surgery and the number of stages of MMS. The hypopigmentation status must be considered when deciding the surgical margin.
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8
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Yin X, Xu A, Huang Z, Fan F, Wang Y, Chen L, Cui G, Hu Y, Sun C. The relationship among primary anatomic subsite and risk and distribution of second malignant neoplasms in patients with stage I/II diffuse large B-cell lymphoma: An analysis of the surveillance, epidemiology, and end results database. Transl Oncol 2021; 14:101106. [PMID: 33932917 PMCID: PMC8102996 DOI: 10.1016/j.tranon.2021.101106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/06/2021] [Accepted: 04/13/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Recent studies have reported that diffuse large B-cell lymphoma (DLBCL) involving different primary extranodal sites have distinct clinicopathological characteristics and prognosis. However, the risk of secondary malignant neoplasms (SMNs) in DLBCL survivors with different primary extranodal sites are unknown. METHODS A total of 40,714 patients diagnosed with stage I/II DLBCL were included from the Surveillance, Epidemiology, and End Results (SEER) database from 1983 to 2015.The standardized incidence ratio (SIR) and absolute excess risk (AER) were used to assess the risk of SMNs. RESULTS The results show that the risk of SMN was significantly higher in extranodal DLBCL than in the US general population (SIR, 1.18; 95% CI, 1.11-1.26), and the risk of developing SMN remains significantly elevated with increased latency. Moreover, there were multiple site-specific risk patterns. There was a 22%, 44%, 66%, 123% and 151% increased risk of SMN 10 years after primary gastrointestinal tract, head/neck, skeletal, lung and liver/pancreas DLBCL diagnosis, respectively. There was a significant decrease risk of SMN with increasing age at diagnosis for primary gastrointestinal tract and skeletal DLBCL. In addition, DLBCL patients with primary sites in the gastrointestinal tract, thyroid and liver/pancreas had the highest incidences of secondary stomach cancer, second thyroid cancer, and second hepatobiliary cancer, respectively, which indicated that the initial site of DLBCL may predict the type of SMN. CONCLUSIONS The strategies for cancer surveillance after extranodal DLBCL diagnosis may need to be individualized according to the subsite of extranodal DLBCL.
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Affiliation(s)
- Xuejiao Yin
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Aoshuang Xu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhenli Huang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fengjuan Fan
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yajun Wang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Chen
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guohui Cui
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Collaborative Innovation Center of Hematology, Huazhong University of Science and Technology, Wuhan, China
| | - Chunyan Sun
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Collaborative Innovation Center of Hematology, Huazhong University of Science and Technology, Wuhan, China
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Santos MD, Soares F, Presa-Fernandes JM, Silva DS. Perianal Paget Disease: Different Entities With the Same Name. Cureus 2021; 13:e15161. [PMID: 34168927 PMCID: PMC8215450 DOI: 10.7759/cureus.15161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Extramammary Paget disease (EMPD) is a rare form of cancer that involves skin areas rich in apocrine glands. The common sites of occurrence include the vulva, perianal region, perineum, and axilla. Perianal Paget disease (PPD) is a subset of EMPD, which arises in the perianal skin. The disease commonly presents with a thickened plaque-like lesion with erythema or white scaly appearance. It is generally classified into two categories based on the origin of the tumor cells: (1) primary PPD if the tumor arises from intraepidermal cells and (2) secondary PPD if cancer originates from the underlying colorectal or urinary tract neoplasm. Due to its rarity, only a few sporadic case reports have been published in the literature, and treatment methods are yet to be standardized. In light of this, we report two PPD cases with different etiopathogenesis and staging: one involved only the perianal skin without regional or metastatic disease, and was not accompanied by visceral adenocarcinomas although there was a previous history of sigmoid adenocarcinoma; the other was probably secondary to an anal canal tumor spreading with disseminated disease involving the perianal and perineum area with bilateral inguinal, pelvic lymph node, and liver metastasis. The treatment plans and the outcomes of both cases were necessarily different from each other.
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Affiliation(s)
- Marisa D Santos
- Colorectal Surgery, Instituto de Ciências Biomédicas Abel Salazar (ICBAS) - University of Porto, Porto, PRT.,Colorectal Surgery, Centro Hospitalar Universitário do Porto, Porto, PRT
| | - Filomena Soares
- Colorectal Surgery, Centro Hospitalar Tâmega e Sousa, Penafiel, PRT
| | | | - Donzília S Silva
- Hepatobiliary and Pancreatic Surgery, Centro Hospitalar Universitário do Porto, Porto, PRT
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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] [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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11
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Hu J, Ge W, Mao S, Ding Q, Hu M, Jiang H. First-time versus recurrent penoscrotal extramammary Paget's disease: Clinicopathological characteristics and risk factors in 164 Chinese male patients. Indian J Dermatol Venereol Leprol 2020; 86:134-140. [PMID: 31650976 DOI: 10.4103/ijdvl.ijdvl_382_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Penoscrotal extramammary Paget's disease is a rare, slow-growing neoplasm with high frequency of local recurrence. Aims The aim of this study was to investigate the difference in clinicopathological characteristics between first-time and recurrent penoscrotal Paget's disease, and to discover the potential risk factors of recurrence. Methods Between January 2007 and February 2014, a total of 164 Chinese patients with biopsy-proven tramammary Paget's diseaseex in penis and scrotum underwent wide local resection in our institution. Among them, 142 patients with first-time disease and other 22 patients with recurrent disease were enrolled in this retrospective analysis. Results The median duration of symptoms was much shorter in recurrent disease than in first-timers (3 vs. 24 months, P < 0.001). Patients with recurrent disease tended to have lower lesion exudation rates (27.3% vs. 51.8%, P= 0.032). In addition, patients with distant stage were more likely to obtain recurrent disease compared with first-time disease (P = 0.005). Through immunohistochemical detection of extramammary Paget's specimen, we found that HER2/neu protein expression in the recurrent group was significantly higher than first-timers (P = 0.036). Limitations In this study, the information on familial history of most patients was insufficient. Moreover, due to the lack of follow-up data of our included cases, we were unable to evaluate the prognosis after diagnosis of extramammary Paget's disease. Conclusion Patients with penoscrotal Paget's disease, especially those with shorter duration of symptoms, exudation of lesions, distant-stage, Paget cells infiltrating into adnexa, and HER2/neu expression, should be followed up more carefully after surgery, as they were more likely to suffer recurrence.
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Affiliation(s)
- Jimeng Hu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenjia Ge
- Department of Nursing, Huashan Hospital, Fudan University, Shanghai, China
| | - Shanhua Mao
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiang Ding
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Mengbo Hu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Haowen Jiang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
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Chang MS, Mulvaney PM, Danesh MJ, Feltmate CM, Schmults CD. Modified peripheral and central Mohs micrographic surgery for improved margin control in extramammary Paget disease. JAAD Case Rep 2020; 7:71-73. [PMID: 33354612 PMCID: PMC7744804 DOI: 10.1016/j.jdcr.2020.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Michael S Chang
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Patrick M Mulvaney
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Melissa J Danesh
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Colleen M Feltmate
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chrysalyne D Schmults
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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13
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Ghazawi FM, Iga N, Tanaka R, Fujisawa Y, Yoshino K, Yamashita C, Yamamoto Y, Fujimura T, Yanagi T, Hata H, Matsushita S, Le M, Roy SF, Lagacé F, Ishida Y, Kabashima K, Otsuka A. Demographic and clinical characteristics of extramammary Paget's disease patients in Japan from 2000 to 2019. J Eur Acad Dermatol Venereol 2020; 35:e133-e135. [PMID: 32780877 DOI: 10.1111/jdv.16868] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- F M Ghazawi
- Division of Dermatology, University of Ottawa, Ottawa, ON, Canada
| | - N Iga
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - R Tanaka
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Y Fujisawa
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - K Yoshino
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo, Japan
| | - C Yamashita
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo, Japan
| | - Y Yamamoto
- Department of Dermatology, Wakayama Medical University Graduate School of Medicine, Wakayama, Japan
| | - T Fujimura
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - T Yanagi
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - H Hata
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - S Matsushita
- Department of Dermato-Oncology/Dermatology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - M Le
- Division of Dermatology, McGill University, Montreal, QC, Canada
| | - S F Roy
- Department of Pathology and Cell Biology, University of Montreal, Montreal, QC, Canada
| | - F Lagacé
- Division of Dermatology, McGill University, Montreal, QC, Canada
| | - Y Ishida
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - K Kabashima
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - A Otsuka
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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14
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Weng S, Zhu N, Li D, Chen Y, Tan Y, Chen J, Yuan Y. Clinical Characteristics, Treatment, and Prognostic Factors of Patients With Primary Extramammary Paget's Disease (EMPD): A Retrospective Analysis of 44 Patients From a Single Center and an Analysis of Data From the Surveillance, Epidemiology, and End Results (SEER) Database. Front Oncol 2020; 10:1114. [PMID: 32983958 PMCID: PMC7477308 DOI: 10.3389/fonc.2020.01114] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/04/2020] [Indexed: 12/20/2022] Open
Abstract
Objective: Primary extramammary Paget's disease (EMPD) is a rare cutaneous malignancy. The aim of this article is to analyze clinical characteristics, evidence of the prognosis, and share treatment experience of primary EMPD. Methods: We extracted 771 patients' data from the Surveillance, Epidemiology, and End Results (SEER) program between 1973 and 2013 to investigate the characteristics and prognosis of patients with EMPD. In addition, 44 patients with primary EMPD in our hospital were retrospectively reviewed for 10 years. Results: Compared with patients younger than 65 years, patients diagnosed at 65–74 years [hazard ratio (HR), 2.453] and 75 years or older (HR, 5.750) had shorter survival. Patients with a primary site in the truncal skin (HR, 0.367) or scrotum (HR, 0.246) had better survival compared to those with a primary site in the perianal area. Compared with localized EMPD, EMPD with distant (HR, 18.821) and regional (HR, 2.180) metastases was associated with a worse prognosis. Patients who received radiotherapy had decreased survival, with an HR of 2.039. Patients with a higher N stage, M stage, and American Joint Committee on Cancer (AJCC) stage had a decreased prognosis (p < 0.001). Conclusions: Older age at diagnosis, primary site in the perianal area, distant metastasis, radiotherapy, and higher N stage, M stage, and AJCC stage may result in decreased survival.
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Affiliation(s)
- Shanshan Weng
- Department of Medical Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ning Zhu
- Department of Medical Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dan Li
- Department of Medical Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yurong Chen
- Department of Medical Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Medical Oncology, Zhuji People's Hospital of Zhejiang Province, Shaoxing, China
| | - Yinuo Tan
- Department of Medical Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiaqi Chen
- Department of Medical Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ying Yuan
- Department of Medical Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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15
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Lu CY, Hsieh MS, Wei KC, Ezmerli M, Kuo CH, Chen W. Gastrointestinal involvement of primary skin diseases. J Eur Acad Dermatol Venereol 2020; 34:2766-2774. [PMID: 32455473 DOI: 10.1111/jdv.16676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/11/2020] [Indexed: 12/14/2022]
Abstract
Less is known about gastrointestinal (GI) involvement of primary skin diseases due to the difference in embryology, histology, microbiology and physiology between integument and alimentary tract. Oesophagus, following the oropharyngeal mucosa, is the most common GI segment affected by primary skin diseases, especially by eosinophilic oesophagitis, lichen planus and autoimmune bullous dermatoses like pemphigus vulgaris, mucosal membrane pemphigoid and epidermolysis bullosa acquisita. Eosinophilic oesophagitis is an emerging chronic atopic disease with oesophageal dysfunction as the typical presentation, and oesophageal narrowing, rings and stricture as late complications. Oesophageal lichen planus mainly involves the proximal to mid-oesophagus in elderly aged women with long-term oral mucosal lesions. In acute attack of pemphigus vulgaris, oesophageal involvement is not uncommon but often neglected and may cause sloughing oesophagitis (oesophagitis dissecans superficialis) with acute GI bleeding in rare cases. GI manifestation of hereditary bradykininergic angio-oedema with colicky acute abdomen mostly affects small intestine, usually in the absence of pruritus or urticaria, and is more severe and long-lasting than the acquired histaminergic form. Strong evidence supports association between inflammatory bowel disease, especially Crohn disease, and hidradenitis suppurativa/acne inversa. Patients with vitiligo need surveillance of autoimmune liver disease, autoimmune atrophic gastritis or coeliac disease when corresponding symptoms become suspect. Melanoma is the most common primary tumour metastatic to the GI tract, with small intestine predominantly targeted. Gastrointestinal involvement is not uncommon in disseminated mycosis fungoides. Extramammary Paget's disease is an intraepidermal adenocarcinoma of controversial origin, and a high association between the anogenital occurrence and colorectal adenocarcinoma has been reported. As GI tract is the largest organ system with multidimensional functions, dermatologists in daily practice should be aware of the gastrointestinal morbidities related to primary skin diseases for an early diagnosis and treatment.
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Affiliation(s)
- C-Y Lu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - M-S Hsieh
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| | - K-C Wei
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - M Ezmerli
- Department of Dermatology, Faculty of Medicine in Rabigh, Kingdom of Saudi Arabia, King Abdulaziz University, Jeddah, Saudi Arabia
| | - C-H Kuo
- Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| | - W Chen
- Center for Research & Development, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan.,Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
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16
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Invasive vulvar extramammary Paget's disease in the United States. Gynecol Oncol 2020; 157:649-655. [PMID: 32268952 DOI: 10.1016/j.ygyno.2020.03.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/13/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess the incidence, treatment, and outcomes in patients with invasive vulvar extramammary Paget's disease (EMPD) in a national cohort of patients. METHODS Patients from the Surveillance, Epidemiology and End Results (SEER) database with diagnoses of vulvar EMPD from 1992 to 2016 were included. Demographic, treatment, and outcome data were analyzed. RESULTS A total of 1268 cases of invasive EMPD were identified. Of those, 69.6% had localized disease, 12.0% regional disease, 1.3% distant disease, and 17.1% were unstaged. The annual incidence of invasive vulvar EMPD was 0.36 per 100,000 person years: rates have increased >2-fold since 1992 (1992: 0.19 per 100,000 person years to 0.50 per 100,000 person years in 2016). Most patients underwent primary surgery (n = 1034; 81.5%). Five-year cancer specific survival (CSS) was 95.5% and was associated with stage. Compared to patients with localized disease, patients with distant metastases had dramatically worse CSS (HR: 85.8 (31.8-248) p < 0.0001). Synchronous cancers (diagnosed within one calendar year of EMPD diagnosis year) were observed in 35 cases (2.8%), and 195 patients (15.4%) developed a secondary malignancy (diagnosed >one year from year of EMPD diagnosis year). The most common synchronous breast, gastrointestinal tract, melanoma and the most common secondary cancers were breast, gastrointestinal tract and genitourinary tract. CONCLUSIONS The incidence of invasive vulvar EMPD has increased over time. CSS is excellent for localized disease, but those with metastatic disease are in need of novel therapies. Approximately 15% will develop a secondary malignancy, indicating that patients with invasive vulvar EMPD should undergo site specific preventative health screens during recurrence surveillance.
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17
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Kambayashi Y, Fujimura T, Ohuchi K, Tono H, Ishida Y, Otsuka A, Aiba S. Advanced Invasive Extramammary Paget's Disease Concomitant with Cecal Cancer Possessing Rare Variant of TP53 Single Nucleotide Polymorphism. Case Rep Oncol 2019; 12:855-860. [PMID: 31824279 DOI: 10.1159/000504339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 11/19/2022] Open
Abstract
Patients with invasive extramammary Paget's disease have an increased risk of secondary malignancy, mostly occurring colorectal carcinoma. TP53 is a regulator of apoptosis, cell cycle arrest, and DNA damage response pathways, and has been reported as one of the genetic biomarkers for colorectal carcinoma. In this report, we describe a case of advanced invasive EMPD concomitant with cecal cancer with a rare variant of TP53 single nucleotide polymorphism (rs121912665). To our knowledge, there is no English report that presents EMPD concomitant with cecal carcinoma.
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Affiliation(s)
- Yumi Kambayashi
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Taku Fujimura
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kentaro Ohuchi
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hisayuki Tono
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Atsushi Otsuka
- Department of Dermatology, Kyoto University, Kyoto, Japan
| | - Setsuya Aiba
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
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18
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Primo WQSP, Primo GRP, Basilio DB, Machado KK, Carvalho JP, Carvalho FM. Vulvar Paget disease secondary to high-grade urothelial carcinoma with underlying massive vascular embolization and cervical involvement: case report of unusual presentation. Diagn Pathol 2019; 14:125. [PMID: 31699107 PMCID: PMC6836446 DOI: 10.1186/s13000-019-0895-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/25/2019] [Indexed: 12/17/2022] Open
Abstract
Background Vulvar extramammary Paget disease is a rare chronic condition, that presents with non-specific symptoms such as pruritus and eczematous lesions. Because most of these lesions are noninvasive, the distinction between primary and secondary Paget disease is crucial to management. Case presentation We report an unusual case of vulvar Paget disease associated with massive dermal vascular embolization, cervicovaginal involvement and metastasis to inguinal and retroperitoneal lymph nodes. The intraepithelial vulvar lesion had a classical appearance and was accompanied by extensive component of dermal lymphovascular tumor emboli, similar to those observed in inflammatory breast carcinoma. Immunohistochemical analysis revealed that the lesion was secondary to high-grade urothelial cell carcinoma. The patient had a history of superficial low-grade papillary urothelial carcinoma of the bladder, which had appeared 2 years before the onset of vulvar symptoms. Conclusions Eczematoid vulvar lesions merit careful clinical examination and biopsy, including vulva mapping and immunohistochemistry. The information obtained may help to define and classify a particular presentation of Paget disease. Noninvasive primary lesions do not require the same aggressive approaches required for the treatment of invasive and secondary disease.
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Affiliation(s)
| | | | - Dunya Bachour Basilio
- Department of Pathology, Instituto Hospital de Base do Distrito Federal IHBDF, Secretaria de Estado da Saude, Brasilia, DF, Brazil
| | | | - Jesus Paula Carvalho
- Instituto do Cancer do Estado de São Paulo ICESP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Filomena M Carvalho
- Department of Pathology, Faculdade de Medicina FMUSP, Universidade de São Paulo, Av. Dr. Arnaldo, 455 - room 1149, Sao Paulo, SP, 01246-903, Brazil.
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19
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Pourmaleki M, Young JH, Socci ND, Chiang S, Edelweiss M, Li Y, Zhang M, Roshal L, Chi DS, Busam KJ, Mellinghoff IK, Hollmann TJ. Extramammary Paget disease shows differential expression of B7 family members B7-H3, B7-H4, PD-L1, PD-L2 and cancer/testis antigens NY-ESO-1 and MAGE-A. Oncotarget 2019; 10:6152-6167. [PMID: 31692889 PMCID: PMC6817453 DOI: 10.18632/oncotarget.27247] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/16/2019] [Indexed: 12/12/2022] Open
Abstract
Extramammary Paget disease (EMPD) is a rare cutaneous adenocarcinoma of the anogenital region most commonly treated with surgical excision. Surgical margin clearance is often problematic and recurrence rates remain high indicating the need for additional therapeutic options. Topical immunomodulators have been used with reported success suggesting EMPD may respond to other immunotherapies. This study investigates EMPD protein expression of targetable B7 family members and cancer/testis antigens (CTAs) B7-H3, B7-H4, PD-L1, PD-L2, MAGE-A, and NY-ESO-1 and components of antigen presenting machinery B2M and MHC-I. Fifty-seven specimens from 48 patients (31 female and 17 male), representing in situ, invasive, and metastatic disease of primary and secondary origin were stained and scored (627 total slides). The percentage of cases expressing each immune regulatory molecule in the in situ followed by invasive tumor components was: B7-H3 (94, 90), B7-H4 (82, 78), PD-L1 (6, 10), MAGE-A (39, 50), NY-ESO-1 (16, 20), B2M (100, 89), and MHC-I (78, 79). PD-L2 was negative in all cases. There was high correlation between marker expression within the in situ and invasive tumor components of the same case. B7-H4 was preferentially expressed in primary cutaneous EMPD. Co-expression of B7 family members B7-H3 and B7-H4 was found within the in situ and invasive tumor components of 74% and 48% of cases, respectively. These findings provide an initial characterization of EMPD tumor cell expression of B7-H3, B7-H4, PD-L1, PD-L2, MAGE-A, and NY-ESO-1 and indicate the potential for new immunotherapeutic options for patients with EMPD.
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Affiliation(s)
- Maryam Pourmaleki
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jonathan H Young
- Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.,Present address: School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Nicholas D Socci
- Bioinformatics Core, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Sarah Chiang
- Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Marcia Edelweiss
- Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Yanyun Li
- Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Mianlei Zhang
- Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Lev Roshal
- Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Dennis S Chi
- Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Klaus J Busam
- Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Ingo K Mellinghoff
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.,Neurology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Travis J Hollmann
- Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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20
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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.
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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
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21
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22
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Panoskaltsis T, Arkoumanis TP, Panagopoulos N, Mastorakos D. Vulvo-Perineal and Perianal Paget Disease. Radical Excision and Reconstruction with Singapore Flap. ACTA MEDICA (HRADEC KRÁLOVÉ) 2019; 62:77-81. [PMID: 31362815 DOI: 10.14712/18059694.2019.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Extramammary Paget disease (EMPD) is an uncommon intraepithelial malignancy, affecting the vulvo-perineal and perianal region, occurring in 6.5% of all Paget diseases. Usually, an underlying invasive adenocarcinoma denotes a more aggressive behaviour of the disease. We present the multidisciplinary approach in a 75-year old patient with this rare disease. The patient underwent a radical surgical excision and, subsequently, a Singapore flap was used for primary closure. The final histology confirmed the presence of a non-invasive Paget tumor, but a focus of high-grade invasive adenocarcinoma was noted in a perineal nodule. The histological margins were free of tumor. The patient did not undergo any adjuvant treatment because of severe chronic medical problems, although, eighteen months after treatment, she remains well, with no signs of recurrence. In conclusion, radical surgical excision, often necessitating reconstruction techniques, remains the gold standard of care and further adjuvant treatment should be individualised.
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Affiliation(s)
- Theodoros Panoskaltsis
- Gynaecological Oncology Unit, 2nd Academic Department of Obstetrics & Gynaecology, Aretaieion Hospital, National & Kapodistrian University of Athens, Greece
| | | | - Nikolaos Panagopoulos
- Gynaecological Oncology Unit, 2nd Academic Department of Obstetrics & Gynaecology, Aretaieion Hospital, National & Kapodistrian University of Athens, Greece
| | - Dimitrios Mastorakos
- 2nd Academic Department of General Surgery, Aretaieion Hospital, National & Kapodistrian University of Athens, Greece
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23
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Kang Z, Zhu Y, Zhang QA, Dong L, Xu F, Zhang X, Guan M. Methylation and expression analysis of mismatch repair genes in extramammary Paget's disease. J Eur Acad Dermatol Venereol 2019; 33:874-879. [PMID: 30784122 DOI: 10.1111/jdv.15404] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/21/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Extramammary Paget's disease (EMPD) is a rare skin cancer with relative high frequencies of germline and somatic mismatch repair (MMR) genes mutations. However, the methylation and expression of these genes have not been validated in EMPD. OBJECTIVE This study aims to confirm the methylation and expression of MMR genes in EMPD. METHODS Immunohistochemical (IHC) staining detection and Methylation-specific PCR (MSP) were used to analyse MLH1, MSH2, MSH6 and PMS2 proteins' expression and promoters' methylation in 57 EMMD samples, and pyro-sequence was used to find highly methylated CpG sites in MSH2 promoter. RESULTS Immunohistochemical detection displayed reduced expression of MSH2 in 38.6% EMPD cases but normal expression of MLH1, MSH6 and PMS2 in all tumour tissues. Hypermethylation also was found in the promoter of MSH2 but not in other MMR genes. Pyrosequencing of MSH2 promoter showed CpG6 (-87) and CpG3 (-98) were the most common two methylated CpG dinucleotides. There is a significant correlation between reduced MSH2 expression and MSH2 methylation. CONCLUSION Reduced MSH2 expression and hypermethylation in this gene promoter were common genetic changes in EMPD, which expands our understanding of the role of MMR function in this skin cancer.
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Affiliation(s)
- Z Kang
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, P. R. China
| | - Y Zhu
- Department of Pathology, Huashan Hospital North, Fudan University, Shanghai, P. R. China
| | - Q-A Zhang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, P. R. China
| | - L Dong
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, P. R. China
| | - F Xu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, P. R. China
| | - X Zhang
- Central Laboratory, Huashan Hospital, Fudan University, Shanghai, P. R. China
| | - M Guan
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, P. R. China.,Central Laboratory, Huashan Hospital, Fudan University, Shanghai, P. R. China
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24
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Simonds RM, Segal RJ, Sharma A. Extramammary Paget's disease: a review of the literature. Int J Dermatol 2018; 58:871-879. [PMID: 30569580 DOI: 10.1111/ijd.14328] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 11/08/2018] [Accepted: 11/14/2018] [Indexed: 01/01/2023]
Abstract
Extramammary Paget's disease (EMPD) is a rare cutaneous malignancy. The disease typically affects older individuals aged 60-80 years and is seen most frequently in postmenopausal Caucasian women and Asian men. EMPD exhibits a predilection for the genital and perianal regions and may be associated with an underlying carcinoma in adjacent organs. EMPD presents a challenge in both diagnosis and management. Often treated empirically as various dermatitides, the correct diagnosis is frequently delayed by many years. Following diagnosis, an extensive search for an associated malignancy should be initiated. If invasive disease is present on biopsy, a sentinel lymph node biopsy may guide further treatment. Mohs micrographic surgery appears to be superior to wide local excision when considering tissue sparing ability and disease recurrence. Nonsurgical interventions have also been investigated with varied results. Regardless of treatment method, long-term follow-up is recommended to monitor for local disease recurrence, development of internal malignancy, regional lymphadenopathy, or distant metastasis.
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Affiliation(s)
- Robert M Simonds
- Department of Dermatology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Robert J Segal
- Division of Dermatology, University of Arizona, Tucson, AZ, USA
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25
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Cooper SM, Matin R. Screening for associated malignancies in vulval Paget disease clarified. Br J Dermatol 2018; 179:1242. [PMID: 30508245 DOI: 10.1111/bjd.17116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- S M Cooper
- Department of Dermatology, Churchill Hospital, Headington, Oxford, OX3 7LJ, U.K
| | - R Matin
- Department of Dermatology, Churchill Hospital, Headington, Oxford, OX3 7LJ, U.K
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26
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van der Linden M, Schuurman M, Bulten J, Massuger L, IntHout J, van der Aa M, de Hullu J. Stop routine screening for associated malignancies in cutaneous noninvasive vulvar Paget disease? Br J Dermatol 2018; 179:1315-1321. [DOI: 10.1111/bjd.16894] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2018] [Indexed: 12/13/2022]
Affiliation(s)
- M. van der Linden
- Department of Obstetrics and Gynaecology (791); Radboud University Medical Center; 6500 HB Nijmegen the Netherlands
| | - M.S. Schuurman
- Department of Research; Comprehensive Cancer Organisation the Netherlands (IKNL); Utrecht the Netherlands
| | - J. Bulten
- Department of Pathology (812); Radboud University Medical Center; 6500 HB Nijmegen the Netherlands
| | - L.F.A.G. Massuger
- Department of Obstetrics and Gynaecology (791); Radboud University Medical Center; 6500 HB Nijmegen the Netherlands
| | - J. IntHout
- Department for Health Evidence (133); Radboud Institute for Health Sciences; Radboud University Medical Center; 6500 HB Nijmegen the Netherlands
| | - M.A. van der Aa
- Department of Research; Comprehensive Cancer Organisation the Netherlands (IKNL); Utrecht the Netherlands
| | - J.A. de Hullu
- Department of Obstetrics and Gynaecology (791); Radboud University Medical Center; 6500 HB Nijmegen the Netherlands
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Schmitt AR, Long BJ, Weaver AL, McGree ME, Bakkum-Gamez JN, Brewer JD, Cliby WA. Evidence-Based Screening Recommendations for Occult Cancers in the Setting of Newly Diagnosed Extramammary Paget Disease. Mayo Clin Proc 2018; 93:877-883. [PMID: 29804724 DOI: 10.1016/j.mayocp.2018.02.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/20/2018] [Accepted: 02/23/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To identify the rates of associated and occult cancers in patients with extramammary Paget disease (EMPD) discovered using cancer screening methods at a tertiary medical center; to propose evidence-based cancer screening guidelines at the time of diagnosis of EMPD; and to clarify terminology associating EMPD with underlying malignancies. PATIENTS AND METHODS A retrospective review of patients with histologically confirmed EMPD presenting for care at our institution between January 1, 1992, and December 31, 2015, was performed. Both male and female patients were included. Descriptive analysis was performed. RESULTS A total of 161 patients met the inclusion criteria. Most (59.6%) were female patients, and the mean age at the time of EMPD diagnosis was 70.8±10.1 years. Most (82%) of the 161 patients had at least 1 cancer screening test performed, though screening practices varied widely. Of those screened for an underlying malignancy, 17 distant, noncontiguous malignancies were identified in 15 patients (11.4%), with prostate (n=5), urinary tract (n=5), and breast (n=2) malignancies found most frequently. Most malignancies were identified by urine cytology, mammography, and prostate-specific antigen blood test. Of all patients, 37 (23.0%) had an underlying contiguous malignancy identified by pathology. CONCLUSION All patients diagnosed with EMPD should undergo cancer screening. At minimum, evaluation should include age-appropriate screening and the addition of urine cytology, mammography, and prostate-specific antigen blood test-if not already performed-may be of particular use. An algorithm for evaluation of patients with newly diagnosed EMPD is proposed.
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Affiliation(s)
| | - Beverly J Long
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Amy L Weaver
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Michaela E McGree
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Jamie N Bakkum-Gamez
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Jerry D Brewer
- Department of Dermatology, Mayo Clinic, Rochester, MN; Division of Dermatologic Surgery, Mayo Clinic, Rochester, MN
| | - William A Cliby
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN.
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Yao H, Xie M, Fu S, Guo J, Peng Y, Cai Z, Jiang Y, Zheng D, Wang Z. Survival analysis of patients with invasive extramammary Paget disease: implications of anatomic sites. BMC Cancer 2018; 18:403. [PMID: 29636019 PMCID: PMC5894213 DOI: 10.1186/s12885-018-4257-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 03/20/2018] [Indexed: 11/21/2022] Open
Abstract
Background Extramammary Paget disease (EMPD) is a rare malignant dermatosis with poorly defined outcomes. We investigated clinical characteristics of invasive EMPD at different anatomic sites and by subject demographics to determine prognostic factors for overall survival (OS). Methods All patient data were collected from the Surveillance, Epidemiology, and End Results (SEER) program, 1973–2013, of the U.S. National Cancer Institute. Patients with invasive EMPD of skin, vulva/labia, vagina, scrotum/penis, or other sites were included. After excluding patients with unknown radiation status, data of 2001 patients were analyzed. Primary endpoint was EMPD mortality by anatomic sites. Independent variables included patients’ demographic data, concurrent malignancy (ie, non-EMPD related cancers), tumor size, distant metastasis, and surgery and/or radiation or not. Results Multivariate regression analysis showed that mortality was significantly higher in patients with vaginal EMPD than in patients with vulvar/labial EMPD (adjusted hazard ratio [aHR] = 3.26, p < 0.001). Patients with distant metastasis had higher mortality than those without (aHR = 3.36, p < 0.001). Patients who received surgery had significantly lower mortality than those who did not receive surgery (aHR = 0.77, p = 0.030), and those treated with radiation had significantly higher mortality than those who did not receive radiation (aHR = 1.60, p = 0.002). Older age was associated with significantly increased mortality (aHR = 1.09, p < 0.001), and mortality was significantly higher in males than in females (aHR = 1.42, p = 0.008). Conclusions In conclusion, among EMPD patients, mortality is higher in patients with vaginal EMPD than in those with vulvar/labial EMPD and higher in those who are older, those with concurrent malignancy or distant metastasis. Mortality is also higher in males than in females. Surgery is a protective factor and radiation is a risk factor for OS. Greater understanding of EMPD clinical characteristics, and considering EMPD in differential diagnosis of chronic genital and perianal dermatoses may provide support for early EMPD diagnosis and definitive surgical treatment.
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Affiliation(s)
- Haijun Yao
- Department of Urology, Shanghai 9th People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, People's Republic of China
| | - Minkai Xie
- Department of Urology, Shanghai 9th People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, People's Republic of China
| | - Shibo Fu
- Department of Urology, Shanghai 9th People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, People's Republic of China
| | - Jianhua Guo
- Department of Urology, Shanghai 9th People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, People's Republic of China
| | - Yubing Peng
- Department of Urology, Shanghai 9th People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, People's Republic of China
| | - Zhikang Cai
- Department of Urology, Shanghai 9th People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, People's Republic of China
| | - Yueqing Jiang
- Department of Urology, Shanghai 9th People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, People's Republic of China
| | - Dachao Zheng
- Department of Urology, Shanghai 9th People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, People's Republic of China.
| | - Zhong Wang
- Department of Urology, Shanghai 9th People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, People's Republic of China.
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Extramammary Paget Disease of the Vulva: A Case Series Examining Treatment, Recurrence, and Malignant Transformation. Int J Gynecol Cancer 2018; 28:632-638. [DOI: 10.1097/igc.0000000000001189] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
ObjectivesExtramammary Paget disease (EMPD) of the vulva is a rare lesion with a high recurrence rate ranging from 12% to 61%. The rate of underlying adenocarcinoma varies, but in the largest series was reported at 4%. Given the rarity of the disease there is a paucity of data to optimize treatment. This study aims to describe the management and recurrence patterns in a tertiary care setting and to offer suggestions for management in a modern-day setting.MethodsPatients with pathologically confirmed EMPD treated from 2000 to 2015 were retrospectively identified using an IRB approved database. Clinical data were abstracted from the electronic medical record. Pathology underwent central review.ResultsForty-four patients met criteria and underwent central pathology review. Forty-two patients were treated with surgical excision. Alternative treatment modalities included Mohs surgery in 3 patients and medical therapy in 20 patients. The median number of surgical procedures was 1 and the number of procedures ranged from 1 to 16. Twenty-five patients (56.8%) had recurrent disease with a median of 2 (1-6) recurrences per patient. The median disease-free interval was 28.7 months with a median follow up of 45.8 months (1.2-178.9 months). Three patients (7%) had invasive cancer and 7 patients (16%) were diagnosed with a separate malignancy at or following diagnosis of EMPD. Despite radical resection, the majority of patients had positive margins and there was no significant difference in disease recurrence between simple and radical resection (P = 0.69).ConclusionsPatients with EMPD in this series have a high rate of recurrence. Many undergo multi-modal therapy often with multiple providers. However, patients experience relatively long disease-free intervals with a low rate of associated malignancy. We propose an algorithm for management that focuses on symptom control and minimizing morbidity of treatment intervention once invasive disease has been excluded.
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Zhao M, Zhou L, Sun L, Song Y, Guo Y, Zhang X, Zhao F, Wang P, Yue J, Niu D, Li Z, Huang X, Kang Q, Jia L, Lai J, Cao D. GATA3 is a sensitive marker for primary genital extramammary paget disease: an immunohistochemical study of 72 cases with comparison to gross cystic disease fluid protein 15. Diagn Pathol 2017; 12:51. [PMID: 28693610 PMCID: PMC5504764 DOI: 10.1186/s13000-017-0638-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 06/26/2017] [Indexed: 02/08/2023] Open
Abstract
Background GATA-binding protein 3 (GATA3) has been identified as a sensitive marker for breast carcinoma but its sensitivity in primary genital extramammary Paget diseases (EMPDs) has not been well studied. Methods Here we investigated immunohistochemical expression of GATA3 in 72 primary genital EMPDs (35 from female, 37 from male; 45 with intraepithelial disease only, 26 with both intraepithelial disease and invasive adenocarcinoma including 14 also metastasis, 1 with metastatic adenocarcinoma only for study). We also compared GATA3 to gross cystic disease fluid protein 15 (GCDFP15) for their sensitivity. Results Positive GATA3 staining was seen in all 71 (100%) intraepithelial diseases, 25/26 (96%; female 10/10, male 15/16) invasive adenocarcinomas and 14/15 (93%; female 3/3, male 11/12) metastatic adenocarcinomas, respectively. Positive GCDFP15 staining was seen in 46/71 (65%; female 28/34 or 82%, male 18/37 or 49%) intraepithelial diseases, 20/26 (77%; female 9/10, male 11/16) invasive adenocarcinomas, and 12/15 (80%; female 2/3, male 10/12) metastatic adenocarcinomas, respectively (GATA3 versus GCDFP15: p < 0.01 for both intraepithelial disease and invasive adenocarcinoma, p = 0.28 for metastatic adenocarcinoma). In positive-stained cases, GATA3 stained more tumor cells than GCDFP15 (79% versus 25% for intraepithelial disease, 71% vs 34% for invasive adenocarcinoma, 73% vs 50% for metastatic adenocarcinoma, p < 0.01 for all 3 components). Conclusions Our findings indicate that GATA3 is a very sensitive marker for primary genital EMPDs and is more sensitive than GCDFP15.
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Affiliation(s)
- Ming Zhao
- Department of Pathology, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Lixin Zhou
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital (Beijing Cancer Hospital), Beijing, China
| | - Li Sun
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital (Beijing Cancer Hospital), Beijing, China
| | - Yan Song
- Department of Pathology, Cancer Hospital of Chinese Academy of Medical Sciences, Beijing, China
| | - Yunquan Guo
- Department of Pathology, Xinjiang Medical University Affiliated Tumor Hospital, Urumqi, China
| | - Xun Zhang
- Department of Pathology, Cancer Hospital of Chinese Academy of Medical Sciences, Beijing, China
| | - Feng Zhao
- Department of Pathology, Xinjiang Medical University Affiliated Tumor Hospital, Urumqi, China
| | - Peng Wang
- Department of Pathology, Beijing Ditan Hospital, Beijing, China
| | - Junqiu Yue
- Department of Pathology, Hubei Cancer Hospital, Wuhan, China
| | - Dongfeng Niu
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital (Beijing Cancer Hospital), Beijing, China
| | - Zhongwu Li
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital (Beijing Cancer Hospital), Beijing, China
| | - Xiaozheng Huang
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital (Beijing Cancer Hospital), Beijing, China
| | - Qiang Kang
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital (Beijing Cancer Hospital), Beijing, China
| | - Lin Jia
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital (Beijing Cancer Hospital), Beijing, China
| | - Jinping Lai
- Department of Pathology, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Dengfeng Cao
- Department of Pathology and Immunology, Washington University School of Medicine, 660 S South Euclid Avenue Campus Box 8118, Saint Louis, MO, 63110, USA.
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Invasive Extramammary Paget Disease of the Vulva With Signet Ring Cell Morphology in a Patient With Signet Ring Cell Carcinoma of the Stomach: Report of a Case. Int J Gynecol Pathol 2017; 37:147-151. [PMID: 28582341 DOI: 10.1097/pgp.0000000000000405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This report describes a rare case of invasive extramammary Paget disease of the vulva with signet ring cell morphology in a 58-yr-old woman with a history of signet ring cell carcinoma of the stomach. This case was initially misinterpreted as a metastatic gastric carcinoma to the vulva because an initial small, superficial biopsy specimen showed infiltration of signet ring cells in the dermis without intraepidermal Paget cells. However, a surgically resected specimen showed concordant immunophenotypes in both intraepidermal Paget cells and intradermal signet ring cell components with immunoreactivity to cytokeratin (CK) 7, CEA, and gross cystic disease fluid protein-15, and immunonegativity for CK20, MUC5AC, and MUC6. Gastric signet ring cell carcinoma showed immunoreactivity to CK7, CEA, MUC5AC, and MUC6, and immunonegativity for gross cystic disease fluid protein-15 and CK20. The diagnosis of primary invasive extramammary Paget disease of the vulva was also supported by a long interval after gastrectomy (7.5 yr), the solitary involvement of the vulva, and the absence of lymphovascular invasion. This case demonstrates that invasive extramammary Paget disease may have a signet ring cell morphology and immunohistochemical profile similar to those of gastric signet ring cell carcinoma, but the addition of gross cystic disease fluid protein-15 immunostain in the panel of markers is helpful in the differential diagnosis.
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Surgical Treatment of Cutaneous Extramammary Paget’s Disease. CURRENT DERMATOLOGY REPORTS 2016. [DOI: 10.1007/s13671-016-0142-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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van der Linden M, Meeuwis K, Bulten J, Bosse T, van Poelgeest M, de Hullu J. Paget disease of the vulva. Crit Rev Oncol Hematol 2016; 101:60-74. [DOI: 10.1016/j.critrevonc.2016.03.008] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 01/25/2016] [Accepted: 03/03/2016] [Indexed: 01/03/2023] Open
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Phuoc V, Grothey A. Metastatic extramammary Paget's disease responding to weekly paclitaxel. BMJ Case Rep 2015; 2015:bcr-2014-208653. [PMID: 25903204 DOI: 10.1136/bcr-2014-208653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Metastatic extramammary Paget's disease (EMPD) is a rare cancer with no validated systemic treatment. Regimens including FECOM 5-fluorouracil (5-FU, epirubicin, carboplatin, vincristine and mitomycin C), 5-FU/cisplatin and single agent docetaxel exhibited varying levels of efficacy in case reports. A 58-year-old man with EMPD diffusely metastatic to bone presented with worsening shortness of breath, significant pancytopenia and disseminated intravascular coagulation (DIC). He was started on low-dose heparin for the DIC and weekly paclitaxel. Initially requiring almost daily transfusions, his shortness of breath improved after two doses of paclitaxel, and he became transfusion-independent after only three doses. Correlating with his disease course, the patient's prepaclitaxel carcinoembryonic antigen level of 62.1 ng/mL decreased to 7.4 ng/mL on 3-month follow-up, and he showed no progression of disease on imaging. With no validated chemotherapy regimen currently, this case can help guide consideration of paclitaxel in future treatment of metastatic EMPD.
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Affiliation(s)
- Vania Phuoc
- Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Axel Grothey
- Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
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35
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36
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Metastatic Extramammary Paget's Disease of Scrotum Responds Completely to Single Agent Trastuzumab in a Hemodialysis Patient: Case Report, Molecular Profiling and Brief Review of the Literature. Case Rep Oncol Med 2015; 2015:895151. [PMID: 25692060 PMCID: PMC4322830 DOI: 10.1155/2015/895151] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 01/08/2015] [Indexed: 12/19/2022] Open
Abstract
Extramammary Paget's disease (EMPD) is a rare cancer. Although EMPD is usually noninvasive and treated with local therapy, once metastatic the prognosis of EMPD is poor and treatment options are limited. We report a case of a complete response to single agent trastuzumab in a hemodialysis patient with metastatic Her2/neu overexpressed EMPD of the scrotum. Molecular profiling of his case as well as 12 other EMPD and 8 mammary Paget disease (MPD) cases was completed and revealed multiple biomarker aberrations. Overexpression of Her2 was frequently noted (30%-40%) in both EMPD and MPD patients and when present can be effectively treated with Her2 targeted agents. Trastuzumab therapy can be safely utilized in a hemodialysis patient. In addition, multiple protein overexpression and loss were seen in EMPD including PD-1, PD-L1, PTEN, and AR as well as PIK3CA mutation. These findings may lead to possible therapeutic interventions targeting these pathways in a disease with few effective treatment options.
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Rabban JT, Vohra P, Zaloudek CJ. Nongynecologic Metastases to Fallopian Tube Mucosa. Am J Surg Pathol 2015; 39:35-51. [DOI: 10.1097/pas.0000000000000293] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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38
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Ito T, Kaku Y, Nagae K, Nakano-Nakamura M, Nakahara T, Oda Y, Hagihara A, Furue M, Uchi H. Tumor thickness as a prognostic factor in extramammary Paget's disease. J Dermatol 2014; 42:269-75. [DOI: 10.1111/1346-8138.12764] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 11/30/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Takamichi Ito
- Department of Dermatology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
- Department of Anatomic Pathology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Yumiko Kaku
- Department of Dermatology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Konosuke Nagae
- Department of Dermatology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Misa Nakano-Nakamura
- Department of Dermatology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Takeshi Nakahara
- Department of Dermatology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Akihito Hagihara
- Department of Health Services Management and Policy; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Masutaka Furue
- Department of Dermatology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Hiroshi Uchi
- Department of Dermatology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
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