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Pérez JC, Salgado AC, Pérez-Mies B, Rullán JAD, Ajuria-Illarramendi O, Alia EMG, Serrano Domingo JJ. Extramammary Paget Disease: a Therapeutic Challenge, for a Rare Entity. Curr Oncol Rep 2023; 25:1081-1094. [PMID: 37421583 PMCID: PMC10556167 DOI: 10.1007/s11912-023-01434-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE OF REVIEW Extramammary Paget disease (EMPD) is a rare entity which is more frequently localized at the vulva, though it only accounts for 1-2% of vulvar neoplasms. It is a primary cutaneous adenocarcinoma whose cell of origin is still a matter of controversy: it can either arise from apocrine/eccrine glands or from stem cells. The diagnosis demands a biopsy and entails a histopathological analysis by which cells show similar characteristics as breast Paget disease. RECENT FINDINGS Treatment approach can entail surgery, radiotherapy, photodynamic therapy, systemic chemotherapy, and topical chemotherapy. For metastatic disease, many different chemotherapy regimens have been explored and even targeted therapy can play an important role in this disease. Since almost 30-40% of patients overexpress HER-2, trastuzumab and anti-HER-2 therapies can be employed in this setting. Due to its low incidence, there is almost no specific evidence on therapeutic interventions for this disease. Thus, there is a neat unmet need for molecular characterization of EMPD and diagnostic tools that allow clinicians to guide treatment both in the early and in the advanced disease settings. In this review, we aim to summarize available evidence about diagnosis and treatment of EMPD, both localized and metastatic, and to provide a comprehensive analysis that may help clinicians for therapeutic decisions.
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Affiliation(s)
- Jesús Chamorro Pérez
- Medical Oncology Department, Ramón y Cajal University Hospital, Carretera de Colmenar Viejo, Km 9.100, 28034 Madrid, CP Spain
| | - Alfonso Cortes Salgado
- Medical Oncology Department, Ramón y Cajal University Hospital, Carretera de Colmenar Viejo, Km 9.100, 28034 Madrid, CP Spain
| | - Belén Pérez-Mies
- Pathology Department, Ramón y Cajal University Hospital, Carretera de Colmenar Viejo, Km 9.100, 28034 Madrid, CP Spain
| | - Jose Antonio Domínguez Rullán
- Radiation Oncology Department, Ramón y Cajal University Hospital, Carretera de Colmenar Viejo, Km 9.100, 28034 Madrid, CP Spain
| | - Odile Ajuria-Illarramendi
- Nuclear Medicine Department, Ramón y Cajal University Hospital, Carretera de Colmenar Viejo, Km 9.100, 28034 Madrid, CP Spain
| | - Eva María Guerra Alia
- Medical Oncology Department, Ramón y Cajal University Hospital, Carretera de Colmenar Viejo, Km 9.100, 28034 Madrid, CP Spain
| | - Juan José Serrano Domingo
- Medical Oncology Department, Ramón y Cajal University Hospital, Carretera de Colmenar Viejo, Km 9.100, 28034 Madrid, CP Spain
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2
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Irawati N, Moghadam A, Abdul-Razak M, Strach M, Elliott M, Ch'ng S, Shannon K, Palme CE, Clark J, Wykes J, Low THH. Outcomes after definitive treatment for head and neck angiosarcoma. ANZ J Surg 2022; 92:1407-1414. [PMID: 35531880 DOI: 10.1111/ans.17695] [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: 01/30/2022] [Revised: 03/08/2022] [Accepted: 03/22/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Head and neck angiosarcoma (HN-AS) is a rare and aggressive, representing <1% of all head and neck malignancies. It is characterized by a high rate of local recurrence and poor 5-year survival (10-54%). Australian data in this rare disease is lacking. We aim review the clinical outcomes of HN-AS from two high volume head and neck cancer units in Australia. METHODS Retrospective chart review. RESULTS A total 26 patients were identified, consist of predominantly male patients (81%) with a mean age of 77 year old. Most of the HN-AS arises from the scalp (62%). The 5-year overall survival (OS) and disease free survival (DFS) were 41% and 15%, respectively. Patients treated with upfront surgery with adjuvant therapy has better OS and DFS compared with patients receiving upfront chemoradiotherapy (median OS 3.63 vs. 0.53 years, P = 0.011 and median DFS 1.19 vs. 0.33 years, P = 0.001). There is no difference in OS or DFS for the sites of HN-AS or age of patients. Recurrences were noted in 15 patients (57.7%). For those with metastatic disease, the most common site was the lung (80%) with a median time to development of distant disease of 2.7 years (range 1.8-3.6 years). In patients who underwent salvage treatment, the median survival (post-salvage) was 1.3 years (0-2.8 years). CONCLUSION This is the first Australian report of treatment patterns and outcomes of patients with HN-AS. Our cohort confirms that HN-AS is a slowly progressive disease with poor survival. Patients treated with surgery and adjuvant radiotherapy in this series had better outcomes compared with those treated with chemoradiotherapy alone. The role of neoadjuvant chemotherapy is an area of ongoing research.
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Affiliation(s)
- Nina Irawati
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia
| | | | | | - Madeleine Strach
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia
| | - Michael Elliott
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - Sydney Ch'ng
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - Kerwin Shannon
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - Carsten E Palme
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - Jonathan Clark
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - James Wykes
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - Tsu-Hui Hubert Low
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia.,Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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3
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Management of secondary Paget’s disease of the vulva associated with transitional cell carcinoma. J Cancer Res Clin Oncol 2022; 148:1697-1702. [DOI: 10.1007/s00432-022-04007-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 03/30/2022] [Indexed: 11/26/2022]
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4
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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.
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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.
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5
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Arita T, Kondo J, Kaneko Y, Tsutsumi M, Kanemaru M, Matsui M, Arakawa Y, Katoh N, Inoue M, Asai J. Novel ex vivo disease model for extramammary Paget's disease using the cancer tissue-originated spheroid method. J Dermatol Sci 2020; 99:185-192. [PMID: 32800410 DOI: 10.1016/j.jdermsci.2020.07.006] [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: 04/21/2020] [Revised: 07/14/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Extramammary Paget's disease (EMPD) is a rare skin cancer that frequently occurs in the anogenital region in the elderly. Prognosis in patients with metastatic EMPD is poor as EMPD treatment has advanced little in recent years, primarily because no EMPD cell line has been established. OBJECTIVE We aimed to establish an ex vivo EMPD disease model using the cancer tissue-originated spheroid (CTOS) method, which is used to prepare and culture primary cancer cells while maintaining cell-cell contact. METHODS Thirteen samples from 12 EMPD patients were obtained. CTOSs were prepared and cultured using CTOS method. Histopathological examination of the CTOSs was performed. We investigated optimum medium conditions and effects of growth factors for CTOS growth. Chemo-sensitivity assays were conducted. RESULTS CTOSs were successfully prepared from 3 primary lesions and 2 metastatic lymph nodes. Of these, 2 CTOSs (EMPD-3 and EMPD-4) could be maintained and passaged long term ex vivo. Following transplantation of CTOSs to NOD/Scid mice, CTOS-derived xenotumors exhibited ductal formation, indicating that CTOSs retained the original tumor characteristics. Chemo-sensitivity assays revealed that docetaxel significantly inhibited EMPD-3 growth in a dose-dependent manner, whereas EMPD-4 was not clearly inhibited. These findings indicate the heterogeneity of EMPD and potential use of chemosensitivity assays with patient-derived CTOS to select the most effective drugs for each patient. CONCLUSION To our knowledge, this study represents the first establishment of an ex vivo-EMPD disease model involving conventional cell lines. EMPD CTOSs might be useful for developing new therapeutic strategies.
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Affiliation(s)
- Takahiro Arita
- Department of Dermatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Jumpei Kondo
- Department of Clinical Bio-resource Research and Development, Graduate School of Medicine Kyoto University, Kyoto, Japan.
| | - Yuka Kaneko
- Department of Dermatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Miho Tsutsumi
- Department of Dermatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Mai Kanemaru
- Department of Dermatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Mari Matsui
- Department of Dermatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Yukiyasu Arakawa
- Department of Dermatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Norito Katoh
- Department of Dermatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Masahiro Inoue
- Department of Clinical Bio-resource Research and Development, Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - Jun Asai
- Department of Dermatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.
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6
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Nation-wide survey of advanced non-melanoma skin cancers treated at dermatology departments in Japan. J Dermatol Sci 2018; 92:230-236. [PMID: 30527378 DOI: 10.1016/j.jdermsci.2018.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/25/2018] [Accepted: 10/30/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND There are limited treatment options for advanced non-melanoma skin cancers (NMSCs). To overcome this issue, we need to conduct clinical studies, however, there is a lack of information on how many patients with advanced NMSCs are treated annually in Japan. OBJECTIVE To investigate the actual number of advanced NMSC patients in Japan. METHODS A questionnaire survey was sent to 668 institutes to educe information on: 1) the numbers of patients with squamous cell carcinoma (SCC), extramammary Paget disease (EMPD), other skin origin carcinomas, and cutaneous angiosarcoma (CAS) admitted in 2016 and 2017; 2) the preferred first- and second-line chemotherapies; and 3) the anticipated for future development. RESULTS Questionnaires were returned from 383 (57.3%) institutes. They reported a total of 1765 patients over the 2 years. The annual number patients with SCC, EMPD, other skin carcinomas, and CAS was 323.5, 192.5, 126, and 240.5, respectively. We estimated the annual number of patients for all 668 institutes to be 1255.6. Current first- and second-line treatment for NMSCs were chemotherapy regimens, but immune checkpoint inhibitors were the most anticipated new drugs for SCC and CAS, while chemotherapy was still the most anticipated treatment for EMPD. CONCLUSION Considering that during 2017, the number of deaths in Japan due to NMSC was reported to be 948, our estimated annual number of patients with NMSCs, 1255.6 seems to be an accurate estimation. As most of the treatment options for advanced NMSCs are outdated, the results of this study should be used to propose clinical studies.
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Cai H, Xu W, Yu B, Li X, Zhu L, Xu Z, Zhou J, Zheng Y, Zou Q, Zeng Y, Wang X, Xu T. Docetaxel Combined With Cisplatin for Metastatic Extramammary Paget Disease. Clin Genitourin Cancer 2018; 16:e899-e901. [DOI: 10.1016/j.clgc.2018.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/02/2018] [Accepted: 03/18/2018] [Indexed: 11/29/2022]
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8
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Yoshihara Y, Itoh M, Nobeyama Y, Nakagawa H. A Case of Advanced Extramammary Paget's Disease Successfully Controlled by Monthly but Not Weekly Docetaxel Chemotherapy. Case Rep Oncol 2016; 9:6-10. [PMID: 26933412 PMCID: PMC4748788 DOI: 10.1159/000443234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Extramammary Paget's disease (EMPD) is an uncommon cutaneous adenocarcinoma arising from the apocrine glands within the epidermis or underlying skin appendages in the anogenital and axillary regions. Surgical excision is basically performed as a treatment for EMPD. However, therapeutic options for EMPD in an advanced stage are limited. Herein, we report the case of a Japanese woman with advanced EMPD successfully controlled by monthly but not weekly docetaxel therapy. We also demonstrate the possibility that a monthly regimen of docetaxel is a more effective and optimal schedule than a weekly one through this case report.
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Affiliation(s)
- Yuki Yoshihara
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Munenari Itoh
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yoshimasa Nobeyama
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hidemi Nakagawa
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
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9
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Yoshino K, Fujisawa Y, Kiyohara Y, Kadono T, Murata Y, Uhara H, Hatta N, Uchi H, Matsushita S, Takenouchi T, Hayashi T, Ohara K. Usefulness of docetaxel as first-line chemotherapy for metastatic extramammary Paget's disease. J Dermatol 2015; 43:633-7. [DOI: 10.1111/1346-8138.13200] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 09/28/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Koji Yoshino
- Department of Dermatology; Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital; Tokyo Japan
| | | | - Yoshio Kiyohara
- Department of Dermatology; Shizuoka Cancer Center; Sunto-gun Shizuoka Japan
| | | | - Yozo Murata
- Department of Dermatology; Hyogo Cancer Center; Akashi Japan
| | - Hisashi Uhara
- Department of Dermatology; Shinshu University School of Medicine; Matsumoto Japan
| | - Naohito Hatta
- Department of Dermatology; Toyama Prefectural Central Hospital; Toyama Japan
| | - Hiroshi Uchi
- Department of Dermatology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Shigeto Matsushita
- Department of Dermatology Faculty of Medicine; Kagoshima University; Kagoshima Japan
| | - Tatsuya Takenouchi
- Department of Dermatology; Niigata Cancer Center Hospital; Niigata Japan
| | - Toshihiko Hayashi
- Department of Plastic and Reconstructive Surgery; University of Hokkaido; Sapporo Japan
| | - Kuniaki Ohara
- Department of Dermatology; Toranomon Hospital; Tokyo Japan
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10
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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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11
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Tauveron V, Body G, Machet L, Lenain H, Ouldamer L, Lorette G. Prolonged remission of Paget disease of the vulva after chemotherapy for breast carcinoma. Br J Dermatol 2015; 170:1199-200. [PMID: 24404871 DOI: 10.1111/bjd.12825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- V Tauveron
- Department of Dermatology, CHRU de Tours, Tours, France
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12
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Dai B, Kong YY, Chang K, Qu YY, Ye DW, Zhang SL, Zhang HL. Primary invasive carcinoma associated with penoscrotal extramammary Paget's disease: a clinicopathological analysis of 56 cases. BJU Int 2014; 115:153-60. [DOI: 10.1111/bju.12776] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Bo Dai
- Department of Urology; Fudan University Shanghai Cancer Center; Shanghai China
- Department of Oncology; Fudan University Shanghai Medical College; Shanghai China
| | - Yun-Yi Kong
- Department of Oncology; Fudan University Shanghai Medical College; Shanghai China
- Department of Pathology; Fudan University Shanghai Cancer Center; Shanghai China
| | - Kun Chang
- Department of Urology; Fudan University Shanghai Cancer Center; Shanghai China
- Department of Oncology; Fudan University Shanghai Medical College; Shanghai China
| | - Yuan-Yuan Qu
- Department of Urology; Fudan University Shanghai Cancer Center; Shanghai China
- Department of Oncology; Fudan University Shanghai Medical College; Shanghai China
| | - Ding-Wei Ye
- Department of Urology; Fudan University Shanghai Cancer Center; Shanghai China
- Department of Oncology; Fudan University Shanghai Medical College; Shanghai China
| | - Shi-Lin Zhang
- Department of Urology; Fudan University Shanghai Cancer Center; Shanghai China
- Department of Oncology; Fudan University Shanghai Medical College; Shanghai China
| | - Hai-Liang Zhang
- Department of Urology; Fudan University Shanghai Cancer Center; Shanghai China
- Department of Oncology; Fudan University Shanghai Medical College; Shanghai China
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13
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Rajendran S, Koh CE, Solomon MJ. Extramammary Paget's disease of the perianal region: a 20-year experience. ANZ J Surg 2014; 87:132-137. [PMID: 25113623 DOI: 10.1111/ans.12814] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND To evaluate the results obtained from cases of perianal Paget's disease (PPD) and to provide a current perspective in the diagnostic evaluation and surgical management of this condition. METHODS A retrospective review of a single quaternary referral centre's experience with PPD from January 1994 to December 2013 was performed. Medical records were reviewed to collect data on demographics, preoperative investigations, complications, pathology and recurrence. A review of existing literature was also performed. RESULTS Five patients (four females, one male) with histologically confirmed PPD were identified. The median age of presentation was 72 (range 61 to 78). Three patients were recurrences following previous excisions and first presentations in two patients. Only one patient had an underlying diagnosis of cancer. The median time to diagnosis was 24 months. Four patients underwent wide local excision with skin graft and/or local flap reconstruction and one patient required an abdominoperineal excision for recurrence. Four patients had involved lateral margins despite wide local excision but follow-up to date has only revealed one local recurrence. A review of available literature suggests that synchronous cancers can occur in up to 33% of patients and that a further 10% may be associated with metachronous cancers. Surveillance recommendations seem anecdotal and do not appear to be supported by available literature. CONCLUSION PPD is a management challenge. Association with synchronous and metachronous carcinomas may not be as strong as initially thought. Surgery is the mainstay treatment with the need to balance between minimizing disease recurrence and functional sequelae from excessive tissue loss.
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Affiliation(s)
- Saissan Rajendran
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Cherry E Koh
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Michael J Solomon
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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14
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Oashi K, Tsutsumida A, Namikawa K, Tanaka R, Omata W, Yamamoto Y, Yamazaki N. Combination chemotherapy for metastatic extramammary Paget disease. Br J Dermatol 2014; 170:1354-7. [DOI: 10.1111/bjd.12788] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2013] [Indexed: 10/25/2022]
Affiliation(s)
- K. Oashi
- Department of Dermatologic Oncology; National Cancer Center Hospital; 5-1-1 Tsukiji, Chuo-ku Tokyo 104-0045 Japan
- Department of Plastic and Reconstructive Surgery; Graduate School of Medicine; University of Hokkaido at Sapporo, Kita-15 Nishi-7, Kita-Ku, Sapporo Hokkaido, 060-8638 Japan
| | - A. Tsutsumida
- Department of Dermatologic Oncology; National Cancer Center Hospital; 5-1-1 Tsukiji, Chuo-ku Tokyo 104-0045 Japan
| | - K. Namikawa
- Department of Dermatologic Oncology; National Cancer Center Hospital; 5-1-1 Tsukiji, Chuo-ku Tokyo 104-0045 Japan
| | - R. Tanaka
- Department of Dermatologic Oncology; National Cancer Center Hospital; 5-1-1 Tsukiji, Chuo-ku Tokyo 104-0045 Japan
| | - W. Omata
- Department of Dermatologic Oncology; National Cancer Center Hospital; 5-1-1 Tsukiji, Chuo-ku Tokyo 104-0045 Japan
| | - Y. Yamamoto
- Department of Plastic and Reconstructive Surgery; Graduate School of Medicine; University of Hokkaido at Sapporo, Kita-15 Nishi-7, Kita-Ku, Sapporo Hokkaido, 060-8638 Japan
| | - N. Yamazaki
- Department of Dermatologic Oncology; National Cancer Center Hospital; 5-1-1 Tsukiji, Chuo-ku Tokyo 104-0045 Japan
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15
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Lu YS, Jeng CH, Lin HC, Hsieh CH, Lin YH, Lo KC. Reconstruction of the massive defect after excision of penoscrotal and perianal extramammary Paget's disease. FORMOSAN JOURNAL OF SURGERY 2014. [DOI: 10.1016/j.fjs.2013.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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16
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Moretto P, Nair V, Hallani SE, Malone S, Belanger E, Morash C, Canil C. Management of penoscrotal extramammary Paget disease: case series and review of the literature. Curr Oncol 2013; 20:e311-20. [PMID: 23904770 PMCID: PMC3728060 DOI: 10.3747/co.20.1353] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Extramammary Paget disease (empd) is a rare, slow-growing neoplasm, considered to be an adenocarcinoma of the apocrine glands. In men, the penoscrotal region is the most commonly affected area. The disease can present as carcinoma in situ or as invasive disease that can subsequently metastasize to lymph nodes and distant sites. Because of the rarity of empd, the medical literature available to guide management of the disease is limited, particularly in patients with metastases. In addition, metastatic disease may pose a diagnostic challenge, because invasive cancer of the genitourinary or gastrointestinal tract can occur in association with empd. In the present case series, we describe our experience in treating penoscrotal empd with multimodality therapy, and we review the existing literature concerning its diagnosis and management.
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Affiliation(s)
- P. Moretto
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
| | - V.J. Nair
- Division of Radiation Oncology, Department of Radiology, The Ottawa Hospital Cancer Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
| | - S. El Hallani
- Division of Anatomical Pathology, Department of Pathology and Laboratory Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON
| | - S. Malone
- Division of Radiation Oncology, Department of Radiology, The Ottawa Hospital Cancer Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
| | - E. Belanger
- Division of Anatomical Pathology, Department of Pathology and Laboratory Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON
| | - C. Morash
- Division of Urology, The Ottawa Hospital Cancer Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
| | - C.M. Canil
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
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Tanaka R, Sasajima Y, Tsuda H, Namikawa K, Tsutsumida A, Otsuka F, Yamazaki N. Human epidermal growth factor receptor 2 protein overexpression and gene amplification in extramammary Paget disease. Br J Dermatol 2013; 168:1259-66. [DOI: 10.1111/bjd.12249] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Delport ES. Extramammary Paget's disease of the vulva: An annotated review of the current literature. Australas J Dermatol 2012; 54:9-21. [PMID: 22671146 DOI: 10.1111/j.1440-0960.2012.00898.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Extramammary Paget's disease is a rare and unusual neoplastic entity that presents mainly on apocrine gland-bearing skin. The vulva is the most common site of involvement but any area of the anogenital skin can be affected. Due to its rarity, variable clinical course and deceptive histological appearance it has a high misdiagnosis rate and both gynaecologists and dermatologists have limited experience in its management. The significance of the disease lies in its association with underlying malignancy as well as its inherent ability to invade the dermis and metastasise. The management is notoriously complicated and recurrence rates are high despite aggressive surgeries. Several alternative modalities are being explored, with results that are often variable and unpredictable. This review summarises the histopathological, clinical and therapeutic features of extramammary Paget's disease of the vulva reported in recent years.
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Nakamori R, Omoto Y, Yamanaka K, Habe K, Kurokawa I, Mizutani H. Complete remission of advanced extramammary Paget’s disease treated with docetaxel: a case report. Clin Exp Dermatol 2011; 37:194-5. [DOI: 10.1111/j.1365-2230.2011.04204.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Immunohistochemical study of HER2 and TUBB3 proteins in extramammary Paget disease. Am J Dermatopathol 2011; 32:578-85. [PMID: 20534991 DOI: 10.1097/dad.0b013e3181cd35e0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Metastatic extramammary Paget disease (EMPD) is a potentially fatal malignancy for which effective chemotherapy and good biomarkers are desirable for management. We investigated the status of human epidermal growth factor receptor (HER2) and neuronal β-tubulin isotype (class III β-tubulin; TUBB3), whose overexpression is a factor involved in resistance of tumor cells to taxane derivatives) in 32 patients with EMPD. HER2 status was evaluated by immunohistochemistry followed by fluorescence in situ hybridization, and TUBB3 status was evaluated by immunohistochemistry. On the basis of the US Food and Drug Administration-approved criteria, 20 (63%) of the 32 EMPD tumors were found to overexpress HER2. Positive immunoreactivity for TUBB3 was observed in 7 (22%) of the 32 patients. Although some clinicopathologic variables (nodule formation, depth of tumor cells, presence of lymph node metastasis, and serum carcinoembryonic antigen level) were significantly associated with disease outcome (P < 0.05), HER2 gain or aberrant TUBB3 expression showed no significant correlation. However, the higher incidence of HER2 gain and the relatively lower incidence of aberrant TUBB3 expression suggested that HER2-targeted immunotherapy combined with taxane derivatives is warranted for metastatic EMPD, and that HER2 and TUBB3 status might be a good biomarker for determining the most appropriate therapeutic modality.
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Kyriazanos ID, Stamos NP, Miliadis L, Noussis G, Stoidis CN. Extra-mammary Paget's disease of the perianal region: a review of the literature emphasizing the operative management technique. Surg Oncol 2011; 20:e61-71. [PMID: 20884199 DOI: 10.1016/j.suronc.2010.09.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2010] [Revised: 09/07/2010] [Accepted: 09/08/2010] [Indexed: 12/13/2022]
Abstract
The perianal skin is a common area for extra-mammary Paget's disease development. The unique clinical, histopathological, and immunohistochemical features which this medical phenomenon demonstrates, along with its rarity and frequent association with synchronous or metachronous carcinomas, present us with a treatment challenge. In order to organize the surgical treatment, it is important to determine whether the disease is localized exclusively to the perianal skin or associated with metastasis or anorectal carcinomas. Despite several controversies concerning its optimal therapeutic management, wide local excision of the skin and subcutaneous tissue in the perianal region is generally recommended for the treatment of the non-invasive form of the disease. Such an aggressive operative management usually results in a large perianal tissue defect, which can not be primarily suppressed without resultant tension and possible complications, requiring a special technique for its coverage. Various techniques have been described in the literature for the treatment of these defects, often associated with unfavourable long term results, i.e. split-thickness skin grafts and vacuum-assisted closure devices. More recently several authors have reported favourable results using various transposition or rotation local skin flaps, myocutaneous flaps of the gluteal and thigh muscles, and V-Y island flaps to cover these areas of tissue loss. In this article we present a short review of the literature concerning perianal Paget's disease with special attention to its management and a demonstration of the operative technique we prefer on patients with perianal non-invasive Paget's disease, i.e. wide local excision with a 2 cm margin in the anal mucosa and use of U and V-Y shaped perianal fatty-cutaneous island flaps for reconstruction by covering the bilateral anal skin defects.
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Matsushita S, Yonekura K, Mera K, Kawai K, Kanekura T. Successful treatment of metastatic extramammary Paget's disease with S-1 and docetaxel combination chemotherapy. J Dermatol 2011; 38:996-8. [PMID: 21972953 DOI: 10.1111/j.1346-8138.2010.01149.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hata M, Omura M, Koike I, Wada H, Miyagi E, Tayama Y, Odagiri K, Minagawa Y, Ogino I, Inoue T. Role of radiotherapy as curative treatment of extramammary Paget's disease. Int J Radiat Oncol Biol Phys 2010; 80:47-54. [PMID: 20951507 DOI: 10.1016/j.ijrobp.2010.01.073] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 01/13/2010] [Accepted: 01/13/2010] [Indexed: 01/08/2023]
Abstract
PURPOSE Extramammary Paget's disease (EMPD) is a relatively rare malignancy that usually arises in the genital areas. Wide surgical excision remains the standard and most reliable curative treatment of EMPD. However, surgery is sometimes not possible, because many patients are elderly, and complete excision can be difficult owing to the tumor location. We, therefore, performed a review to determine the role of radiotherapy (RT) for EMPD. METHODS AND MATERIALS A total of 22 patients with EMPD in their external genitalia (4 men and 18 women, age 52-94 years at RT) underwent RT with curative intent. Nine patients had regional lymph node metastases. A total dose of 45-70.2 Gy (median, 60) was delivered to the pelvis, including the tumors, in 25-39 fractions (median, 33). RESULTS In all but 3 patients, the irradiated tumors were controlled during a follow-up period of 8-133 months (median, 42). Of the 22 patients, 13 developed recurrences, including local progression within the radiation field in 3 and lymph node and/or distant metastases outside the radiation field in 10, at 3-43 months after treatment. The 2- and 5-year local progression-free rates were 91% and 84%, respectively. Of the 22 patients, 7 patients had died at 33-73 months after RT. The cause of death was tumor progression in 4, infectious pneumonia in 2, and renal failure in 1 patient. The overall and cause-specific survival rates were 100% for both at 2 years and 53% and 73% at 5 years, respectively. No therapy-related Grade 3 or greater toxicity was observed. CONCLUSIONS RT is safe and effective for patients with EMPD. It appears to contribute to prolonged survival as a result of good tumor control.
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MESH Headings
- Aged
- Aged, 80 and over
- Disease-Free Survival
- Dose Fractionation, Radiation
- Female
- Genital Neoplasms, Female/pathology
- Genital Neoplasms, Female/radiotherapy
- Genital Neoplasms, Male/pathology
- Genital Neoplasms, Male/radiotherapy
- Humans
- Male
- Middle Aged
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/radiotherapy
- Paget Disease, Extramammary/mortality
- Paget Disease, Extramammary/radiotherapy
- Retrospective Studies
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Affiliation(s)
- Masaharu Hata
- Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
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Abstract
PURPOSE Extramammary Paget's disease (EMPD) is frequently associated with adnexal or visceral synchronous or metachronous malignancies. Our purpose was to evaluate, retrospectively, the results obtained in six cases of EMPD and to review the literature. METHODS Six patients with the perianal Paget's disease had been treated in our division between March 1996 and December 2006. In three cases, the disease was confined in the epidermis; in one case, there was a microinvasion of the dermis, while in another one the dermis was infiltrated. The last case was associated to a low rectal adenocarcinoma. All patients underwent wide perianal excision and reconstruction with skin graft. We performed a transanal resection of the rectal adenocarcinoma. A review of the literature from 1990 to 2008 revealed 193 cases of perianal EMPD, 112 were intraepithelial/intradermal while 81 were associated with malignancies. Anorectal adenocarcinoma was already existing in two cases, synchronous in 48, and subsequent to diagnosis in 11. RESULTS In three cases, the disease recurred locally, but no patient developed metastatic spread. Five patients survived and are free of disease. The review of the literature allows a clear identification of the primitive EMPD and the form associated to anorectal adenocarcinoma and little information about cases associated with synchronous adnexal adenocarcinoma. The Paget's disease can relapse after radical surgery and has a capacity of metastatic spread. CONCLUSIONS Up to now, no clear guidelines have been established for the diagnosis of EMPD. The association with synchronous or metachronous carcinomas imposes a long-term follow-up with frequent clinical, radiological, and endoscopical controls.
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Zhu Y, Ye D, Yao X, Zhang S, Dai B, Zhang H, Shen Y, Mao H. Clinicopathological characteristics, management and outcome of metastatic penoscrotal extramammary Paget’s disease. Br J Dermatol 2009; 161:577-82. [DOI: 10.1111/j.1365-2133.2009.09203.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Paget's disease is an intra-epidermal adenocarcinoma seen over the nipple/areola (mammary Paget's disease) or in extramammary body zones, such as the anogenital and perineal skin and the axilla. Mammary and extramammary Paget's disease share many common clinicopathological features but also show several differences, namely, with regard to pathogenesis and association with underlying malignancies. Indeed, mammary Paget's disease is as a rule associated with an underlying breast carcinoma whereas association of extramammary Paget's disease with underlying (skin or visceral) malignancies occurs much less frequently. We review here the main clinicopathological and therapeutic features of mammary and extramammary Paget's disease.
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Affiliation(s)
- J Kanitakis
- Department of Dermatology, Ed. Herriot Hospital, Lyon, France.
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