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Banta J, Robinson CH, Schaffenburg W. Two cases of ectopic extramammary Paget's disease. JAAD Case Rep 2025; 59:81-84. [PMID: 40290797 PMCID: PMC12022411 DOI: 10.1016/j.jdcr.2025.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2025] Open
Affiliation(s)
- Jonathan Banta
- Dermatology Resident, Department of Dermatology, Wilford Hall Ambulatory Surgical Center, Lackland AFB, Texas
| | - Carolyn Hardin Robinson
- Staff Dermatologist and Mohs Surgeon, Department of Dermatology, Wilford Hall Ambulatory Surgical Center, Lackland AFB, Texas
| | - William Schaffenburg
- Dermatologist and Dermatopathologist, Department of Dermatology, Wilford Hall Ambulatory Surgical Center, Lackland AFB, Texas
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Cook EE, Harrison BT, Hirsch MS. TRPS1 expression is sensitive and specific for primary extramammary Paget disease. Histopathology 2023. [DOI: 10.1111/his.14908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 03/29/2023]
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Role of GATA3 in tumor diagnosis: A review. Pathol Res Pract 2021; 226:153611. [PMID: 34547599 DOI: 10.1016/j.prp.2021.153611] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/05/2021] [Accepted: 09/08/2021] [Indexed: 11/21/2022]
Abstract
GATA binding protein 3 (GATA3) belongs to a family of transcription factors comprising six members. These proteins identify G-A-T-A containing sequences in the target gene and bind to DNA target via two zinc-finger domains. The aim of this study was to evaluate the role of GATA3 in the diagnosis of tumors and its value as a prognostic marker. To perform this review, a comprehensive search was conducted through PubMed, Embase, Scopus, Cochrane and Google Scholar databases from 1985 to 2020. Articles were considered thoroughly by independent reviewers and data were extracted in predefined forms. Final synthesis was conducted by using appropriate data from included articles in each topic. Studies have shown that GATA3 has a critical role in the development of epithelial structures in both embryonic and adult tissues. The majority of studies regarding GATA3 expression in tumor evaluation focused on breast and urothelial neoplasms, whether primary or metastatic. Its sensitivity in these neoplasms has been reported to be high and made this marker more valuable than other available immunohistochemistry markers. However, GATA3 expression was not restricted to these tumors. Studies have shown that GATA3 immunostaining could be a useful tool in various tumors in kidney, salivary gland, endocrine system, hematopoietic system, and skin. GATA3 can also be used as a useful prognostic tool. Although GATA3 is a multi-specific immunohistochemical stain, it is a valuable marker in the panel for confirming many epithelial or mesenchymal neoplasms as both a diagnostic and prognostic tool.
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Kado S, Kamiya K, Jin M, Kimura M, Hossain MR, Maekawa T, Komine M, Ohtsuki M. GATA‐binding protein 3 and gross cystic disease fluid protein 15 as a potential diagnostic marker for extramammary Paget's disease. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2021. [DOI: 10.1002/cia2.12193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Soichiro Kado
- Department of Dermatology Jichi Medical University Shimotsuke Japan
| | - Koji Kamiya
- Department of Dermatology Jichi Medical University Shimotsuke Japan
| | - Meijuan Jin
- Department of Dermatology Jichi Medical University Shimotsuke Japan
| | - Miho Kimura
- Department of Dermatology Jichi Medical University Shimotsuke Japan
| | - Md Razib Hossain
- Department of Dermatology Jichi Medical University Shimotsuke Japan
| | - Takeo Maekawa
- Department of Dermatology Jichi Medical University Shimotsuke Japan
| | - Mayumi Komine
- Department of Dermatology Jichi Medical University Shimotsuke Japan
| | - Mamitaro Ohtsuki
- Department of Dermatology Jichi Medical University Shimotsuke Japan
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Kiyohara T, Tanimura H. GATA3-Positive Adnexal Adenocarcinoma: Report of a Confusing Case with a Potential Pitfall of Leading to a Misdiagnosis of Urothelial Carcinoma and a Review of Published Work. Ann Dermatol 2020; 32:417-421. [PMID: 33911777 PMCID: PMC7992588 DOI: 10.5021/ad.2020.32.5.417] [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: 08/22/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 11/11/2022] Open
Abstract
We describe a confusing case of GATA3-positive adnexal adenocarcinoma with a potential pitfall of leading to a misdiagnosis of urothelial carcinoma. A 62-year-old male presented with a subcutaneous nodule on the right lower abdomen around a scar from surgery for urothelial carcinoma in the right urinary tract, which had been resected 8 years previously. Histologically, atypical cells possessing ample cytoplasm and partial intracytoplasmic lumens were densely grouped in the subcutaneous expansive nodule and bilateral inguinal lymph nodes dissected. Decapitation secretion could not be seen. Neoplastic cells were positive for CK7, GATA3, and GCDFP15, and negative for CK5/6, CK20, p63, CD10, PAX8, HER-2, and uroplakin-II. Neoplastic cells in the urothelium and the metastasized lung were positive for CK7, CK5/6, and GATA3, and negative for CK20, p63, GCDFP15, and TTF-1. A variable level of GATA3 expression in malignant tumors with apocrine and eccrine differentiation should be recognized by dermatologists.
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Affiliation(s)
- Takahiro Kiyohara
- Department of Dermatology, Kansai Medical University Medical Center, Osaka, Japan
| | - Hirotsugu Tanimura
- Department of Dermatology, Kansai Medical University Medical Center, Osaka, Japan
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Chandradevan R, Takeda H, Hayes B, Faulkner K, Darrow M. Metastatic breast cancer presenting as acute liver injury: diagnostic dilemma in the setting of suspected hemochromatosis. Oxf Med Case Reports 2020; 2020:omaa019. [PMID: 32395253 PMCID: PMC7202048 DOI: 10.1093/omcr/omaa019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 02/28/2020] [Accepted: 03/05/2020] [Indexed: 11/13/2022] Open
Abstract
A 70-year-old female with a history of lobular carcinoma of the breast, status post-mastectomy followed by adjuvant radio-chemotherapy in remission for 4 years was admitted with the features of acute liver failure (ALF). Iron studies revealed a hemochromatosis picture and the CT and MRI scans of the abdomen suggested cirrhosis. An extensive workup failed to identify an etiology. A trans-jugular liver biopsy was obtained and revealed poorly differentiated carcinoma consistent with the metastasis of breast primary. The patient’s condition deteriorated and died within a week following the onset of acute hepatic failure. DNA testing revealed that the patient was heterozygous for H63D mutation. In cases of ALF with the suspicion of malignancy, liver biopsy should be obtained to evaluate an infiltrative hepatic disease.
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Affiliation(s)
- Raguraj Chandradevan
- Graduate Medical Education-Internal Medicine, Northside Hospital Gwinnett, Lawrenceville, GA, USA
| | - Hironobu Takeda
- Graduate Medical Education-Internal Medicine, Northside Hospital Gwinnett, Lawrenceville, GA, USA
| | - Benjamin Hayes
- Graduate Medical Education-Internal Medicine, Northside Hospital Gwinnett, Lawrenceville, GA, USA
| | - Kalli Faulkner
- Department of Pathology, Northside Hospital Gwinnett, Lawrenceville, GA, USA
| | - Matthew Darrow
- Graduate Medical Education-Internal Medicine, Northside Hospital Gwinnett, Lawrenceville, GA, USA
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Liao X, Liu X, Fan X, Lai J, Zhang D. Perianal Paget's disease: a clinicopathological and immunohistochemical study of 13 cases. Diagn Pathol 2020; 15:29. [PMID: 32209119 PMCID: PMC7093992 DOI: 10.1186/s13000-020-00952-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/19/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Perianal Paget's disease (PPD) is rare and mostly described in clinical literature as case reports or small series. METHODS We investigated the clinicopathologic and immunohistochemical features of PPD in a total of 13 cases retrieved from multiple academic institutions. RESULTS The median age at diagnosis was 75 (range 50-86) years. Males were predominant with a male to female ratio of 2.25:1. Four (30.8%) cases were classified as primary PPD due to lack of synchronous or metachronous underlying malignancies, while nine (69.2%) were classified as secondary PPD with concurrent invasive adenocarcinoma (n = 8) or tubular adenoma with high-grade dysplasia (n = 1). Immunohistochemically, there is no differential expression of CK7 or CK20 in Paget's cells between primary and secondary PPD; however, GCDFP-15 was only positive in primary PPD (3/3 vs. 0/6, P = 0.012), while CDX2 was only positive in secondary PPD (0/3 vs. 7/7, P = 0.008), suggesting different cell origin. All patients received local surgical resection with or without adjuvant therapy. After a median follow-up of 47 months, one patient with secondary PPD (7.7%) died of disease progression from underlying adenocarcinoma. CONCLUSIONS PPD occurs in elderly patients with male predominance and is frequently associated with underlying malignancies. Differential expression of CDX2 and GCDFP-15 may help distinguishing primary vs. secondary PPD, which is important for management as the presence of an underlying malignancy impacts clinical course and prognosis. Surgical excision remains the major treatment strategy for PPD. Long-term follow-up is required to monitor the disease recurrence and metastasis.
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Affiliation(s)
- Xiaoyan Liao
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Xiuli Liu
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Xuemo Fan
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jinping Lai
- Department of Pathology and Laboratory of Medicine, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, USA
| | - Dongwei Zhang
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA.
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Chow CY, Namuduri RP, Yeo YC, Mihir G. The diagnostic challenge of primary adenocarcinoma of the vulva: a case report. PROCEEDINGS OF SINGAPORE HEALTHCARE 2020. [DOI: 10.1177/2010105819877895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The diagnosis and classification of primary adenocarcinoma of the vulva is a complicated and understudied area, as this is a rare histological subtype of vulvar cancers. The differential diagnoses include extramammary Paget disease with invasion, adenocarcinoma arising from mammary-like glands, skin adnexal structures as well as Bartholin’s glands in the vicinity. We report a case of extramammary Paget disease which first presented as primary vulvar adenocarcinoma. The patient was a 71-year-old woman who presented with a swelling at the external genitalia. Clinical examination revealed a right vulvar lump, with eczematous features on the overlying skin. The lump was biopsied and was called Paget disease with underlying adenocarcinoma. Subsequently, the patient underwent radical vulvectomy and bilateral groin and pelvis dissection. The resection specimen was reported as extramammary Paget disease, with dermal invasion forming a poorly differentiated adenocarcinoma showing strong HER-2 expression on immunohistochemistry. This case illustrates the diagnostic challenge in the classification of primary vulvar adenocarcinoma. Positivity for HER-2 has been reported in Paget-associated vulvar adenocarcinoma and might offer potentially actionable targets on the selection of therapy, especially in advanced metastatic disease.
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Affiliation(s)
- Chun Yuen Chow
- Department of Pathology, Singapore General Hospital, Singapore
| | - Rama P Namuduri
- Department of Pathology and Laboratory Medicine, KK Women’s and Children’s Hospital, Singapore
| | - Yen Chin Yeo
- Department of Gynecological Oncology, KK Women’s and Children’s Hospital, Singapore
| | - Gudi Mihir
- Department of Pathology and Laboratory Medicine, KK Women’s and Children’s Hospital, Singapore
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Koyanagi Y, Kubo C, Nagata S, Ryu A, Hatano K, Kano R, Tanada S, Ashimura JI, Idota A, Kamiura S, Yamasaki T, Nakatsuka SI. Detection of pagetoid urothelial intraepithelial neoplasia extending to the vagina by cervical screening cytology: a case report with renewed immunochemical summary. Diagn Pathol 2019; 14:9. [PMID: 30711015 PMCID: PMC6359825 DOI: 10.1186/s13000-019-0788-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/24/2019] [Indexed: 12/05/2022] Open
Abstract
Background Pagetoid spread of urothelial carcinoma (UC) to the lower genital tract is quite a rare and diagnostically challenging condition. Pagetoid urothelial intraepithelial neoplasia extending to the vagina is difficult to diagnose, especially in remote recurrences without symptomatic or macroscopic lesions typical to Paget disease. However, its identification by cervical screening cytology is important because UC is often characterized by a long history of relapse. Case presentation A 68-year-old Japanese postmenopausal woman developed brown vaginal discharge after radical cystectomy for bladder cancer (high-grade UC, pT2a pN0 cM0 [Union for International Cancer Control, 8th edition]) concomitant with focal in-situ UC in the urethra. She had a history of left renal pelvis UC, which was surgically removed 9 months before the radical cystectomy. Gynecologic examination of the lower genital tract was unremarkable although cervical screening cytology demonstrated severely atypical cells with pleomorphism repeatedly. Cervical colposcopy and diagnostic conization revealed no cervical neoplasm. In retrospect, immunocytochemical p16/Ki-67 dual staining for the previous cervical screening was negative for p16 labeling, and the neoplastic cells were positive for cytokeratins 7 and 20, p63, and GATA binding protein 3. No high-risk human papillomavirus genotype was identified by an automated DNA chip system using liquid-based cytology samples. Eleven months post-cystectomy, punch biopsy of the vulva and vagina confirmed intraepithelial UC in the juxtaposed squamous epithelium with pagetoid spread demonstrating positivity for specific urothelial markers: uroplakins II and III and thrombomodulin. Concurrent invasive malignancy was ruled out, and CO2 laser vaporization of the vulvar and vaginal lesion was performed. The patient remained alive without evidence of invasive malignancy for 14 months after the radical cystectomy for bladder cancer. Conclusions To detect recurrent pagetoid urothelial intraepithelial neoplasia with pagetoid spread in the lower genital tract, pathologists should recognize the history of prior UC with special attention to absence of p16 labeling in cervical cytology as a pointer to the diagnosis of urothelial cancer. Using further biopsy and immunohistochemical confirmation of UC relapse, investigation to rule out invasive malignancies and careful follow-up throughout the patient’s lifetime is recommended.
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Affiliation(s)
- Yuki Koyanagi
- Department of Clinical Laboratory, Osaka International Cancer Institute Hospital, Osaka, Japan
| | - Chiaki Kubo
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute Hospital, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Shigenori Nagata
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute Hospital, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan.
| | - Ayumi Ryu
- Department of Clinical Laboratory, Osaka International Cancer Institute Hospital, Osaka, Japan
| | - Koji Hatano
- Department of Urology, Osaka International Cancer Institute Hospital, Osaka, Japan
| | - Rieko Kano
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute Hospital, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Satoshi Tanada
- Department of Clinical Laboratory, Osaka International Cancer Institute Hospital, Osaka, Japan
| | - Jun-Ichi Ashimura
- Department of Clinical Laboratory, Osaka International Cancer Institute Hospital, Osaka, Japan
| | - Atsushi Idota
- Department of Clinical Laboratory, Osaka International Cancer Institute Hospital, Osaka, Japan
| | - Shoji Kamiura
- Department of Gynecologic Oncology, Osaka International Cancer Institute Hospital, Osaka, Japan
| | - Tomoyuki Yamasaki
- Department of Clinical Laboratory, Osaka International Cancer Institute Hospital, Osaka, Japan
| | - Shin-Ichi Nakatsuka
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute Hospital, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
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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: 1.6] [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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