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Dababneh MN, Bottalico DM, Schneider KM, Moh M, Stojanov IJ. Extramammary Paget Disease of Oral Mucosa: Case Report with Literature Review. Head Neck Pathol 2024; 18:33. [PMID: 38658519 PMCID: PMC11043298 DOI: 10.1007/s12105-024-01638-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/15/2024] [Indexed: 04/26/2024]
Abstract
Extramammary Paget disease (EPMD) of the oral mucosa is an unusual and extremely rare condition, with fewer than ten cases documented. Here, we report a case of EMPD extensively involving oral mucosa and underlying salivary ducts in a 72-year-old male and review published clinical, histologic, immunophenotypic, and prognostic features of this rare entity.
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Affiliation(s)
- Melad N Dababneh
- Robert J. Tomsich Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Keith M Schneider
- Private Practice, Mentor, OH, USA
- Department of Oral and Maxillofacial Surgery, Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA
| | - Michelle Moh
- Robert J. Tomsich Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Ivan J Stojanov
- Robert J. Tomsich Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA.
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Shimomura M, Kawakami F, Sano N, Honda Y, Arita H, Kawahara K, Nakayama H, Nakaura T, Mikami Y. Extramammary Paget's disease of the hard palate: A case report and review of the literature. Pathol Int 2021; 71:216-218. [PMID: 33406310 DOI: 10.1111/pin.13062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 12/17/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Mari Shimomura
- Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan
| | - Fumi Kawakami
- Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan
| | - Naoki Sano
- Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan
| | - Yumi Honda
- Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan
| | - Hidetaka Arita
- Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenta Kawahara
- Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hideki Nakayama
- Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yoshiki Mikami
- Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan
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Park SO, Ha JH, Hong KY, Chang H. Usefulness of Mapping Biopsy in the Treatment of Penoscrotal Extramammary Paget’s Disease. Ann Surg Oncol 2017; 24:3229-3236. [DOI: 10.1245/s10434-017-5947-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Indexed: 11/18/2022]
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Kennedy H, Kunjur J, Amarasinghe K, Smith G. Extramammary Paget's disease of the oral tissues-literature review and a rare case report. J Surg Case Rep 2016; 2016:rjw152. [PMID: 27587306 PMCID: PMC5007617 DOI: 10.1093/jscr/rjw152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 08/06/2016] [Indexed: 11/12/2022] Open
Abstract
Extramammary Paget's disease (EMPD) is a rare, cutaneous adenocarcinoma in situ characterized by a chronic eczema-like rash of the anogenital regions. It is usually slow growing, locally invasive and presents mainly with pruritis. Extremely rare in the oral tissues, here we present a case of EMPD of the hard palate and a review of the existing literature base.
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Affiliation(s)
- Hana Kennedy
- St. George's Hospital, Tooting, SW170QT London, UK
| | | | | | - Graham Smith
- St. George's Hospital, Tooting, SW170QT London, UK
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Abstract
Pagetoid spread, is used to define intraepithelial spread of cancer cells, when a massive carcinoma is identified beneath the basal membrane. There are only few reports of pagetoid spread at the head and neck region. Herein a 74 year old male patient with bilateral transglottic laryngeal high grade malignant epithelial tumor with pagetoid spread is presented. The tumor was located at the submucosa and there was spread of the CK7 and CK19 positive tumor cells into the non neoplastic mucosa, which was CK5/6 positive, sparing the basement membrane, creating a typical pagetoid pattern. Radiographic and positron emission tomography scan examination of the patient was unremarkable at presentation other than the laryngeal and neck lesions; but extensive systemic metastasis developed at 6 months following operation. To the best of our knowledge no epithelial malignancy with pagetoid spread was described at the larynx. Pagetoid spread may be a hallmark of very aggressive behavior in laryngeal carcinoma.
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Dedifferentiated salivary hybrid carcinoma of the maxillary sinus with pagetoid spread to the overlying lining mucosa. Head Neck Pathol 2014; 9:293-9. [PMID: 25179376 PMCID: PMC4424200 DOI: 10.1007/s12105-014-0564-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 08/13/2014] [Indexed: 10/24/2022]
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Wagner G, Sachse MM. Extramammary Paget disease - clinical appearance, pathogenesis, management. J Dtsch Dermatol Ges 2011; 9:448-54. [PMID: 21205169 DOI: 10.1111/j.1610-0387.2010.07581.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Extramammary Paget disease is a rare malignant neoplasm. With regard to the pathogenesis, two prognostically different forms can be distinguished. The primary form of extramammary Paget disease is an in situ carcinoma of the apocrine gland ducts. In contrast, the secondary form is characterized by an intraepithelial spread due to an underlying carcinoma of the skin or other organ systems. Extramammary Paget disease occurs in older patients. The predilection sites include the entire anogenital skin and less often the axillary region. We present five different patients with this disease, thereby demonstrating its variation in clinical morphology. The lesion usually presents as an erythematous sharply defined spot. The polygonal borders, caused by the centrifugal growth of the tumor, may provide a diagnostic clue. The treatment of choice for extramammary Paget disease remains Mohs' microscopic surgery. However, radiotherapy or topical applications may be alternative treatment options in selected cases. In patients with the secondary form of extramam-mary Paget disease, treatment of the primary tumor is the main approach.
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Affiliation(s)
- Gunnar Wagner
- Department of Dermatology, Bremerhaven Hospital (Reinkenheide), Bremerhaven, Germany.
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Kikuchi Y, Uozaki H, Itoyama S, Saijo H, Takato T, Fukayama M. Pagetoid spread to oral mucosa from submandibular gland salivary duct carcinoma: a case report. Hum Pathol 2009; 40:1036-9. [PMID: 19297007 DOI: 10.1016/j.humpath.2008.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Revised: 11/17/2008] [Accepted: 11/19/2008] [Indexed: 11/25/2022]
Abstract
Salivary duct carcinoma is a high-grade malignant tumor arising predominantly in the major salivary glands. We describe herein a rare presentation of salivary duct carcinoma arising in the submandibular gland and showing pagetoid spread to the oral mucosa. A 46-year-old man was admitted with a 2-year history of swelling in the floor of the mouth. Resection of the submandibular gland tumor was followed by mucosal biopsy around the aperture of the right Wharton's duct. The tumor recurred in the oral mucosa with pagetoid spread and extended widely in the oral cavity for the following 10 years, despite chemo- and radiotherapy. Mucosal spread, although a relatively remote possibility, can occur in the setting of salivary duct carcinoma.
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Affiliation(s)
- Yoshinao Kikuchi
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-0033 Japan.
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Appert DL, Otley CC, Phillips PK, Roenigk RK. Role of Multiple Scouting Biopsies before Mohs Micrographic Surgery for Extramammary Paget's Disease. Dermatol Surg 2006; 31:1417-22. [PMID: 16416610 DOI: 10.2310/6350.2005.31207] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Extramammary Paget's disease (EMPD) frequently extends subclinically, resulting in high recurrence rates after surgical excision. Mohs micrographic surgery (MMS) improves cure rates but may require time-consuming reexcision of subclinical extension. A mechanism to estimate the location and extent of subclinical extension would be helpful. OBJECTIVE To describe and evaluate a technique for multiple scouting biopsies before MMS for EMPD. METHOD A retrospective review of patients at Mayo Clinic who had multiple scouting biopsies before MMS for EMPD without dermal invasion. TECHNIQUE The clinical extent of EMPD is identified. The scouting biopsy sites are determined and documented with photographs. The scouting biopsy specimens are sent for permanent sections. The results of the scouting biopsies help guide the extent of the initial Mohs layer. The tumor is cleared with MMS. An additional 1 mm peripheral margin of tissue is usually submitted for permanent sections. RESULTS Multiple scouting biopsies were done in five patients. Four of the five patients had at least one true-positive result. At least one true-negative result was obtained in all five patients. Two patients had at least one false-negative result. CONCLUSION Multiple scouting biopsies before MMS for EMPD without dermal invasion can be a beneficial adjuvant technique.
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Affiliation(s)
- David L Appert
- Division of Dermatologic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA
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Role of Multiple Scouting Biopsies before Mohs Micrographic Surgery for Extramammary Pagetʼs Disease. Dermatol Surg 2005. [DOI: 10.1097/00042728-200511000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lai YL, Yang WG, Tsay PK, Swei H, Chuang SS, Wen CJ. Penoscrotal extramammary Paget's disease: a review of 33 cases in a 20-year experience. Plast Reconstr Surg 2003; 112:1017-23. [PMID: 12973217 DOI: 10.1097/01.prs.0000076193.67701.6a] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Extramammary Paget's disease in men most frequently involves the penoscrotal area. The uncertainty of the outcome and of the relationship to the underlying adnexal carcinoma and associated internal malignancy still exists. From 1982 to 2001, 33 patients with penoscrotal extramammary Paget's disease were treated and followed up. Therapeutic modalities included carbon dioxide laser ablation (two patients) and local wide excision (31 patients). Split-thickness skin graft (22 patients), local scrotal flap (six patients), and primary closure (three patients) were utilized to reconstruct the penoscrotal defects after local wide excision. An underlying adnexal carcinoma occurred in seven of 33 patients (21.2 percent). The incidence of associated internal malignancy was 9.1 percent (three of 33 patients), including one concurrently and two nonconcurrently associated malignancies. Eight of 33 patients had local recurrence, representing an incidence of 24.2 percent. Three patients (9.1 percent) had distant metastasis and ultimately died of metastatic carcinoma. Of these patients, 31 were grouped according to the degrees of involvement: limited to the epidermis (group 1, n = 14), involvement of the adnexal gland and/or hair follicle (group 2, n = 10), and the presence of an underlying adnexal carcinoma (group 3, n = 7). Local wide excision with subsequent reconstruction by split-thickness skin graft was favored in this series. Patients with an underlying adnexal carcinoma or pathological invasion of the dermis (group 2 or 3) had a worse prognosis than patients without. From this study, it is difficult to address the particular relationship between the outcome and the associated internal malignancy.
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Affiliation(s)
- Yung-Lung Lai
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Fu-Shing St., Kweishan 333 Taoyuan, Taiwan.
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Kao GF, Graham JH, Helwig EB. Paget's disease of the ectopic breast with an underlying intraductal carcinoma: report of a case. J Cutan Pathol 1986; 13:59-66. [PMID: 3009569 DOI: 10.1111/j.1600-0560.1986.tb00461.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Paget's disease may occur at mammary and extramammary sites. Mammary Paget's disease typically involves the nipple and adjacent skin. Almost all such cases are associated with an underlying ductal carcinoma of the breast. A case of Paget's disease occurring at the site of an ectopic breast adjacent to a supernumerary nipple and associated with an underlying intraductal carcinoma is described. A search of the literature revealed no previous report of such cases. Detailed clinical history and histopathologic, histochemical, and follow-up information on this case are presented. The literature on mammary and extramammary Paget's disease is reviewed.
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Paget-Carcinom bei invertiertem Nasenpapillom. Eur Arch Otorhinolaryngol 1973. [DOI: 10.1007/bf00460607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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