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Miura S, Kijima N, Fujimori N, Nakagawa T, Nakagawa R, Tachi T, Okita Y, Kanemura Y, Nakajima S, Mano M, Kishima H, Ozawa K, Fujinaka T. Surgical Treatment of Brain Metastasis of Extramammary Paget's Disease: A Case Report. NMC Case Rep J 2020; 7:189-193. [PMID: 33062567 PMCID: PMC7538455 DOI: 10.2176/nmccrj.cr.2019-0292] [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: 01/07/2020] [Accepted: 03/04/2020] [Indexed: 11/23/2022] Open
Abstract
Extramammary Paget’s disease (EMPD) is a rare form of neoplasm. Metastasis of EMPD to locations other than lymph nodes and intra-epithelial regions is rare; there are a limited number of case reports of metastases to the liver, lung, bone, and brain. We present a rare case of EMPD that metastasized to the brain and was treated with surgical resection. A 66-year-old man presented with a small palpable mass in the scrotum. After 5 years of observation, he was diagnosed with EMPD that metastasized to the lymph nodes and lung. Tumor resection and postoperative chemotherapy were performed. Six months after the last chemotherapy treatment, he presented with a right temporal lobe tumor and underwent surgical resection. Histopathological analysis revealed brain metastasis of EMPD. Three months after surgery, magnetic resonance imaging (MRI) showed local tumor recurrence, and intensity modulated radiation therapy (IMRT) (45 Gy/15 Fr) was performed. Although the metastatic brain tumor was well controlled, the primary tumor progressed. He was provided best supportive care and died 5 months after brain tumor resection. In this report, we present a rare case of brain metastasis of EMPD, treated with surgical resection, and histopathologically confirmed to be metastatic EMPD.
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Affiliation(s)
- Shimpei Miura
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, Osaka, Osaka, Japan.,Department of Neurosurgery, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan
| | - Noriyuki Kijima
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, Osaka, Osaka, Japan.,Department of Neurosurgery, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan
| | - Nagisa Fujimori
- Department of Dermatology, Osaka National Hospital, National Hospital Organization, Osaka, Osaka, Japan
| | - Tomoyoshi Nakagawa
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, Osaka, Osaka, Japan
| | - Ryota Nakagawa
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, Osaka, Osaka, Japan
| | - Tetsuro Tachi
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, Osaka, Osaka, Japan
| | - Yoshiko Okita
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, Osaka, Osaka, Japan
| | - Yonehiro Kanemura
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, Osaka, Osaka, Japan
| | - Shin Nakajima
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, Osaka, Osaka, Japan
| | - Masayuki Mano
- Department of Central Laboratory and Surgical Pathology, Osaka National Hospital, National Hospital Organization, Osaka, Osaka, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan
| | - Kentaro Ozawa
- Department of Dermatology, Osaka National Hospital, National Hospital Organization, Osaka, Osaka, Japan
| | - Toshiyuki Fujinaka
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, Osaka, Osaka, Japan
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Furlan K, Rohra P, Mir F, Gattuso P. Non-human-papillomavirus-related malignancies of the vulva: A clinicopathological study. J Cutan Pathol 2020; 47:917-922. [PMID: 32511773 DOI: 10.1111/cup.13768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 05/22/2020] [Accepted: 05/29/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Malignant tumor of the vulva is the fourth gynecological malignancy in frequency. Close to 70% of all vulvar malignancies are related to high-risk human papillomavirus (HPV) infection. METHODS A search for non-HPV-related malignant tumors of the vulva was performed in the last 20 years (2000-2020) in the pathology database of a single tertiary institution. We aim to estimate the prevalence of non-HPV-related malignancies in our population, describe clinicopathological features of these tumors and investigate the expression of some potential therapeutic targets. RESULTS A total of 71 patients were recovered; 26 patients (36%) had the diagnosis of extramammary Paget disease, 17 patients (24%) had basal cell carcinomas, 17 patients (24%) had primary melanomas, 10 patients (14%) had metastatic disease to the vulva and one patient (1%) had a primary dermatofibrosarcoma protuberans. Fifty-four percent of patients with extramammary Paget disease had a secondary malignancy and 12.5% had invasive disease. Programmed death-ligand 1 (PDL-1) was positive in seven out of nine primary melanomas and Her2/neu was overexpressed in six out of seven extramammary Paget disease. CONCLUSION Non-HPV-related malignancies are important differential diagnoses in patient with vulvar lesions. Additional research is necessary to further understand these complex malignancies and potential new therapeutic targets.
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Affiliation(s)
- Karina Furlan
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Prih Rohra
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Fatima Mir
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
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Azmahani A, Nakamura Y, Ozawa Y, McNamara KM, Fujimura T, Haga T, Hashimoto A, Aiba S, Sasano H. Androgen receptor, androgen-producing enzymes and their transcription factors in extramammary Paget disease. Hum Pathol 2015; 46:1662-9. [DOI: 10.1016/j.humpath.2015.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/06/2015] [Accepted: 07/10/2015] [Indexed: 11/16/2022]
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Kim IY, Yun SJ, Lee JS, Jung S, Jung TY, Moon KS, Jang WY. Brain metastasis from extramammary Paget's disease of the scrotum. J Clin Neurosci 2013; 21:694-6. [PMID: 24210806 DOI: 10.1016/j.jocn.2013.05.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 05/23/2013] [Accepted: 05/26/2013] [Indexed: 11/29/2022]
Abstract
We present to our knowledge the first patient with histopathologically proven brain metastasis from extramammary Paget's disease (EMPD) and discuss the effect of brain radiation therapy for this condition. A 68-year-old man presented to our hospital with headache and gait disturbance. Brain MRI showed multiple enhancing mass lesions, and two large cystic lesions in the left cerebellum. The patient had been diagnosed with scrotal Paget's disease 3 months previously but no further management had been performed due to his refusal. The patient underwent stereotactic aspiration and biopsy of the two large cystic lesions. A histopathological examination revealed that the tumor was a metastatic adenocarcinoma. Immunohistochemical staining revealed that the tumor cells were strongly positive for cytokeratin 7 and moderately positive for carcinoembryonic antigen and gross cystic disease fluid protein 15. These findings were similar to those of his scrotal skin lesions and were consistent with metastatic EMPD. The patient underwent brain radiation therapy with a total radiation dose of 30 Gy in 10 fractions. The patient improved neurologically so as to be self-ambulatory, and a mild improvement in the metastatic tumors was found on follow-up MRI. We had planned systemic chemotherapy, but the patient died of acute respiratory failure 2 months after radiation therapy.
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Affiliation(s)
- In-Young Kim
- Brain Tumor Clinic and Gamma Knife Center, Department of Neurosurgery, Chonnam National University Hwasun Hospital, 160, Ilsimri, Hwasun-eup, Hwasun-gun, Chonnam 519-809, Republic of Korea; Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea.
| | - Suk-Jung Yun
- Department of Dermatology, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Ji-Shin Lee
- Department of Pathology, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Shin Jung
- Brain Tumor Clinic and Gamma Knife Center, Department of Neurosurgery, Chonnam National University Hwasun Hospital, 160, Ilsimri, Hwasun-eup, Hwasun-gun, Chonnam 519-809, Republic of Korea; Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Tae-Young Jung
- Brain Tumor Clinic and Gamma Knife Center, Department of Neurosurgery, Chonnam National University Hwasun Hospital, 160, Ilsimri, Hwasun-eup, Hwasun-gun, Chonnam 519-809, Republic of Korea; Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Kyung-Sub Moon
- Brain Tumor Clinic and Gamma Knife Center, Department of Neurosurgery, Chonnam National University Hwasun Hospital, 160, Ilsimri, Hwasun-eup, Hwasun-gun, Chonnam 519-809, Republic of Korea; Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Woo-Youl Jang
- Brain Tumor Clinic and Gamma Knife Center, Department of Neurosurgery, Chonnam National University Hwasun Hospital, 160, Ilsimri, Hwasun-eup, Hwasun-gun, Chonnam 519-809, Republic of Korea
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Yoon SN, Park IJ, Kim HC, Yu CS, Lee MW, Koh JK, Kim JW, Park YS, Kim JC. Extramammary Paget's disease in Korea: its association with gastrointestinal neoplasms. Int J Colorectal Dis 2008; 23:1125-30. [PMID: 18535830 DOI: 10.1007/s00384-008-0499-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2008] [Indexed: 02/04/2023]
Abstract
BACKGROUND Extramammary Paget's disease (EMPD) most commonly occurs in the perineal and genital areas of elderly people. The current treatment of choice is adequate surgical excision. MATERIALS AND METHODS Between 1990 and 2007, 28 patients (27 men and one woman) with EMPD were treated at Asan Medical Center, Seoul, Korea, by wide local excision (WLE) with a 2- to 3-cm normal skin margin. "Carcinoma in situ" (CIS) was defined as confinement of Paget cells to the epithelium, whereas "invasive carcinoma" was defined as infiltration of Paget cells into more than dermal connective tissue. RESULTS Of the 28 lesions, 21 (75%) were located in the penoscrotal area. Six (21.4%) patients had associated gastrointestinal neoplasms, three with associated gastrointestinal malignancies and four with synchronous colorectal adenomas, including one with both. Surgical procedures included WLE with primary repair in 13 patients (46.4%), WLE with skin graft in 12 (42.9%), WLE with skin graft and Gracilis muscle transposition in two (7.1%), and combined abdominoperineal resection and distal gastrectomy in one (3.6%). Four patients (14.3%) also underwent inguinal lymph node dissection, with three found to have lymph node metastases. Of 11 patients with invasive carcinoma, three (27.3%) had lymph node metastases, compared with none of 17 patients with CIS. Patients with lymph node metastases showed a significantly lower disease-specific survival rate (P = 0.008). Patients with invasive carcinoma tended to have a lower disease-specific survival rate (P = 0.087). CONCLUSIONS EMPD in Korea showed an absolute male predominance and an association with gastrointestinal neoplasms. Lymph node metastasis significantly affected, and depth of invasion tended to affect, disease-specific survival rate.
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Affiliation(s)
- Sang Nam Yoon
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-ku, Seoul 138-736, Republic of Korea
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