Clinicopathological study of invasive extramammary Paget’s disease: subgroup comparison according to invasion depth

Shiomi, Tadahiro; Noguchi, T.; Nakayama, H.; Yoshida, Yuichi; Yamamoto, Osamu; Hayashi, Naganobu; Ohara, Kuniaki

doi:10.1111/j.1468-3083.2012.04489.x

Cited by 50 publications

(36 citation statements)

References 11 publications

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“…The effect of treatment correlated well with changes of CYFRA 21-1 observed before and after treatment (Fig. 2,21 We suggest that post-treatment CYFRA 21-1 levels may be helpful to determine which patients with EMPD should receive adjuvant treatment. These data indicate that CYFRA 21-1 is an effective marker to evaluate treatment efficacy.…”

Section: Discussionsupporting

confidence: 62%

Serum cytokeratin 19 fragment 21‐1 is a useful tumor marker for the assessment of extramammary Paget's disease

Kato

Sumikawa

Hida

et al. 2017

The Journal of Dermatology

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Cytokeratin 19 fragment 21-1 (CYFRA 21-1) has been used as a tumor marker for several malignancies. However, to date, no studies have assessed whether CYFRA 21-1 could be a useful marker for extramammary Paget's disease (EMPD). The present study aimed to evaluate the significance of CYFRA 21-1 as a serum tumor marker for EMPD progression. Concentrations of serum CYFRA 21-1 and carcinoembryonic antigen (CEA) in 13 cases of EMPD were measured prior to undergoing treatment at Sapporo Medical University Hospital from January 2014 to May 2016. Four of the 13 patients had lymph node metastases at diagnosis, but none had distant metastases. Immunohistochemistry indicated that all 13 primary tumors and four metastatic tumors in lymph nodes were positive for cytokeratin 19. Although none of the 13 patients showed high serum CEA levels, six patients (46.2%) had elevated serum CYFRA 21-1. Furthermore, CYFRA 21-1 was reduced in association with post-treatment tumor reduction in all six patients. Among these six patients, four developed recurrence and metastasis during the follow-up period. CYFRA 21-1 was re-elevated in all four of these patients; however, serum CEA was elevated only in the patient with distant metastasis. These results suggest that CYFRA 21-1 is more sensitive compared with CEA, and can be useful as a tumor marker for evaluating tumor progression and treatment efficacy in patients with EMPD.

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Section: Discussionsupporting

confidence: 62%

Serum cytokeratin 19 fragment 21‐1 is a useful tumor marker for the assessment of extramammary Paget's disease

Kato

Sumikawa

Hida

et al. 2017

The Journal of Dermatology

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“…tumor size) would impair the survival of patients with EMPD, as in the case with melanoma. We determined cut‐off points of 1 mm in accordance with previous studies and 3 mm using the signal detection analysis, and divided the subjects into three subgroups. These subgroups clearly differed in survival, as shown in Figure .…”

Section: Discussionmentioning

confidence: 99%

Tumor thickness as a prognostic factor in extramammary Paget's disease

Ito

Kaku

Nagae

et al. 2014

The Journal of Dermatology

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Extramammary Paget's disease (EMPD) is a rare tumor and a widely accepted classification system specific for the disease has not been established. To elucidate prognostic factors of EMPD, we conducted a retrospective review of 145 patients with 155 EMPD lesions and investigated clinicopathological factors using univariate and multivariate analyses. We also explored tumor thickness and metastatic lymph nodes using detection analysis to determine cut-off points for survival. All patients were Japanese (88 men and 57 women), with EMPD in the genital (82.8%), perianal (3.4%) and axillary regions (1.4%). In the remaining cases (12.4%), there were lesions at two or more regions. Univariate analysis revealed the following prognostic factors: perianal location, presence of nodules, invasion depth, tumor thickness, number of metastatic nodes and serum carcinoembryonic antigen level. Both tumor thickness and perianal location retained statistical significance in multivariate analysis (hazard ratio, 1.39; 95% confidence interval, 1.12-1.72; P = 0.0024; hazard ratio, 50.72; 95% confidence interval, 4.20-612.63; P = 0.0020; respectively). The signal detection analysis indicated tumor thickness of more than 3 mm and three or more metastatic lymph nodes as cut-off points for survival. In conclusion, tumor thickness and the number of metastatic lymph nodes closely correlated with patient outcome and these factors could be suitable for the tumor and node classification.

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“…It usually affects older patients, and the lesions commonly develop in the vulva, penis, scrotum, perineum, perianal area, umbilicus, and axilla [1]. Invasive EMPD, although relatively rare, is reported to be highly metastatic to lymph nodes (47.1%) or even other organs (17.6%), including bone (5.9%) [2]. Histologically, both noninvasive EMPD and invasive EMPD show significant numbers of lymphocytes around the tumor mass.…”

Section: Introductionmentioning

confidence: 99%

Potential Use of Bisphosphonates in Invasive Extramammary Paget’s Disease: An Immunohistochemical Investigation

Fujimura

Furudate

Kambayashi

et al. 2013

Clinical and Developmental Immunology

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Invasive extramammary Paget's disease (EMPD) is relatively rare and is reported to be highly metastatic to lymph nodes or even other organs, including bone. Histologically, EMPD shows significant numbers of lymphocytes around the tumor mass, suggesting the possible development of novel immunomodulatory therapy for EMPD by targeting these infiltrating lymphocytes. Previously, bisphosphonates (BPs) were administered for the treatment of malignancy, especially osteolytic bone disease. Recent reports also suggested that BPs might have a direct antitumor effect through several pathways beyond their beneficial effect on bone metastasis. Among them, the abrogation of immunosuppressive cells, myeloid derived suppressor cells (MDSC), by BPs might be one of the optimal methods to induce an antitumor immune response both locally and at sites remote from the tumor. In this study, we employed immunohistochemical staining for immunosuppressive macrophages and cytotoxic T cells in the lesional skin of patients with noninvasive EMPD and those with invasive EMPD.

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Clinicopathological study of invasive extramammary Paget’s disease: subgroup comparison according to invasion depth

Abstract: These results suggest that invasive EMPD can be divided according to invasion depth, with a cut-off depth of 1 mm. This might represent the basis for a useful, EMPD-specific staging system.

Cited by 50 publications

References 11 publications

Serum cytokeratin 19 fragment 21‐1 is a useful tumor marker for the assessment of extramammary Paget's disease

Serum cytokeratin 19 fragment 21‐1 is a useful tumor marker for the assessment of extramammary Paget's disease

Tumor thickness as a prognostic factor in extramammary Paget's disease

Potential Use of Bisphosphonates in Invasive Extramammary Paget’s Disease: An Immunohistochemical Investigation

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