Vulvar Paget's disease: The need to exclude an invasive lesion

Feuer, Gerold; Shevchuk, Maria M.; Calanog, Anthony

doi:10.1016/0090-8258(90)90016-e

Cited by 96 publications

(37 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although it is rarely associated with underlying adenocarcinoma, it mostly begins as an intraepidermal adenocarcinoma that can invade the dermis and may metastasize via the lymphatic system (Feuer et al, 1990;Hart and Millman, 1977;Jones et al, 1979;Murata et al, 1999). The histogenesis of EMPD has long been disputed.…”

mentioning

confidence: 99%

Expression of Structurally Unaltered Androgen Receptor in Extramammary Paget's Disease

Fujimoto

Takata

Hatta

et al. 2000

Laboratory Investigation

View full text Add to dashboard Cite

SUMMARY: Extramammary Paget's disease (EMPD) is an uncommon neoplasm of the skin that shows differentiation to an apocrine sweat gland. Although we previously showed that erbB-2 overexpression may play a part in the progression of EMPD, molecular genetic defects underlying the development of EMPD are poorly understood. In the study described here, we examined androgen receptor expression and gene alterations in 30 cases of EMPD without internal malignancy. Immunohistochemistry revealed that 24 of 30 (80%) cases of EMPD variably expressed nuclear androgen receptor. Semi-quantitation of receptor content by scoring immunostained sections showed no difference between in situ (n ϭ 17) and invasive (n ϭ 13) EMPD tumors. Androgen receptor expression was also observed in four of six lymph node metastases. In these lymph nodes, expression of androgen receptor mRNA was confirmed by reverse transcriptase-polymerase chain reaction. Direct sequencing of exon 2 through exon 8, which encodes DNA-and hormone-binding domains of the androgen receptor gene, revealed no mutation in any of the 10 advanced stage tumors. Neither amplification nor deletion of the androgen receptor gene locus was detected by dual color fluorescence in situ hybridization analysis in 14 tumors. The present findings showing frequent expression of structurally unaltered androgen receptor in an advanced stage of EMPD may provide a rational basis for hormone therapy, which is widely used in the treatment of metastatic prostate cancer and androgen receptor-positive breast cancer recurrence. (Lab Invest 2000, 80:1465-1471.E xtramammary Paget's disease (EMPD) is an uncommon neoplasm of apocrine gland-bearing skin, that most commonly involves the vulvar, perianal, perineal, scrotal, and penile regions (Heymann, 1993). Although it is rarely associated with underlying adenocarcinoma, it mostly begins as an intraepidermal adenocarcinoma that can invade the dermis and may metastasize via the lymphatic system (Feuer et al, 1990;Hart and Millman, 1977;Jones et al, 1979;Murata et al, 1999). The histogenesis of EMPD has long been disputed. Emerging information, however, supports the concepts that Paget's cells in EMPD are of glandular origin, usually showing apocrine differentiation and that the disease may arise from a pluripotential epidermal precursor (Guarner et al, 1989;Mazoujian et al, 1984;Roth et al, 1977).The molecular genetic defects underlying EMPD are poorly understood. We previously showed that erbB-2 overexpression by either gene amplification or transcriptional activation may play a part in the progression of EMPD (Takata et al, 1999). However, other molecular genetic defects, including p53 mutations, allelic loss of several selected chromosome arms as well as abnormal activation of the ␤-catenin gene, which are commonly seen in other epithelial malignancies, were not detected in EMPD (Takata et al, 1999;Takata et al, 1997). To explore further the molecular pathogenesis of EMPD, we aimed at examining androgen receptor expression in Paget's cells of EMPD f...

show abstract

mentioning

confidence: 99%

Expression of Structurally Unaltered Androgen Receptor in Extramammary Paget's Disease

Fujimoto

Takata

Hatta

et al. 2000

Laboratory Investigation

View full text Add to dashboard Cite

show abstract

“…6,8,10,14,15,30,[35][36][37] Progression of noninvasive vulvar PD to invasion and nodal metastasis has been convincingly documented in some cases by serial excisions over multiple years. 10,17,35,38,39 Microinvasive PD is a term proposed by some authors for invasion that measures less than 0.1 cm from the basal layer. While some series show that nodal metastasis occurs only in patients with invasion deeper than 0.1 cm, nodal metastases have also been described in patients with microinvasive vulvar PD, as well as in some in whom invasion has not been documented.…”

Section: Behaviormentioning

confidence: 98%

“…Thus, the significance of microinvasion has yet to be fully determined. 14,35,36,40 Regional lymph node metastasis has been reported in a small number of patients. In 2 of the larger series of vulvar PD, nodal metastases eventually developed in approximately 10% of patients.…”

Section: Behaviormentioning

confidence: 99%

Vulvar Paget Disease

Rabban¹,

Zaloudek²

2005

Pathology Case Reviews

View full text Add to dashboard Cite

Paget disease of the vulva is an intraepithelial adenocarcinoma that has a propensity for local recurrence. Intraepithelial Paget cells may also reflect vulvar extension of an adnexal or visceral carcinoma, such as vulvar sweat gland, urothelial, or colorectal carcinoma. Mimics of vulvar Paget disease include melanoma and pagetoid squamous cell carcinoma in situ (vulvar intraepithelial neoplasia). The different prognostic and treatment implications among the diagnostic possibilities mandate a careful morphologic and immunohistochemical approach to the diagnosis.

show abstract

“…An ocular micrometer was used to measure the depth from the surface of the epidermis (cornified layer) or epithelium to the deepest located tumor cell in an involved adnexal structure. In all cases, we determined if there was microinvasion (defined as stromal invasion to a depth of no more than 1 mm below the basement membrane 22 ) or if depth of invasion exceeded 1 mm. Twelve lesions were the subject of 2 previous reports.…”

Section: Light Microscopymentioning

confidence: 99%

Depth and Patterns of Adnexal Involvement in Primary Extramammary (Anogenital) Paget Disease: A Study of 178 Lesions From 146 Patients

Konstantinova¹,

Shelekhova

Stewart

et al. 2016

The American Journal of Dermatopathology

View full text Add to dashboard Cite

Extramammary Paget disease (EMPD) is a rare neoplasm usually presenting in the anogenital area, most commonly in the vulva. Adnexal involvement in primary EMPD is a very common feature and serves as a pathway for carcinoma to spread into deeper tissue. The depth of carcinomatous spread along the appendages and the patterns of adnexal involvement were studied in 178 lesions from 146 patients with primary EMPD. Hair follicles and eccrine ducts were the adnexa most commonly affected by carcinoma cells. The maximal depth of involvement was 3.6 mm in this series. When planning topical therapy or developing novel local treatment modalities for EMPD, this potential for significant deep spread along adnexa should be taken into account.

show abstract

Vulvar Paget's disease: The need to exclude an invasive lesion

Cited by 96 publications

References 11 publications

Expression of Structurally Unaltered Androgen Receptor in Extramammary Paget's Disease

Expression of Structurally Unaltered Androgen Receptor in Extramammary Paget's Disease

Vulvar Paget Disease

Depth and Patterns of Adnexal Involvement in Primary Extramammary (Anogenital) Paget Disease: A Study of 178 Lesions From 146 Patients

Contact Info

Product

Resources

About