Perianal Paget’s disease: presentation of six cases and literature review
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Extramammary Paget’s disease (EMPD) is frequently associated with adnexal or visceral synchronous or metachronous malignancies. Our purpose was to evaluate, retrospectively, the results obtained in six cases of EMPD and to review the literature.
Six patients with the perianal Paget’s disease had been treated in our division between March 1996 and December 2006. In three cases, the disease was confined in the epidermis; in one case, there was a microinvasion of the dermis, while in another one the dermis was infiltrated. The last case was associated to a low rectal adenocarcinoma. All patients underwent wide perianal excision and reconstruction with skin graft. We performed a transanal resection of the rectal adenocarcinoma. A review of the literature from 1990 to 2008 revealed 193 cases of perianal EMPD, 112 were intraepithelial/intradermal while 81 were associated with malignancies. Anorectal adenocarcinoma was already existing in two cases, synchronous in 48, and subsequent to diagnosis in 11.
In three cases, the disease recurred locally, but no patient developed metastatic spread. Five patients survived and are free of disease. The review of the literature allows a clear identification of the primitive EMPD and the form associated to anorectal adenocarcinoma and little information about cases associated with synchronous adnexal adenocarcinoma. The Paget’s disease can relapse after radical surgery and has a capacity of metastatic spread.
Up to now, no clear guidelines have been established for the diagnosis of EMPD. The association with synchronous or metachronous carcinomas imposes a long-term follow-up with frequent clinical, radiological, and endoscopical controls.
KeywordsExtramammary Paget’s disease Perianal Paget’s disease Perianal gland neoplasm Pagetoid phenomenon
- 27.Nowak MA, Guerriere-Kovach P, Pathan A, Campbell TE, Deppisch LM (1998) Perianal Paget’s disease: distinguishing primary and secondary lesions using immunohistochemical studies including gross cystic disease fluid protein-15 and cytokeratin 20 expression. Arch Pathol Lab Med 122(12):1077–1081. ReviewPubMedGoogle Scholar
- 38.Vereecken P, Awada A, Ghanem G, da Costa CM, Larsimont D, Simoens C, da Costa PM, Hendlisz A (2007) A therapeutic approach to perianal extramammary Paget’s disease: topical imiquimod can be useful to prevent or defer surgery. Med Sci Mon 13(6):CS75–CS77Google Scholar
- 59.Yamamoto AI, Sato K, Wada T, Takahashi H, Toyota N, Shibaki T, Yamazaki K, Tokusashi Y, Miyokawa N, Hajime I (2002) Fibroepithelioma-like changes occurring in perianal Paget’s disease with rectal mucinous carcinoma: case report and review of 49 cases of extramammary Paget’s disease. J Cutan Pathol 29:185–189CrossRefGoogle Scholar
- 60.Le Fur R, Mears L, Dannawi Z (2004) A peri-anal extramammary Paget’s disease associated with two well-differentiated invasive intramucosal sigmoid carcinomas, a very rare case: an immunohistochemical and clinical review of extramammary Paget’s disease. Ann R Coll Surg Engl 86(6):W26–W31PubMedGoogle Scholar