Difference between revisions of "Extramammary Paget disease"
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*Epitheliod morphology (round/ovoid). | *Epitheliod morphology (round/ovoid). | ||
*Cells nested or single. | *Cells nested or single. | ||
*Classically Paget cells ride above the basal cell layer | |||
*But the process can fill the entire epidermis | |||
*Clear/pale cytoplasm '''key feature''' - may also be eosinophilic. | *Clear/pale cytoplasm '''key feature''' - may also be eosinophilic. | ||
*Large nucleoli. | *Large nucleoli. | ||
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===DDx=== | ===DDx=== | ||
*[[Malignant melanoma in situ]]. | |||
*[[Malignant melanoma]]. | *[[Bowen disease]] - Pagetoid squamous cell carcinoma in situ. | ||
*[[Bowen disease]]. | *[[Apocrine carcinoma of the skin]] - really Paget with an underlying apocrine carcinoma.<ref>URL: [http://derm101.com/searchResults.aspx?searchStr=apocrine+carcinoma&rootTerm=apocrine+carcinoma&searchType=2&rootID=12687 http://derm101.com/searchResults.aspx?searchStr=apocrine+carcinoma&rootTerm=apocrine+carcinoma&searchType=2&rootID=12687]. Accessed on: 9 September 2011.</ref> | ||
*[[Apocrine carcinoma of the skin]].<ref>URL: [http://derm101.com/searchResults.aspx?searchStr=apocrine+carcinoma&rootTerm=apocrine+carcinoma&searchType=2&rootID=12687 http://derm101.com/searchResults.aspx?searchStr=apocrine+carcinoma&rootTerm=apocrine+carcinoma&searchType=2&rootID=12687]. Accessed on: 9 September 2011.</ref> | |||
*[[Vulvar squamous cell carcinoma]]. | *[[Vulvar squamous cell carcinoma]]. | ||
*Pagetoid vulvar intraepithelial neoplasia | |||
*Toker cell hyperplasia is really just a nipple (mammary Paget issue). | |||
==Stains== | ==Stains== | ||
Revision as of 10:46, 11 March 2015
| Extramammary Paget disease | |
|---|---|
| Diagnosis in short | |
 Extramammary Paget's disease. H&E stain. | |
|
| |
| LM | large epithelioid cells - nested or single - in the epidermis, clear/pale cytoplasm (occasionally eosinophilic), large nucleoli |
| LM DDx | benign Toker cell hyperplasia, malignant melanoma, Bowen's disease, apocrine carcinoma of the skin |
| IHC | CK7 +ve, CEA +ve, S-100 -ve, CK5/6 -ve, HER2 +ve |
| Gross | erythema, +/-weeping, +/-crusted |
| Site | vulva, penis, scrotum, others |
|
| |
| Symptoms | pruritis (itchy) |
| Prognosis | typically benign - usually not associated with an underlying malignancy (unlike Paget's disease of the breast) |
| Clin. DDx | contact dermatitis, lichen sclerosus |
Extramammary Paget disease, abbreviated EMPD, is a skin disease. As the name suggests, there is also a Paget disease of the breast.
There is also a Paget disease of the bone - just to make things confusing. This is dealt with in the bone article and has nothing (from a pathologic perspective) to do with the Paget disease discussed in this article
General
- Two types
- Primary Extramammary Paget disease - a malignancy of the cutaneous apocrine glands
- Arises in apocrine rich areas - usually the vulva but also the groin, inguinal area, perineum, penis[1] or scrotum.[2] and rarely axilla or eye.
- Usually entirely intraepidermal but may be associated with an underlying apocrine gland carcinoma (in contrast to mammary Paget disease which is usually associated with underlying mammary carcinoma).
- Secondary Extramammary Paget disease - intraepidermal spread from a distant tumor
- Usually of urothelial or colorectal origin.
- Arises in the perineal areas near these organs
- Primary Extramammary Paget disease - a malignancy of the cutaneous apocrine glands
Clinical:
- Pruritis.
- R/O VIN
- R/O vulvitis
Gross
Features:[2]
- Plaque with an irregular border.
- Erythematous or white.
Clinical DDx:
- Lichen sclerosus.[3]
- Vulvar intraepithelial neoplasia
- Vulvar squamous cell carcinoma in situ
- Other vulvitis
Images
Microscopic
Features:
- Epitheliod morphology (round/ovoid).
- Cells nested or single.
- Classically Paget cells ride above the basal cell layer
- But the process can fill the entire epidermis
- Clear/pale cytoplasm key feature - may also be eosinophilic.
- Large nucleoli.
Images
- Anus Pagets Disease PA.JPG
Anus Pagets Disease - (SKB)
Anus Pagets Disease - (SKB)
Anus Pagets Disease - (SKB)
DDx
- Malignant melanoma in situ.
- Bowen disease - Pagetoid squamous cell carcinoma in situ.
- Apocrine carcinoma of the skin - really Paget with an underlying apocrine carcinoma.[4]
- Vulvar squamous cell carcinoma.
- Pagetoid vulvar intraepithelial neoplasia
- Toker cell hyperplasia is really just a nipple (mammary Paget issue).
Stains
- Mucicarmine stain +ve.
IHC
Panel:
- CEA +ve (-ve in Bowen's disease, -ve in Toker cells).
- CK7 +ve.
- Toker cells CK7 +ve.[5]
- S100 -ve, HMB-45 -ve (both typically +ve in melanoma).
Additional:
- HER2/neu - usually +ve.
- CK5/6 -ve.[6]
- Usu. +ve in squamous cell carcinoma.
- CAM 5.2 +ve.
See also
References
- ↑ Ekwueme, KC.; Zakhour, HD.; Parr, NJ. (2009). "Extramammary Paget's disease of the penis: a case report and review of the literature.". J Med Case Reports 3: 4. doi:10.1186/1752-1947-3-4. PMID 19126202.
- ↑ 2.0 2.1 2.2 Guerra, R.; Misra, S. (2013). "Management of Extramammary Paget's Disease: A Case Report and Review of the Literature.". Case Rep Dermatol Med 2013: 436390. doi:10.1155/2013/436390. PMID 24349803.
- ↑ Bansal, D.; Bowman, CA. (Feb 2004). "Extramammary Paget's disease masquerading as lichen sclerosus.". Int J STD AIDS 15 (2): 141-2. doi:10.1258/095646204322764361. PMID 15006079.
- ↑ URL: http://derm101.com/searchResults.aspx?searchStr=apocrine+carcinoma&rootTerm=apocrine+carcinoma&searchType=2&rootID=12687. Accessed on: 9 September 2011.
- ↑ Nofech-Mozes, S.; Hanna, W.. "Toker cells revisited.". Breast J 15 (4): 394-8. doi:10.1111/j.1524-4741.2009.00743.x. PMID 19601945.
- ↑ RS. May 2010.