Diagnosis and Therapeutic Methods of Paget's Disease_West China Medical Journal

Authors：

 XUYang ¹ , CHENLi-bo ² , LINYing-ying ³ ,  CENYing ¹

1. Department of Burn and Plastic, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Urology Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Deaprtment of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

CENYing, Email: cenying0141@163.com

Keywords：

Paget’s disease of scrotum; Diagnosis; Therapy; Prognosis

DOI：

10.7507/1002-0179.20140511

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Objective To investigate the clinical features, diagnosis, therapeutic methods of Paget's disease involving the scrotum. Methods The clinical data of 18 patients with Paget's disease treated in our hospital between 2008 and 2013 involving the scrotum were analyzed retrospectively. The patients' age ranged from 55 to 81 years old with an average of 69. The disease course ranged from 9 months to 18 years, averaging 6 years and 3 months. The main clinical pr was itching (94.4%), followed by exudation (66.7%), pain (11.1%), and desquamation (5.6%). All patients underwent extended resection. Results The patients were followed up for 8 to 52 months averaging 34 months. Four patients' postoperative pathological report found focus on the excision margin, and one of them had local recurrence after 14 months. The remaining 14 cases had no local recurrence. One patient's pathological findings reported Paget's disease combined with invasive adenocarcinoma which invaded subcutaneous fat tissue layer, and this patient developed inguinal lymph node metastasis 20 months after operation. Another patient combined with adenocarcinoma which invaded deep dermis layer developed liver and lung metastasis 18 months after operation. Conclusion Paget's disease involving the scrotum is more commonly seen in older patients, and its main clinical presentation is itching. Paget's disease is usually misdiagnosed, so patients should undergo pathological examination early to clear diagnosis. Surgery is the main treatment. Paget's disease combined with invasive adenocarcinoma has poor prognosis.

Citation： XUYang, CHENLi-bo, LINYing-ying, CENYing. Diagnosis and Therapeutic Methods of Paget's Disease. West China Medical Journal, 2014, 29(9): 1674-1677. doi: 10.7507/1002-0179.20140511 Copy

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13.	Parker LP,Parker JR,Bodurka-Bevers D,et al.Paget's disease of pathology pattern of involvement and prognosis[J].Gynecol Oncol,2000,77(1):183-189.
14.	Fanning J,Lambert HC,Hale TM,et al.Paget's disease of the vulva:prevalence of associated vulvar adenocarcinoma,invasive Paget's disease,and recurrence after surgical excision[J].Am J Obstet Gynecol,1999,180(1):24-27.
15.	Parker LP,Parker JR,Bodurka-Bevers D,et al.Paget's disease of the vulva:pathology,pattern of involvement,and prognosis[J].Gynecol Oncol,2000,77(1):183-189.

1. Ray B,Whitmore WF Jr.Experience with carcinoma of the scrotum[J].J Urol,1977,117(6):741-745.
2. Lai YL,Yang WG,Tsay PK,et al.Penoscrotal extramammary Paget's disease:a review of 33 cases in a 20-year experience[J].Plast Reconstr Surg,2003,112(4):1017-1023.
3. 汪春年,赵飞行.阴囊、阴茎Paget病临床病理分析[J].中华男科学杂志,2008,14(9):810-814.
4. Brown RS,Lankester KJ,McCormack M,et al.Radiotherapy for perianal Paget's disease[J].Clin Oncol (R Coll Radio),2002,14(4):272-284.
5. Luk NM,Yu KH,Yeung WK,et al.Extramammary Paget's disease:outcome of radiotherapy with curative intent[J].Clin Exp Dermatol,2003,28(4):360-363.
6. Berman B,Spencer J,Villa A,et al.Successful treatment of extramammary Paget's disease of the scrotum with imiquimod 5% cream[J].Clin Exp Dermatol 2003,28(Suppl 1):36-38.
7. Shieh S,Dee AS,Cheney RT,et al.Photodynamic therapy for the treatment of extramammary Paget's disease[J].Br J Dermatol,2002,146(6):1000-1005.
8. Park S,Grossfeld GD,Mcaninch JW,et al.Extramammary Paget's disease of the penis and scrotum:excision,reconstruction,and evaluation of occult malignancy[J].J Urol,2001,166(6):2112-2117.
9. Zhang N,Gong K,Zhang X,et al.Extramammary Paget's disease of scrotum:report of 25 cases and literature review[J].Urol Oncol,2008,28(1):28-33.
10. Yang WJ,Kim DS,Im YJ,et al.Extramammary Paget's disease of penis and scrotum[J].Urology,2005,65(5):972-975.
11. Ng LG,Yip SK,Tan PH.Extramammary Paget's disease of scrotum[J].Urology,2001,58(1):105-106.
12. Tsut sumida A,Yamamoto Y,Minakawa H,et al.Indications for lymphnode dissection in the treatment of extrmammary Paget's disease[J].Dermatol Surg,2003,29(1):212-224.
13. Parker LP,Parker JR,Bodurka-Bevers D,et al.Paget's disease of pathology pattern of involvement and prognosis[J].Gynecol Oncol,2000,77(1):183-189.
14. Fanning J,Lambert HC,Hale TM,et al.Paget's disease of the vulva:prevalence of associated vulvar adenocarcinoma,invasive Paget's disease,and recurrence after surgical excision[J].Am J Obstet Gynecol,1999,180(1):24-27.
15. Parker LP,Parker JR,Bodurka-Bevers D,et al.Paget's disease of the vulva:pathology,pattern of involvement,and prognosis[J].Gynecol Oncol,2000,77(1):183-189.

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