Paget's cancer extraammary - causes, symptoms, treatment, photos
- 20 Sep 16:45
- Disease Of The Skin
Paget's disease in an extraammar form is adenocarcinoma, which is histologically and clinically similar to Paget's cancer, striking breast tissue( nipples and nearososovye areoles).The disease is observed in elderly patients of any sex, however, in women,is more commonly found in the disease.
- 1 Causes of
- 2 Clinical manifestations of
- diagnostic methods 4
- treatment 5 Forecast and prevention of
- 6 Photo
Causes and mechanism of Paget's disease development are unclear. It is assumed that malignant cells are formed from epithelial cells of the ecchymal or apocrine sweat glands. Penetrating into the epidermis, these cells provoke growth of adenocarcinoma in the surrounding iron structures.
In essence, Paget's disease, like the Kerry erythroplasia, is an insitu cancer, that is, pre-invasive cancer( malignant education at the initial stages of development).
Clinical manifestations of
There are three varieties of extemammary varieties of Paget's cancer:
- A disease without malignant tumor;
- A disease associated with sweat gland cancer;
- A disease associated with cancer of the urogenital or gastrointestinal tract.
With extrahammary Paget's cancer, cells are formed on the skin areas where apocrine glands are located. This is the inguinal and armpit folds, the vulva, the penis, the scrotum, the perineum, the navel region. Very rarely, lesions of the skin of the torso or oral cavity are observed, as are apocrine glands, there are rarefied.
In most cases, the hearth of Paget's cancer is lonely, however, in the literature there is a description and multiple lesions of the lesion.
Clinically, Paget's disease manifests itself in the formation of reddish spots or skin-raised plaques with uneven contours and a wet, velvety surface. On the macerated surface of the skin, plaques may appear crusty or ulcers. Patients complain of itching and burning sensation.
At the first stage of the disease, a red erythematous stain appears on the skin. The surface of the stain may peel off and outwardly it resembles the nummer of eczema.
For several months, and often for several years, the stain is gradually increasing and denser, increasing its maceration. On the surface erosion is formed, covered with serous or bloody crust. When removing the crust exposed granular moisture, slightly bleeding surface. In the center of the lesion area there may be scarring and the appearance of keloid scars.
In women, the greatest probability of localization of extraammammary form of Paget's cancer is the skin of the large labia, and in men it is the scrotum skin. The size of the hearth may be different. The flat may have a diameter of only a few millimeters or expand, covering almost the entire perineum.
In most cases, Paget's extramammary cancer is a superficial tumor that does not extend beyond the epidermis. However, in many patients with Paget's cancer, it is combined with other cancers. Most often, it is the adenocarcinoma of the appendages of the skin, but sometimes extemammary Paget's disease is combined with bladder cancer or the organs of the digestive tract.
The extraammary form of Paget's cancer is rare, so the correct diagnosis is difficult to diagnose. Manifestations of the disease are often taken for psoriasis, fungal lesions, seborrheic dermatitis.
To produce the correct diagnosis, it is necessary to take a stroke-imprint for the cytological examination, as well as to conduct a biopsy for histology.
Significant for the diagnosis is the presence in Paget cell epidermis. These are large cells that are characterized by vacuolized cytoplasm and vesicular nuclei. Moreover, the nucleus of the cell is usually displaced to the periphery.
Paget cell cytoplasm gives a positive coloration when treated with aldehyde-fuchsin. However, the detection of Paget cells to date is a rather difficult task.
When conducting an immunohistochemical study in Paget's cancer, the presence of high molecular weight glycoprotein and cancer-embryonic antigens is detected in the extraammary form.
Thus, the diagnosis of Paget's disease is determined by examining clinical manifestations and evaluating the results of histology and cytology.
In the event that the focus of the disease is located in the perianal region or the perineal region, an examination is required to exclude accompanying and subject to malignant neoplasms.
For this patient are sent for the following diagnostic procedures:
- Colonoscopy - examination of the internal surface of the large intestine;
- Rectoscopy - examination of the inner surface of the rectum;
- Iridology - X-ray examination of the intestine with the introduction of a contrast agent;
- Cystoscopy - a study of the bladder by examining its inner surface with a special device;
- Excretory urography - a roentgenographic method for the study of urinary tract with the introduction of contrast agents.
- For women - a complete gynecological study.
It is necessary to distinguish Extrahamnary Paget's disease from eczema, psoriasis of large folds of the skin, limited neurodermatitis, dermatophy, skin folds, Bowen's disease.
The only effective treatment method for extramammary Paget's disease is surgical removal of the tumor. When carrying out the surgery, carry out a wide incision with the capture of healthy tissue.
So, when detecting an invasive form of Paget's disease of the vulva, vulvectomy is shown with bilateral removal of the inguinal lymph nodes.
In a traditional operation for the treatment of Paget's disease, the risk of relapse in the next 5 years is more than 40%.
To reduce the likelihood of re-development of the disease, today, in most cases, the microscopic technique of operation from Mos( Mohs) is used. In the process of conducting the operation, a layer of incision of tissues is performed, followed by a microscopic examination of the specimens. The operation lasts as long as no atypical cells are detected in the tissue that is being examined.
This operation is most effective because it allows you to remove the entire tumor. In addition, when applying this technique, the healthy tissues are kept as fully as possible.
After the operation, it is necessary to carry out a comprehensive treatment aimed at preventing the development of relapses.
Typically, at Paget's disease, prescribe:
- General chemotherapy drugs( bleomycin, prospidine);
- With the superficial form of Paget's disease, it is possible to use drugs of external chemotherapy - prospidine, colchamine, ointment, fluorouracil cream. Ointments are applied under the occlusion bandage.
With superficial forms of Paget's cancer, it may be possible to use laser therapy or cryodestruction instead of performing a traditional surgery. Radiotherapy is used to treat patients who are contraindicated in conducting surgery.
Forecast and prevention of
Paget's disease prevention has not been developed, as until now, the factors contributing to the development of the disease have not been found.
The prediction of Paget's disease is uncertain and depends on the presence of concomitant or suspected oncological tumors. So, the mortality from Paget's disease in the absence of carcinoma is 18%.In the presence of carcinoma, this figure is increased to 46%.
Approximately 12% of patients with Paget's disease have malignant neoplasms in the internal organs, which further complicates the prognosis.
It has been noted that the localization of the cancerous hearth of Paget's Extraammaric cancer is closely related to the location of the internal tumor. So, with placement of the hearth of Paget's cancer in the perianal region, it can testify to malignant bowel disease. When placing the focus on the genital organs, it is necessary to exclude the cancer of the genitourinary system.
The highest risk of placement is due to tumor in the detection of a focal point of Paget's disease in the perianal region. This type of disease has the most difficult predictor. Mortality for the first kind with this disease is 26%.Conducting surgery with such a location of the tumor is difficult, moreover, frequent relapses after the tumor is excisional.