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Microsoft word - fp1036.doc
FP1036 MAMMARY AND EXTRAMAMMARY PAGET’S DISEASE: STUDY OF 14
CASES AND THE THERAPEUTIC DIFFICULTIES
v. a. tanaka1, c. festa1, j. a. sanches1, l. a. r. torezan1, a. b. niwa1
1Dermatology, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, sao paulo, Brazil
Background: The Paget’s disease is an uncommon cutaneous neoplasm. It is classified into mammary and extramammary. Both have similar clinical and histopathological features, nevertheless they differ in sites, associated neoplasm, treatment and recurrence. Objectives: To analyze clinical evolution and interventions on patients with Paget’s disease followed in our ambulatory between January 1991 and December 2007. Methods:A retrospective review of the charts of 14 patients with Paget’s disease in 17 years follow up. The data was analyzed in relation to personal characteristics, clinical features, treatment need and disease recurrence. Results:In the 14 patients with Paget’s disease 7 had mammary Paget’s disease, 6 of them were diagnosed with associated ductal carcinoma, all of them underwent surgery and did not present recurrence during the follow up period. On the other hand, the others 7 patients with extramammary Paget’s disease underwent different kind of treatment, including: radiotherapy, CO2 laser, Imiquimod topical treatment and surgery, All of them have had recurrence of the disease. Currently 4 of those are in treatment with photodynamic therapy. Regarding the patients with mammary Paget’s disease the clinical features, evolution and treatment were similar to what has been reported in the literature. In the extramammary Paget’s disease it was observed a high recurrence rate. This is also similar to the findings in the literature. Conclusion: The treatment of the mammary Paget’s disease is well established. However in the extramammary Paget’s disease still represents a challenge because the surgery often leads to an anatomic and/or functional impairment of the affected area and the conservative treatments have a high recurrence rate.
References: 1-Paget J. On the disease of the mammary areola preceding cancer of
the mammary gland. StBart holomew Hosp Rep 1874;10:87_9.
2-Kawase K, Dimaio DJ, Tucker SL, et al. Paget's disease of the breast: there is a
role for breast-conserving therapy. Ann Surg Oncol. 2005 May;12(5):391-7. Epub
2005 Mar 29.
3-Jones RE, Austin C, Ackerman AB. Extramammary Paget’s disease. A critical
reexamination. Am J Dermatopathol 1979; 2:101–32.
4-Hendi A, Brodland DG, Zitelli JA. Extrammamary Paget’s disease: surgical
treatment with Mohs micrographic surgery. J Am Acad Dermatol 2004 (nov); 51(5):
5-Guerrieri M, Back MF.Extramammary Paget's disease: role of radiation therapy.
Australas Radiol. 2002 Jun;46(2):204-8.
6-Shieh S, Dee AS, Cheney RT, Frawley NP, Zeitouni NC, Oseroff AR.
Photodynamic therapy for the treatment of extramammary Paget's disease. Br J
Dermatol 2002 (Jun.);146(6):1000–5.
7-Cohen PR, Schulze KE, Tschen JA, Hetherington GW, Nelson BR. Treatment of
extramammary Paget disease with topical imiquimod cream: case report and
literature review. South Med J. 2006 Apr;99(4):396-402.
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