cytokeratin-7

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Well-demarcated erythematous plaque on the arm

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Well-demarcated erythematous plaque on the arm

A 67-year-old Caucasian man presented with an asymptomatic, well-defined, irregular shaped, erythematous scaly plaque on the left upper arm for five years. There was no cervical or axillary lymphadenopathy. A skin punch biopsy was performed from the plaque. Histopathological examination showed hyperkeratosis, acanthosis and atypical large pale cells with abundant vacuolated cytoplasm in the epidermis. There was no dermal invasion. Tumor cells were positive for cytokeratin 7, but negative for cytokeratin 20, P63 and Melan A by immunohistochemistry.

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Extramammary Paget disease

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Extramammary Paget disease

In 1874, Sir James Paget first described Paget disease of the nipple, also known as mammary Paget disease. In 1889, extramammary Paget disease (EMPD) of the scrotum and penis was identified. Although mammary and extramammary Paget disease are both characterized by epidermal Paget cells and share a similar clinical presentation, their uniqueness lies in anatomical location and histogenesis. EMPD presents as an erythematous plaque on apocrine gland bearing areas (i.e. vulva, perineum, perianal region, scrotum, and penis) in older men and women. It can be a focal, multifocal, or an ectopic process. Immunohistochemical staining allows for differentiation between primary and secondary EMPD in addition to the many other disease entities that clinically resemble this malignancy. When diagnosing a patient with EMPD, a full history and physical should be performed given the possibility of an underlying malignancy. Surgical excision currently is first line therapy and the prognosis is often favorable. Recent advances within the field have examined the expression of chemokine receptors within tumors, which may be applicable in determining prognosis. This review addresses the history, epidemiology, pathogenesis, clinical presentation, histopathology, differential diagnosis, diagnosis, management, and new observations with respect to extramammary Paget disease.

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Anal canal adenocarcinoma with neuroendocrine features accompanying secondary extramammary Paget disease, successfully treated with modified FOLFOX6: a case report

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Anal canal adenocarcinoma with neuroendocrine features accompanying secondary extramammary Paget disease, successfully treated with modified FOLFOX6: a case report

Anal canal cancer occasionally accompanies extramammary Paget disease. Although most of them are squamous cell carcinoma, anal canal adenocarcinoma with neuroendocrine features accompanying secondary extramammary Paget disease has never been reported.

This is a clinically significant case, as it reveals novel pathological features about anal canal cancer with secondary Paget disease and successfully treated with modified FOLFOX6. Careful pathological investigation and appropriate treatment choice are needed for this rare cancer.

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Intraoperative Immunostaining for Cytokeratin-7 During Mohs Micrographic Surgery Demonstrates Low Local Recurrence Rates in Extramammary Paget's Disease

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Intraoperative Immunostaining for Cytokeratin-7 During Mohs Micrographic Surgery Demonstrates Low Local Recurrence Rates in Extramammary Paget's Disease

Extramammary Paget’s disease (EMPD) is a rare intraepithelial malignancy typically occurring in the groin and axillary regions. Given its indolent growth pattern and clinical resemblance to inflammatory skin conditions, diagnosis of EMPD is often delayed. Reported recurrence rates for standard surgical treatments including wide local excision, vulvectomy, and abdominoperineal resection are high, ranging from 22% to 60% in the largest retrospective cohort of patients with EMPD treated with Mohs micrographic surgery (MMS) demonstrating local recurrence rates of 26% overall, 16% for primary disease, 50% for recurrent disease, and a salvage rate for recurrent disease after MMS (overall cure rate) of 100%

The authors hypothesize that the increased recurrence rates for EMPD after MMS, as compared to other types of skin cancer, are due to difficulties in recognizing tumor cells on routine hematoxylin and eosin staining. Indeed, the authors have previously shown a case of EMPD in the axilla with irregular yet contiguous finger-like microscopic extensions that were not seen on H&E but identified on sections stained for cytokeratin-7(CK-7). The use of intra-operative immunohistochemistry for CK-7 during MMS for EMPD is described in case studies and small single-center cross-sectional studies.

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