乳房外Ｐａｇｅｔ病患者４５人の臨床病理学的検討

Abstract

Forty-five patients with extramammary Paget's disease (thirty-five male and tenfemale) treated at National Cancer Center Hospital between August 1975 and August 1999 were reviewed. The median age was 65 years (range 42 to 99 years) . The median follow-up was 62months (range 6 to 232 months) . Twenty-one patients had lesions on the scrotum, four on the penis, ten on the scrotum and penis, nine on the vulva, and one on the perianal region. Twenty-nine patients underwent clinical excision with >3cm macroscopic clearance of the surgical margins, nine underwent pathological excision with microscopic clearance of the surgical margins, and seven underwent conservative excision to preserve excretional and sexual function. The patients were divided into four groups according to histopathologic findings; 1. intraepithelial lesion (IE) : histologic findings of Paget cells within the epidermis and the adnexal epithelium, 2. minimally dermal invasion (MDI) : invasion of papillary dermis, 3. dermal invasion (DI) : invasion of reticular dermis, 4. subcutaneous invasion (SI) : invasion of subcutaneous fat tissue. Twelve patients were diagnosed with IE, twenty-four with MDI, five with DI, and four with SI. At the first surgery, four patients with SI and two with DI had lymph node metastasis, and three with SI had distant metastasis. The 5-year survival rate was 0% in SI patients, 80% in DI, 100% in MDI, and 100% in IE. The prognosis was related to the depth of invasion, not to the method of operation. [Skin Cancer (Japan) 2001; 16: 114-119]