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Background: Although extramammary Paget's disease (EMPD) mostly presents as intraepithelial carcinoma, we sometimes encounter patients with invasive EMPD (iEMPD) who have lymph node metastasis and may develop distant metastasis. Although sentinel lymph node biopsy (SLNB) is widely accepted for various cancers, there is no large study that has assessed its role in iEMPD.
Objective: The main objective of this study is to assess the role of SLNB in patients with iEMPD.
Materials And Methods: We retrospectively collected data on 151 iEMPD patients treated from 1998 to 2012 in 11 institutes in Japan. All 151 patients received curative surgery for their primary tumor and none of them had distant metastasis. SLNB was performed on the 107 patients without lymphadenopathy to determine their LN status. The 44 other patients with lymphadenopathy underwent one of the following procedures to determine their LN status: SLNB in 22 cases, immediate LN dissection in 21, and LN biopsy in 1.
Results: Compared to those without lymphadenopathy, patients with lymphadenopathy had advanced primary tumors (nodule in the primary tumor, thicker tumor, deeper invasion level, and lymphovascular invasion). The rate of LN metastasis in patients with lymphadenopathy was 80%, compared to 15% in patients without lymphadenopathy who underwent SLNB. Compared to those with negative SLN, patients with positive SLN had advanced primary tumors (nodule in the primary tumor, deeper invasion level, and lymphovascular invasion). Multivariate analysis revealed that dermal invasion (odds ratio 5.8, p=0.04) and lymphovascular invasion (odds ratio 18.0, p=0.0023) were independent factors associated with SLN positivity. Notably, there was no difference in survival between patients with or without SLN metastasis (p=0.71). On the other hand, patients with lymphadenopathy showed worse survival than those with positive SLN (p=0.045).
Conclusion: Clinical lymphadenopathy was strongly correlated with pathological LN metastasis and also associated with worse survival than absence of lymphadenopathy. The rate of occult LN metastasis detected by SLNB was 15%. Survival was not affected by SLN status even when an advanced primary tumor was present in patients with positive SLN. Our results raise the possibility that SLNB and subsequent LN dissection improved the survival of patients with early stage lymphatic spread. Our study indicates that SLNB should be considered for iEMPD if lymphadenopathy is not apparent.
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http://dx.doi.org/10.1016/j.jdermsci.2015.03.014 | DOI Listing |
Heliyon
December 2024
JSC National Scientific Medical Center, 42 Abylai Khan ave., 010009, Astana, Kazakhstan.
Cavitary sarcoidosis is a rare form and represents non-caseating granulomatous diseases of the lungs exhibiting a narrow range of differential diagnoses. The peculiarity of this case lies in the difficulty of distinguishing atypical manifestations of pulmonary sarcoidosis, such as cystic lesions, from cavernous tuberculosis. Both possess similar clinical and radiological features.
View Article and Find Full Text PDFPan Afr Med J
December 2024
Department of Radiology, Tygerberg Hospital, Stellenbosch University, Stellenbosch, South Africa.
Introduction: cardiovascular magnetic resonance imaging is considered the standard of care for many clinical cardiovascular applications. Magnetic resonance imaging is a scarce resource in sub-Saharan Africa, with a paucity of cardiac magnetic resonance imaging clinical services and research. The aim of this audit was to review the cardiac magnetic resonance imaging service provided at a public tertiary hospital in Cape Town, Western Cape Province, South Africa.
View Article and Find Full Text PDFAnn Hematol
December 2024
Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan.
Dasatinib, a second-generation tyrosine kinase inhibitor, has been reported to have immunomodulatory effects. Epstein-Barr virus (EBV)-associated lymphoproliferative disorders (EBV-LPD) occur in immunocompromised patients, such as those receiving methotrexate or other immunosuppressive drugs or after allogenic transplantation. EBV-LPD is also reported to be a rare side effect in patients receiving long-term dasatinib or imatinib.
View Article and Find Full Text PDFJ Med Case Rep
December 2024
Department of Pathology, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka.
Introduction: Primary bone marrow diffuse large B-cell lymphoma is a rare clinical entity, and the "bone marrow-liver-spleen" type of diffuse large B-cell lymphoma is rarer, with only a few published cases in literature. Though bone marrow-liver-spleen-type diffuse large B-cell lymphoma has unique presentations such as fever, cytopenias, and hemophagocytic lymphohistiocytosis, no cases with cold autoimmune hemolytic anemia have been reported.
Case Presentation: A 39-year-old Sri Lankan woman, previously healthy, presented with shortness of breath, productive cough, and fever for 4 days.
Leuk Lymphoma
December 2024
Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
The diagnosis of myeloid neoplasms with plasmacytoid dendritic cell (pDC) differentiation can be challenging due to immunophenotypic overlap requiring detailed characterization by flow cytometry and immunohistochemistry. We describe two patients with a history of myeloproliferative neoplasm (MPN) and myelodysplastic/myeloproliferative neoplasm (MDS/MPN) who presented years later with leukocytosis, lymphadenopathy, splenomegaly, and cachexia, with rapid clinical deterioration and death. Lymph node biopsy specimens revealed involvement by myeloid sarcoma with prominent pDC differentiation.
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