Surgical indication and complications in vertebral paget's disease. Two case reports

Primary esophageal Paget’s disease is rare. Only a few case reports have described the intraepithelial papillary capillary loop (IPCL) pattern obtained by magnified Narrow Band Imaging (M-NBI) endoscopy in this rare pathology. This report highlights the usefulness of M-NBI and the successful diagnosis using a large bloc specimen obtained by endoscopic mucosal resection with the cap method (EMR−c). A 53-year-old man was referred to endoscopic examination for dysphagia. The endoscopic image revealed a ring-shaped scarring of the esophagus suggestive for eosinophilic esophagitis. The IPCL pattern by M-NBI endoscopy showed an inflammatory pattern, and the entire epithelium of the esophagus was not stained by Lugol iodine spraying. Based on six biopsies randomly performed, a poorly differentiated adenocarcinoma was diagnosed. Since the M-NBI pattern and the histology were completely different, EMR−c was performed to obtain large bloc specimens for a more detailed diagnosis. The pathological findings revealed extensive Paget’s cells infiltration into the epithelium and multifocal invasion from the mucosa to the submucosal layer with adenocarcinoma. In conclusion, a large bloc specimen by EMR-c might be more useful than a small biopsy for an accurate diagnosis of the rare esophageal Paget’s disease.Key words: – – .Abbreviations: EMR−c: endoscopic mucosal resection with cap method; IPCL: intraepithelial papillary capillary loop; LVLs: Lugol-voiding lesions; M-NBI: magnified Narrow Band Imaging; PET-CT: Positron-Emission Tomography and Computed Tomography.

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Novel operative technique of advancement urethral meatoplasty utilizing buccal mucosa for Vulvar Paget’s disease with urethral invasion: two case reports

Journal of Medical Case Reports ◽

10.1186/s13256-021-02729-1 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Masaki Nakamura ◽

Yuji Hakozaki ◽

Shohei Iwata ◽

Yusuke Sato ◽

Katsuhiro Makino ◽

...

Keyword(s):

Urethral Stricture ◽

Buccal Mucosa ◽

Case Reports ◽

Paget’S Disease ◽

External Genitalia ◽

Skin Grafting ◽

Standard Of Care ◽

Paget's Disease ◽

Vaginal Mucosa ◽

Vulvar Paget’S Disease

Abstract Background Vulvar Paget’s disease (VPD) is a rare malignant disorder originating in the external genitalia. It occasionally invades into urethral or vaginal mucosa of female, making surgical treatment more complicating. In case of urethral invasion of Paget’s cells, systematic mapping biopsy of urethral mucosa is the standard of care to determine the range of surgical resection. Resection of urethral mucosa and simple skin grafting often result in urethral stricture after surgery, which severely deteriorates patient’s quality of life. Case presentation We applied a new technique of advancement urethral meatoplasty using buccal mucosa, in two Japanese cases of VPD with urethral invasion. After broad resection of vulvar skin together with the urethral mucosa, buccal mucosa was implanted between advanced urethral mucosa and skin graft. In both cases, we could prevent urethral stricture one year and two years after surgery, respectively. Conclusion This technique prevented urethral stricture after surgery and could be a useful technique as part of urethroplasty for VPD.

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