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

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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Low-dose mitomycin C, etoposide, and cisplatin for invasive vulvar Paget's disease

International Journal of Gynecological Cancer ◽

10.1136/ijgc-00009577-200205000-00011 ◽

2002 ◽

Vol 12 (3) ◽

pp. 304-307 ◽

Cited By ~ 1

Author(s):

Y Watanabe ◽

H Hoshiai ◽

H Ueda ◽

H Nakai ◽

K Obata ◽

...

Keyword(s):

Mitomycin C ◽

Low Dose ◽

Paget’S Disease ◽

Skin Grafting ◽

Complete Response ◽

Paget's Disease ◽

Inguinal Lymph Node Dissection ◽

Vulvar Paget’S Disease ◽

Grade 3

Abstract.Watanabe Y, Hoshiai H, Ueda H, Nakai H, Obata K, Noda K. Low-dose mitomycin C, etoposide, and cisplatin for invasive Paget's disease.We report the effect of low-dose mitomycin C, etoposide, and cisplatin (low-dose MEP) therapy for three patients with invasive vulvar Paget's disease (invasive VPD) who declined radical vulvectomy and skin grafting. One patient achieved a complete response, while the other two showed partial responses (PR) without grade 3 or 4 adverse effects. The two patients with PR were undergone partial vulvectomy and inguinal lymph node dissection. All patients have no sign of recurrence for 10 months after chemotherapy. Our present results suggest that low-dose MEP is an effective and safe chemotherapy for invasive VPD and low-dose MEP may significantly improve postoperative quality of life in patients with invasive VPD by avoiding extensive vulvar resection and skin grafting.

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Rare Primary Esophageal Paget’s Disease Diagnosed on a Large Bloc Specimen Obtained by Endoscopic Mucosal Resection

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.264.pag ◽

2017 ◽

Vol 26 (4) ◽

pp. 417-420 ◽

Cited By ~ 1

Author(s):

Hirohito Mori ◽

Maki Ayaki ◽

Hideki Kobara ◽

Yasuhiro Goda ◽

Noriko Nishiyama ◽

...

Keyword(s):

Endoscopic Mucosal Resection ◽

Narrow Band ◽

Narrow Band Imaging ◽

Case Reports ◽

Paget’S Disease ◽

Paget's Disease ◽

Endoscopic Examination ◽

Capillary Loop ◽

Mucosal Resection ◽

Cap Method

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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