肛周Paget病合并肺腺癌和肛管癌1例并文献复习

周凛梅; 杨美; 王涛; 张建勇

doi:10.11817/j.issn.1672-7347.2023.220617

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临床病例讨论 | 更新时间：2023-10-24

肛周Paget病合并肺腺癌和肛管癌1例并文献复习
Perianal Paget’s disease complicated with lung adenocarcinoma and anal canal carcinoma: A case report and literature review
中南大学学报(医学版) 中南大学学报(医学版) 2023年48卷第8期页码：1274-1280
作者机构：

1.遵义医科大学附属医院呼吸与危重症医学科，贵州遵义 563000
作者简介：

周凛梅，Email: 437723014@qq.com, ORCID: 0009-0004-7526-3910
张建勇，Email: zjy9453@sina.com, ORCID: 0000-0001-5478-6182
基金信息：

遵义市科技计划项目[(2021)19号]
DOI：10.11817/j.issn.1672-7347.2023.220617
中图分类号：
CSTR：

周凛梅, 杨美, 王涛, 等. 肛周Paget病合并肺腺癌和肛管癌1例并文献复习[J]. 中南大学学报(医学版), 2023,48(8):1274-1280.

ZHOU Linmei, YANG Mei, WANG Tao, et al. Perianal Paget’s disease complicated with lung adenocarcinoma and anal canal carcinoma: A case report and literature review[J]. Journal of Central South University. Medical Science, 2023,48(8):1274-1280.
周凛梅, 杨美, 王涛, 等. 肛周Paget病合并肺腺癌和肛管癌1例并文献复习[J]. 中南大学学报(医学版), 2023,48(8):1274-1280. DOI： 10.11817/j.issn.1672-7347.2023.220617.

ZHOU Linmei, YANG Mei, WANG Tao, et al. Perianal Paget’s disease complicated with lung adenocarcinoma and anal canal carcinoma: A case report and literature review[J]. Journal of Central South University. Medical Science, 2023,48(8):1274-1280. DOI： 10.11817/j.issn.1672-7347.2023.220617.

摘要

肛周Paget病(perianal Paget’s disease，PPD)是一种罕见皮肤恶性肿瘤。本文报道1例PPD合并肺腺癌和肛管癌的患者资料。患者为76岁女性，反复下腹部疼痛伴肛周瘙痒5年。体格检查示右侧肛周皮肤5 cm×6 cm大小菜花状新生物，局部皮肤破溃并有少量液体渗出，累及左侧肛周。胸膝位，距肛缘2 cm直肠5~6点直肠黏膜下触及质硬包块。胸部CT示双肺多发病变，考虑转移瘤。氟代脱氧葡萄糖-正电子发射断层显像(fluorodeoxyglucose-positron emission tomography and computed tomography，FDG-PET/CT)提示双肺多发代谢增高结节，全身多发代谢增高淋巴结，左侧臀部小片皮肤早期FDG摄取增高，直肠肛管区FDG摄取增高。支气管镜下右上叶前段开口新生物活检，组织病理学提示肺腺癌。最终诊断为PPD合并肺腺癌、肛管癌、全身多发淋巴结转移。PPD合并消化道肿瘤和其他恶性肿瘤的发生率高，完善结肠镜检查、FDG-PET/CT、组织病理学及免疫组织化学检查，能早期识别局部淋巴结和远处受累，鉴别诊断潜在恶性肿瘤。目前治疗手段多样化，可术后联合或单一化学治疗、放射治疗、靶向治疗及光动力学治疗等，且随着治疗的进展，需重新评估外科手术的范围和有效性。

Abstract

Perianal Paget’s disease (PPD) is a rare malignant cutaneous tumor. This paper reported a case of PPD complicated by lung adenocarcinoma and anal canal cancer. The patient, a 76-year-old female, had been experiencing recurrent lower abdominal pain and perianal pruritus for the past 5 years. Upon physical examination, a cauliflower-like neoplasm in size of 5 cm×6 cm was observed on the right perianal skin, with local skin ulceration and a small amount of fluid discharge. The left perianal skin was also involved. In thoracoknee position, a hard mass was palpable in the rectal submucosa at 5-6 points 2 cm from the anal verge. Chest CT revealed multiple lesions in both lungs, indication of metastatic tumors. Further evaluation with fluorodeoxyglucose positron emission tomography and computed tomography (FDG-PET/CT) indicated multiple hypermetabolic nodules in the lungs, hypermetabolic lymph nodes throughout the body, early FDG uptake in a small patch of skin on the left hip, and increased FDG uptake in the anorectal region. Histopathological examination confirmed the diagnosis of lung adenocarcinoma. This resulted in the patient being diagnosed with PPD, lung adenocarcinoma, anal canal cancer, and systemic multiple lymph node metastasis. The combination of PPD with gastrointestinal tumors and other metachronous malignant tumors is highly prevalent. Colonoscopy, FDG-PET/CT, histopathology, and immunohistochemistry play crucial roles in early identification of local lymph node and distant involvement, facilitating the evaluation of potential malignant tumors and differential diagnosis. Treating methods for PPD are currently diverse, including postoperative combined or single chemotherapy, radiotherapy, targeted therapy, and photodynamic therapy. As trerapeutical options continue to develop, the extent and efficacy of surgery need to be reassessed.

关键词

乳房外Paget病肛周Paget病氟代脱氧葡萄糖-正电子发射断层显像免疫组织化学

Keywords

extramammary Paget’s diseaseperianal Paget’s diseasefluorodeoxyglucose-positron emission tomographyimmunohistochemistry

references

Porter C. A disease of the mammary areola preceding cancer of the mammary glands, Paget’s disease[J]. N Engl J Med, 1882, 106: 412-414. https://doi.org/10.1056/NEJM188205041061802https://doi.org/10.1056/NEJM188205041061802.

Crocker H. Paget’s disease affecting the scrotum and penis[J]. Trans Pathol Soc London, 1889(40): 187-191.

Asel M, LeBoeuf NR. Extramammary Paget’s disease[J]. Oncol Clin N Am, 2019, 33(1): 73-85. https://doi.org/10.1016/j.hoc.2018.09.003https://doi.org/10.1016/j.hoc.2018.09.003.

Minicozzi A, Borzellino G, Momo R, et al. Perianal Paget’s disease: presentation of six cases and literature review[J]. Int J Colorectal Dis, 2010, 25(1): 1-7. https://doi.org/10.1007/s00384- 009-0797-9https://doi.org/10.1007/s00384-009-0797-9.

Perez DR, Trakarnsanga A, Shia J, et al. Management and outcome of perianal Paget’s disease: a 6-decade institutional experience[J]. Dis Colon Rectum, 2014, 57(6): 747-751. https://doi.org/10.1097/DCR.0000000000000100https://doi.org/10.1097/DCR.0000000000000100.

Kyriazanos ID, Stamos NP, Miliadis L, et al. Extra-mammary Paget’s disease of the perianal region: a review of the literature emphasizing the operative management technique[J/OL]. Surg Oncol, 2011, 20(2): e61-e71[2022-12-12]. https://doi.org/10.1016/j.suronc.2010. 09.005https://doi.org/10.1016/j.suronc.2010.09.005.

许昭亭, 方宗武, 舒郁平. 肛周Paget病伴腺体低级别上皮内瘤变1例[J]. 中国现代医药杂志, 2020, 22(6): 76. https://doi.org/10.3969/j.issn.1672-9463.2020.06.022https://doi.org/10.3969/j.issn.1672-9463.2020.06.022.

XU Zhaoting, FANG Zongwu, SHU Yuping. A case of perianal Paget’s disease with low-grade intraepithelial neoplasia of the glands[J]. Modern Medicine Journal of China, 2020, 22(6): 76. https://doi.org/10.3969/j.issn.1672-9463.2020.06.022https://doi.org/10.3969/j.issn.1672-9463.2020.06.022.

刘颖, 张新华, 余波, 等. 30例乳腺外Paget病的临床病理及预后分析[J]. 临床与实验病理学杂志, 2014, 30(11): 1211-1214. https://doi.org/10.13315/j.cnki.cjcep.2014.11.003https://doi.org/10.13315/j.cnki.cjcep.2014.11.003.

LIU Ying, ZHANG Xinhua, YU Bo, et al. Analysis of clinicopathologic features and prognostic factors of 30 patients with extramammary Paget’s disease[J]. Chinese Journal of Clinical and Experimental Pathology, 2014, 30(11): 1211-1214. https://doi.org/10.13315/j.cnki.cjcep.2014.11.003https://doi.org/10.13315/j.cnki.cjcep.2014.11.003.

常浩, 王启明, 何东杰, 等. 放射治疗阴茎阴囊Paget病1例并文献回顾[J]. 山西医科大学学报, 2019, 50(4): 530-532. https://doi.org/10.3969/j.issn.1001-1420.2010.08.022https://doi.org/10.3969/j.issn.1001-1420.2010.08.022.

CHANG Hao, WANG Qiming, HE Dongjie, et al. Radiotherapy for Paget’s disease of penis and scrotum: a case report and literature review[J]. Journal of Shanxi Medical University, 2019, 50(4): 530-532. https://doi.org/10.3969/j.issn.1001-1420.2010.08.022https://doi.org/10.3969/j.issn.1001-1420.2010.08.022.

曾倩, 伊美慧, 李芃芃, 等. 光动力联合放疗治疗巨大原发乳房外Paget病1例[J]. 皮肤病与性病, 2021, 43(1): 62-64. https://doi.org/10.3969/j.issn.1002-1310.2021.01.032https://doi.org/10.3969/j.issn.1002-1310.2021.01.032

ZENG Qian, YI Meihui, LI Pengpeng, et al. Photodynamic combined with radiotherapy for giant primary extramammary Paget disease: a case report[J]. Journal of Dermatology and Venereology, 2021, 43(1): 62-64. https://doi.org/10.3969/j.issn.1002-1310.2021.01.032https://doi.org/10.3969/j.issn.1002-1310.2021.01.032.

Minicozzi A, Borzellino G, Momo R, et al. Perianal Paget’s disease: presentation of six cases and literature review[J]. Int J Colorectal Dis, 2010, 25(1):1-7.https://doi:10.1007/s00384-009- 0797-9https://doi:10.1007/s00384-009-0797-9.

Isik O, Aytac E, Brainard J, et al. Perianal Paget’s disease: three decades experience of a single institution[J]. Int J Colorectal Dis, 2016, 31(1): 29-34. https://doi.org/10.1007/s00384-015-2342-3https://doi.org/10.1007/s00384-015-2342-3.

Niederkohr RD, Gambhir SS. F-18 FDG PET/CT imaging of extramammary Paget disease of the perianal region[J]. Clin Nucl Med, 2006, 31(9): 561-563. https://doi.org/10.1097/01.rlu.0000233226.09449.4ahttps://doi.org/10.1097/01.rlu.0000233226.09449.4a.

Tian Y, Wu HB, Li DL, et al. Utility of 18F-FDG PET/CT in the diagnosis and staging of extramammary Paget’s disease[J]. Nucl Med Commun, 2015, 36(9): 892-897. https://doi.org/10.1097/mnm.0000000000000340https://doi.org/10.1097/mnm.0000000000000340.

Khoo ACH, Yeoh KW. 18F-FDG PET/CT in metastatic extramammary Paget’s disease[J]. Clin Nucl Med, 2019, 44(10): 808-809. https://doi.org/10.1097/rlu.0000000000002739https://doi.org/10.1097/rlu.0000000000002739.

Jiang CJ, Song SL. 68Ga-FAPI and 18F-FDG PET/CT in perineum extramammary Paget disease[J]. Clin Nucl Med, 2021, 46(4): 342-344. https://doi.org/10.1097/rlu.0000000000003523https://doi.org/10.1097/rlu.0000000000003523.

Lam C, Funaro D. Extramammary Paget’s disease: summary of current knowledge[J]. Dermatol Clin, 2010, 28(4): 807-826. https://doi.org/10.1016/j.det.2010.08.002https://doi.org/10.1016/j.det.2010.08.002.

张韡, 曾学思, 孙建方. 乳房外Paget病的病理学研究进展[J]. 中华皮肤科杂志, 2015, 48(12): 897-898. https://doi.org/10.3760/cma.j.issn.0412-4030.2015.12.023https://doi.org/10.3760/cma.j.issn.0412-4030.2015.12.023.

ZHANG Wei, ZENG Xuesi, SUN Jianfang. Pathological research progress of Paget’s disease outside breast[J]. Chinese Journal of Dermatology, 2015, 48(12): 897-898. https://doi.org/10.3760/cma.j.issn.0412-4030.2015.12.023https://doi.org/10.3760/cma.j.issn.0412-4030.2015.12.023.

Tran L, Mattsson JSM, Nodin B, et al. Various antibody clones of napsin A, thyroid transcription factor 1, and p40 and comparisons with cytokeratin 5 and p63 in histopathologic diagnostics of non-small cell lung carcinoma[J]. Appl Immunohistochem Mol Morphol, 2016, 24(9): 648-659. https://doi.org/10.1097/pai.0000000000000235https://doi.org/10.1097/pai.0000000000000235.

Yatabe Y, Dacic S, Borczuk AC, et al. Best practices recommendations for diagnostic immunohistochemistry in lung cancer[J]. J Thorac Oncol, 2019, 4(3):377-407. https://doi:10.1097/PAI.0000000000000235https://doi:10.1097/PAI.0000000000000235.

Wang YC, Li AFY, Yang SH, et al. Perianal Paget’s disease: the 17-year-experience of a single institution in Taiwan[J]. Gastroenterol Res Pract, 2019, 2019: 1-8. https://doi.org/10.1155/2019/2603279https://doi.org/10.1155/2019/2603279.

Liao XY, Liu XL, Fan XM, et al. Perianal Paget’s disease: a clinicopathological and immunohistochemical study of 13 cases[J].Diagn Pathol, 2020, 15(1): 1-7. https://doi.org/10.1186/s13000-020-00952-whttps://doi.org/10.1186/s13000-020-00952-w.

Shutze WP, Gleysteen JJ. Perianal Paget’s disease[J]. Dis Colon Rectum, 1990, 33(6): 502-507. https://doi.org/10.1007/bf02052147https://doi.org/10.1007/bf02052147.

Tsutsumida A, Yamamoto Y, Minakawa H, et al. Indications for lymph node dissection in the treatment of extramammary Paget’s disease[J]. Dermatol Surg, 2003, 29(1): 21-24. https://doi.org/10.1097/00042728-200301000-00005https://doi.org/10.1097/00042728-200301000-00005.

Sarmiento JM, Wolff BG, Burgart LJ, et al. Paget’s disease of the perianal region—an aggressive disease?[J]. Dis Colon Rectum, 1997, 40(10): 1187-1194. https://doi.org/10.1007/bf02055165https://doi.org/10.1007/bf02055165.

Damavandy AA, Terushkin V, Zitelli JA, et al. Intraoperative immunostaining for cytokeratin-7 during mohs micrographic surgery demonstrates low local recurrence rates in extramammary Paget’s disease[J]. Dermatol Surg, 2018, 44(3): 354-364. https://doi.org/10.1097/dss.0000000000001355https://doi.org/10.1097/dss.0000000000001355.

Kim SJ, Thompson AK, Zubair AS, et al. Surgical treatment and outcomes of patients with extramammary Paget disease: a cohort study[J]. Dermatol Surg, 2017, 43(5): 708-714. https://doi.org/10.1097/dss.0000000000001051https://doi.org/10.1097/dss.0000000000001051.

Tran MN, Harvey JA. Extensive extramammary Paget’s disease with underlying perianal adenocarcinoma: the role of neoadjuvant radiation treatment[J/OL]. Cureus, 2020: 12(12):e11966[2022-12-01]. https://doi.org/10.7759/cureus.11966https://doi.org/10.7759/cureus.11966.

Shen KX, Luo H, Hu J, et al. Perianal Paget disease treated with wide excision and thigh skin flap reconstruction: a case report and review of literature[J/OL]. Medicine, 2018, 97(30): e11638[2022-12-01]. https://doi.org/10.1097/MD.0000000000011638https://doi.org/10.1097/MD.0000000000011638.

Lu XL, Zhang PP, Zhu Y, et al. Human epidermal growth factor receptor 2 amplification as a biomarker for treatment in patients with lymph node‑metastatic penoscrotal extramammary Paget’s disease[J]. Oncol Lett, 2019: 17(3): 2677-2686. https://doi.org/10.3892/ol.2019.9930https://doi.org/10.3892/ol.2019.9930.

Apalla Z, Lallas A, Tsorova A, et al. Complete response of extramammary Paget’s disease with imiquimod and PDT: report of two cases[J]. Photodermatol Photoimmunol Photomed, 2018, 34(4): 273-275. https://doi.org/10.1111/phpp.12386https://doi.org/10.1111/phpp.12386.

宋乐彬, 鲁严. 降低乳房外Paget病手术复发率的研究进展[J]. 中华皮肤科杂志, 2020, 53(5): 398-400. https://doi.org/10.35541/cjd.20190138https://doi.org/10.35541/cjd.20190138.

SONG Lebin, LU Yan. Reduction of recurrence rate of extramammary Paget’s disease after surgical treatment[J]. Chinese Journal of Dermatology, 2020, 53(5): 398-400. https://doi.org/10.35541/cjd.20190138https://doi.org/10.35541/cjd.20190138.

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