Co-occurrence of apocrine adenocarcinoma and invasive mammary-type ductal carcinoma in extramammary Paget disease of the axilla

Extramammary Paget disease (EMPD) is an uncommon malignancy that occurs in apocrine gland-rich areas of the body. EMPD of the axilla is rare, but a few cases have been reported. Some cases of EMPD have been reported with underlying apocrine adenocarcinoma; rarely, mammary-type ductal carcinoma can accompany EMPD. Here, we report a very rare case of EMPD with apocrine adenocarcinoma and invasive mammary-type ductal carcinoma. A 55-year-old woman was referred with a brownish pigmented plaque accompanying an area of ulceration in the left axilla. A preoperative biopsy indicated Paget disease, and an additional evaluation was performed to determine whether it was of primary or secondary origin. A wide excision was made, and the axilla was reconstructed using a thoracodorsal artery perforator flap. The biopsy showed apocrine adenocarcinoma and invasive mammary-type ductal carcinoma with pagetoid spreading. The patient had no evidence of recurrence or other postoperative complications.

Keywords

Extramammary Paget disease - Axilla - Immunohistochemical staining

Publication History

Received: 05 September 2019

Accepted: 30 October 2019

Article published online:
25 March 2022

• REFERENCES

• 1 Whorton CM, Patterson JB. Carcinoma of Moll’s glands with extramammary Paget’s disease of the eyelid. Cancer 1955; 8: 1009-15
• 2 Delport ES. Extramammary Paget’s disease of the vulva: an annotated review of the current literature. Australas J Dermatol 2013; 54: 9-21
• 3 Villada G, Farooq U, Yu W. et al. Extramammary Paget disease of the vulva with underlying mammary-like lobular carcinoma: a case report and review of the literature. Am J Dermatopathol 2015; 37: 295-8
• 4 Morgan JM, Carmichael AJ, Ritchie C. Extramammary Paget’s disease of the axilla with an underlying apocrine carcinoma. Acta Derm Venereol 1996; 76: 173-4
• 5 Kazakov DV, Spagnolo DV, Kacerovska D. et al. Lesions of anogenital mammary-like glands: an update. Adv Anat Pathol 2011; 18: 1-28
• 6 Jung HR, Kwon SY, Son D. Apocrine carcinoma of the axilla associated with extramammary Paget’s disease: a case report and review of the literature. J Pathol Transl Med 2015; 49: 535-7
• 7 Belousova IE, Kazakov DV, Michal M. et al. Vulvar toker cells: the long-awaited missing link: a proposal for an origin-based histogenetic classification of extramammary Paget disease. Am J Dermatopathol 2006; 28: 84-6
• 8 Toledo-Pastrana T, Llombart-Cussac B, Traves-Zapata V. et al. Case report: differential diagnosis between primary cutaneous apocrine adenocarcinoma versus extramammary or metastatic breast adenocarcinoma. Am J Dermatopathol 2014; 36: e175-8
• 9 Ohira S, Itoh K, Osada K. et al. Vulvar Paget’s disease with underlying adenocarcinoma simulating breast carcinoma: case report and review of the literature. Int J Gynecol Cancer 2004; 14: 1012-7
• 10 Metaizeau JP, Gayet C, Schmitt M. et al. The use of free full thickness skin grafts in the treatment of complications of burns. Prog Pediatr Surg 1981; 14: 209-23
• 11 Agarwal R, Chandra R. Latissimus dorsi myocutaneous flap reconstruction of neck and axillary burn contractures. Plast Reconstr Surg 2000; 106: 1216
• 12 Wilson IF, Lokeh A, Schubert W. et al. Latissimus dorsi myocutaneous flap reconstruction of neck and axillary burn contractures. Plast Reconstr Surg 2000; 105: 27-33
• 13 Angrigiani C, Grilli D, Siebert J. Latissimus dorsi musculocutaneous flap without muscle. Plast Reconstr Surg 1995; 96: 1608-14
• 14 Er E, Ucar C. Reconstruction of axillary contractures with thoracodorsal perforator island flap. Burns 2005; 31: 726-30