Pap smear of patients with extramammary Paget's disease of the vulva
Department of Pathology, University of California Irvine Medical Center, Orange, California 92868, USA.Diagnostic Cytopathology (Impact Factor: 1.12). 06/2005; 32(6):353-7. DOI: 10.1002/dc.20260
Extramammary Paget's disease (EMPD) of the vulva is a rare entity. The diagnosis is almost always made on biopsy. Tumor cells are seen rarely in Papanicolaou (Pap) smears. We encountered three cases of EMPD that were detected in Pap smears. One patient had vulvar and vaginal involvement and the abnormal cells seen in the vaginal smear initially were interpreted as high-grade squamous intraepithelial lesion. Retrospective review showed scattered single atypical cells with enlarged hyperchromatic nuclei, coarse chromatin, inconspicuous nucleoli, high nuclear/cytoplasmic (N:C) ratio, and scanty basophilic cytoplasm. Rare signet ring cells and cells within cells were present. In the other two patients who had cervical involvement, the correct diagnosis was made on Pap smears. The slides showed both single and cohesive sheets of glandular cells with enlarged round to oval nuclei, coarse chromatin, prominent nucleoli, and abundant basophilic cytoplasm containing prominent vacuoles with signet ring-cell appearance. Cells within cells were abundant. EMPD has distinct cytomorphological features. Although infrequently encountered, EMPD can be diagnosed on Pap smears with adequate clinical history.
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ABSTRACT: Extramammary Paget's disease of the vulva (EMPDV) is a rare gynecologic malignancy. We examined two cases of EMPDV in which cytologic study led to early detection of disease recurrence. In case 1, a 71-year-old woman, recurrence was detected with malignant cells from the vaginal Papanicolaou smear a few months after radical surgery for endometrial cancer. An asymptomatic perineal erythematous lesion was identified and diagnosed as EMPDV by biopsy specimen. She underwent curative surgery, but during the follow-up period, malignant cells appeared again in her vaginal Papanicolaou smear, which led to early detection of the recurrent disease that was macroscopically invisible. In case 2, an 80-year-old woman presented with the complaint of perineal pruritus and was diagnosed with EMPDV. Twenty-two months after the curative primary surgery, bilateral groin lymphadenopathies appeared, and the cytologic specimen by fine needle aspiration biopsy from the lymph nodes led to early detection of the recurrence without her experiencing negative side effects such as severe pain. Cytologic examination is a simple but efficient diagnostic measure without major negative side effects, provided the procedures are applied adequately and performed correctly.Acta cytologica 54(5 Suppl):1007-12. · 1.56 Impact Factor
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ABSTRACT: Breast cancer is a common disease in Western societies, with an incidence of 46.31/100,000 women/year in Brazil. The tumor suppressor gene TP53 is one of the most studied genes regarding the presence of mutations. Indeed, 50% of all tumors are known to exhibit changes in the TP53 nucleotide sequence due to carcinogenic processes. As to the presence of polymorphism, the TP53 gene is polymorphic at the nucleotide residue 347 (codon 72). In the current study, we examine if this polymorphism is associated with the clinicopathological parameters of breast cancer patients in a Brazilian population. One hundred and thirteen patients with breast cancer were included. The polymorphic region of the TP53 gene was PCR-amplified from genomic DNA obtained from buccal cells. Specific primers for the Pro and Arg allele were used. Correlations of polymorphism with age, staging, nuclear grade, lymph node status, estrogen receptor status and lymphatic and/or blood vessel invasion were evaluated. Statistical analysis was performed using the Fisher's exact test. The frequency of p53 Arg/Arg was 57% and of the heterozygous allele Arg/Pro it was 39%. There was no correlation between polymorphism and clinicopathological parameters. According to our results, the TP53 polymorphism, at the 347 residue, is not associated with any clinicopathological findings of patients with breast cancer.European journal of gynaecological oncology 02/2008; 29(4):364-7. · 0.61 Impact Factor
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