Paget's disease of the vulva with bladder invasion: a case report

Tumor excision and dermal-flap skin graft operations were performed on a 72-year-old woman diagnosed with extramammary Paget's disease at our hospital in August 2001. Paget cells were identified in the external urethral meatus even though nine local excisions of recurrent tumors had been performed. She was suffered from severe vesical pain from May 2007. Urine cytology was class V and physical examination revealed redness in external urethral meatus. Pelvic MRI did not show apparent lymph node swelling and the endoscopic multiple biopsies performed at multiple bladder mucosa and distal urethra. Pathological diagnosis of the endoscopic biopsy showed multiple Paget cells from urethra, posterior and bilateral lateral wall, and bladder neck. Because Paget's disease may infiltrate bladder mucosa and cause severe vesical pain due to bladder invasion, total cystorethrectomy, ileal conduit, and external skin excision were performed. Pathological findings were continuous infiltration of Paget cells from external urethral meatus to bladder mucosa.