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Angiogenesis in Paget's Disease of the Vulva and the Breast: Correlation with Microvessel Density
Patricia E Ellis1, Allan B Maclean, L F Wong Te Fong
1Department of Obstetrics and Gynaecology, Royal Free and University College Medical School (Hampstead Campus), Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK.
Insights
Neovascularization, indicated by microvessel density, is key in breast Paget's disease development. However, vulvar Paget's disease pathogenesis involves other biological and molecular factors.
Area of Science:
- Oncology
- Pathology
- Gynecologic Oncology
Background:
- The pathogenesis of Paget's disease of the vulva and breast is not fully understood.
- Angiogenesis, the formation of new blood vessels, is implicated in various disease processes.
- Investigating angiogenesis via microvessel density may elucidate Paget's disease mechanisms.
Purpose of the Study:
- To determine the role of angiogenesis, assessed by microvessel density, in the pathogenesis of vulvar and breast Paget's disease.
- To compare microvessel density in different subtypes of breast and vulvar Paget's disease.
Main Methods:
- Analysis of microvessel density using anti-von Willebrand factor antibody.
- Study included 105 cases: 71 vulvar Paget's disease (8 with invasive disease) and 34 breast Paget's disease.
- Breast cases included ductal carcinoma in situ (DCIS), invasive carcinoma, or no identified tumor.
Main Results:
- Increased microvessel density was observed in breast Paget's disease with DCIS (P < 0.08) and carcinoma alone (P < 0.013) compared to breast Paget's disease alone.
- No significant differences in microvessel density were found in the vulvar Paget's disease cases.
- Neovascularization appears crucial for breast Paget's disease progression.
Conclusions:
- Neovascularization plays a significant role in the development of breast Paget's disease.
- Pathogenesis of vulvar Paget's disease likely involves different biological and molecular mechanisms beyond angiogenesis.
- Further research into these distinct pathways is warranted for targeted therapies.
Abstract:
Our understanding of the pathogenesis of Paget's disease of the vulva and the breast remains limited. Current evidence supports the fact that angiogenesis plays an important role in the pathogenesis of several diseases. Therefore, we sought to define its role, as correlated with microvessel density, in Paget's disease of the vulva and the breast. Microvessels were analysed using anti-von Willebrand factor antibody in 105 cases of Paget's disease of the vulva and the breast comprising 71 cases of Paget's disease of the vulva, including 8 cases with invasive disease, and 34 cases of Paget's disease of the breast. The latter included 12 cases with DCIS, 5 cases with both DCIS and invasive carcinoma, and 6 with carcinoma alone. Eleven cases had no underlying tumour identified. Increased microvessel density was demonstrated in Paget's disease of the breast with DCIS and with carcinoma alone compared to Paget's disease of the breast alone, P < 0.08 and P < 0.013, respectively. There were no significant differences in microvessel density in the vulval cases. Neovascularisation is an important process in the development of Paget's disease of the breast. Other biological and molecular processes are more involved in the pathogenesis of Paget's disease of the vulva.
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