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Clinicopathological Correlation and Recurrence Outcome of Adnexal Involvement on Primary Extramammary Paget's Disease
Sabita Aryal1, Subodh Bashyal2, Liu Ye Qiang3
1Department of Dermatology and Venereology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, CHN.
Abstract:
Introduction Primary extramammary Paget's disease (EMPD) is a rare neoplasm that manifests as well-defined erythematous plaques, often misdiagnosed due to its similarity with different dermatoses. It may exhibit invasive features, involving adnexal invasions. The study aims to assess and compare the clinicopathological correlation of primary EMPD with adnexal features. Materials and methodology The monocentric observational retrospective study observed 43 confirmed primary EMPD cases in patients aged 45-95, excluding those with infectious dermatoses, pseudo-tumors, secondary lesions, or survived less than a month. Demographical, clinical and pathological observations were recorded. Expert dermatopathologists, blinded to the initial diagnosis, conducted a comprehensive histopathological evaluation yielding differential pathological diagnosis. Statistical analysis involved Pearson's Chi-square, Mann-Whitney U, and Spearman's Correlations for clinicopathological concordance and adnexal features. Recurrence was evaluated using Kaplan-Meier and log-rank tests, while multivariate recurrence analyses include Cox regression. A p-value < 0.05 was deemed significant. Results There was a significant association between adnexal involvement and the site of lesion (p < 0.05). There was a significant association (p < 0.05) between involved adnexal depth and primary EMPD subtypes. Adnexal involvement has a significant association with the concordance rates derived from clinicopathological correlations (p < 0.05). Smaller lesions and non-invasive EMPD significantly predict longer recurrence onset (p < 0.01). The primary EMPD subtype was the only independent predictor for recurrence time using the Cox regression model. Conclusion Adnexal proliferation in primary EMPD is considered vital on clinicopathological correlations and recurrence predictions, suggestive of its utility on both diagnosis and prognosis.
Insights
Adnexal proliferation in extramammary Paget's disease (EMPD) is crucial for diagnosis and predicting recurrence. Understanding these features improves patient outcomes and treatment strategies for this rare skin neoplasm.
Area of Science:
- Dermatology
- Oncology
- Pathology
Background:
- Primary extramammary Paget's disease (EMPD) presents as erythematous plaques, often misdiagnosed.
- EMPD can involve adnexal structures, impacting its invasive potential.
Purpose of the Study:
- To assess the clinicopathological correlation of primary EMPD with adnexal features.
- To compare the diagnostic and prognostic significance of adnexal involvement in EMPD.
Main Methods:
- Retrospective observational study of 43 primary EMPD cases.
- Histopathological evaluation by blinded dermatopathologists.
- Statistical analysis including Chi-square, Mann-Whitney U, Spearman's, Kaplan-Meier, and Cox regression.
Main Results:
- Adnexal involvement significantly correlates with lesion site and depth in primary EMPD.
- Adnexal features are associated with clinicopathological concordance rates.
- Smaller, non-invasive EMPD lesions predict longer recurrence-free survival.
Conclusions:
- Adnexal proliferation is vital for clinicopathological correlation in primary EMPD.
- Adnexal features serve as important prognostic indicators for recurrence.
- Evaluating adnexal involvement aids in both diagnosis and prognosis of EMPD.
