Lu H, Zhu G, Lu H
Obstetrics and Gynecology Hospital, Shanghai Medical University, Shanghai 200011.
Zhonghua Fu Chan Ke Za Zhi. 1999 Mar;34(3):156-8.
To improve understanding the factors of development, recurrence and prognosis of vulvar Paget disease (VP).
Clinicopathologic analyses were performed in 14 patients with VP treated in our hospital from Jan 1959 to Dec 1996. Immunohistochemical stainings for CK7, 34 beta E12, carcinoembryonic antigen (CEA), C-erbB2 and HMB45 were carried out in 6 cases.
The mean duration from manifestation of symptoms to diagnosis was 57.1 months. The local recurrent rate after operation was 69%. The mean period from the initial operation to recurrence was 68.8 months. 2 cases out of 4 intraepithelial VP cases recurred with positive surgical margins, but no recurrence in of the other 4 cases with negative surgical margins. Immunohistochemical stainings for CK7 and CEA in 6 cases with VP showed strong positive, whereas for 34 beta E12 and HMB45 in all 6 cases were negative, and for C-erbB2 in 2 cases were positive.
The findings that CK7 and CEA positive in Paget cell of VP, whereas 34 beta E12 and HMB45 negative, suggests that Paget cell of VP possesses characteristics of adenocarcinoma. The recurrence of VP correlates with positive surgical margins. Long term follow-up after operation is essential for VP. The prognosis of intraepithelial and minimally invasive VP was favourable, adjunctive radiotherapy after operation was effective for invasive VP in our studied cases.
提高对外阴佩吉特病（VP）发生、复发及预后相关因素的认识。
对1959年1月至1996年12月在我院治疗的14例VP患者进行临床病理分析。对其中6例进行了细胞角蛋白7（CK7）、34βE12、癌胚抗原（CEA）、C-erbB2和HMB45的免疫组化染色。
从症状出现到诊断的平均时间为57.1个月。术后局部复发率为69%。从初次手术到复发的平均时间为68.8个月。4例上皮内VP患者中有2例手术切缘阳性时复发，而另外4例手术切缘阴性者未复发。6例VP患者的CK7和CEA免疫组化染色呈强阳性，而所有6例的34βE12和HMB45均为阴性，2例C-erbB2为阳性。
VP的佩吉特细胞中CK7和CEA阳性，而34βE12和HMB45阴性，提示VP的佩吉特细胞具有腺癌特征。VP的复发与手术切缘阳性相关。VP术后必须进行长期随访。上皮内和微浸润性VP的预后良好，在我们的研究病例中，术后辅助放疗对浸润性VP有效。
