Gu Mai, Ghafari Sophie, Lin Fritz
Department of Pathology, University of California Irvine Medical Center, Orange, California 92868, USA.
Diagn Cytopathol. 2005 Jun;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.
外阴部乳腺外佩吉特病（EMPD）是一种罕见的疾病。诊断几乎总是依靠活检进行。在巴氏涂片检查中很少能见到肿瘤细胞。我们遇到了3例在巴氏涂片检查中被检测出的EMPD病例。1例患者有外阴和阴道受累，最初在阴道涂片中见到的异常细胞被解释为高级别鳞状上皮内病变。回顾性检查显示有散在的单个非典型细胞，核增大、染色质深染、粗糙，核仁不明显，核质比高，嗜碱性细胞质稀少。可见罕见的印戒细胞和细胞内细胞。在另外2例有宫颈受累的患者中，巴氏涂片检查做出了正确诊断。玻片显示有单个和聚集的腺细胞片，细胞核圆形至椭圆形增大，染色质粗糙，核仁突出，丰富的嗜碱性细胞质中含有明显的空泡，呈印戒细胞外观。细胞内细胞丰富。EMPD具有独特的细胞形态学特征。尽管很少遇到，但结合充分的临床病史，EMPD可在巴氏涂片检查中得以诊断。
