Yamada Yuki, Matsumoto Toshiharu, Arakawa Atsushi, Ikeda Shigaku, Fujime Makoto, Komuro Yuzo, Takeda Satoru
Department of Obstetrics and Gynecology, Juntendo University, School of Medicine, Tokyo, Japan.
Pathol Int. 2008 Feb;58(2):114-7. doi: 10.1111/j.1440-1827.2007.02198.x.
In extramammary Paget's disease (EPD), lymph node metastasis occasionally occurs and nodal metastasis influences prognosis. Therefore, in the present study a predictor of nodal metastasis in EPD was examined. Surgical specimens from 54 cases of EPD in the external genitalia were examined on D2-40 immunostain. In 23 cases, dissection of the inguinal lymph nodes was performed. Dermal invasion occurred in 24 patients (44.4%). Nodal metastasis was found in seven patients who had dermal invasion >1 mm. In non-metastatic patients, three had dermal invasion <0.5 mm in depth. Lymphatic invasion was well detected on D2-40 immunostain, and invasion was found in five patients. All four patients with lymphatic invasion, in whom lymph node dissection was performed, had nodal metastasis. However, three patients with dermal invasion, who did not have lymphatic invasion, did have nodal metastasis, and the depth of invasion was >1 mm. Dermal invasion (P < 0.001) and lymphatic invasion according to D2-40 immunostain (P = 0.001) had a positive correlation with nodal metastasis. In conclusion, evaluation using a combination of lymphatic invasion according to D2-40 immunostain and depth of dermal invasion is a strong predictor of nodal metastasis in EPD.
在乳房外佩吉特病（EPD）中，偶尔会发生淋巴结转移，而淋巴结转移会影响预后。因此，在本研究中，对EPD中淋巴结转移的预测指标进行了检测。对54例发生于外生殖器的EPD手术标本进行D2-40免疫染色检查。其中23例行腹股沟淋巴结清扫术。24例患者（44.4%）出现真皮浸润。在真皮浸润>1mm的7例患者中发现有淋巴结转移。在无转移的患者中，3例真皮浸润深度<0.5mm。通过D2-40免疫染色能很好地检测到淋巴管浸润，有5例患者发现有淋巴管浸润。所有4例接受淋巴结清扫术且有淋巴管浸润的患者均发生了淋巴结转移。然而，3例有真皮浸润但无淋巴管浸润的患者也发生了淋巴结转移，且浸润深度>1mm。真皮浸润（P<0.001）以及根据D2-40免疫染色确定的淋巴管浸润（P=0.001）与淋巴结转移呈正相关。总之，联合应用基于D2-40免疫染色的淋巴管浸润评估和真皮浸润深度评估是EPD中淋巴结转移的有力预测指标。
