Baldovini Chiara, Betts Christine M, Reggiani Camilla, Reggiani Maurizio, Foschini Maria P
*Department of Biomedical and Neuro Motor Sciences, Section of Anatomic Pathology "M.Malpighi" at Bellaria Hospital, University of Bologna, Bologna, Italy; †Department of Experimental Pathology, DIMES, University of Bologna, Bologna, Italy; ‡Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy; and §Department of Dermatology, Bellaria Hospital, Bologna, Italy.
Am J Dermatopathol. 2015 Jul;37(7):e83-6. doi: 10.1097/DAD.0000000000000123.
A panel of immunohistochemical markers may be used to differentiate between pagetoid Bowen disease (PBD) and primary extramammary Paget disease (EMPD) in selected cases. Although diffuse staining with cytokeratin 7 (CK7), CAM5.2, carcinoembryonic antigen, epithelial membrane antigen (EMA), and gross cystic disease fluid protein 15 generally supports diagnosis of EMPD, cases have been reported where PBD also expressed CK7, EMA, and CAM5.2. Based on these findings, some authors suggested that the 2 entities may arise from the same multipotent stem cell, capable of further differentiation toward squamous and secretory lines. To the best of our knowledge, this issue has never been investigated by comparing PBD and EMPD at the ultrastructural level. We performed the first ultrastructural study of a case of PBD exhibiting common immunohistochemical features with EMPD. The lesion displayed some ultrastructural features often observed in Bowen disease and some that are typically found in EMPD. These findings indicate the presence of a bidirectional differentiation--secretory and squamous--within the same lesion, thus supporting the hypothesis that PBD and primary EMPD may arise from a common progenitor cell.
在某些特定病例中，一组免疫组织化学标志物可用于区分派杰样鲍恩病（PBD）和原发性乳腺外佩吉特病（EMPD）。尽管细胞角蛋白7（CK7）、CAM5.2、癌胚抗原、上皮膜抗原（EMA）和巨大囊肿病液体蛋白15的弥漫性染色通常支持EMPD的诊断，但也有报道称PBD也表达CK7、EMA和CAM5.2。基于这些发现，一些作者认为这两种实体可能起源于同一个多能干细胞，该干细胞能够进一步向鳞状和分泌谱系分化。据我们所知，从未通过在超微结构水平上比较PBD和EMPD来研究这个问题。我们对一例表现出与EMPD常见免疫组织化学特征的PBD病例进行了首次超微结构研究。该病变显示出一些在鲍恩病中经常观察到的超微结构特征，以及一些在EMPD中典型发现的特征。这些发现表明在同一病变中存在双向分化——分泌性和鳞状性——从而支持了PBD和原发性EMPD可能起源于共同祖细胞的假说。
