Department of Dermatology, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara, Sakyo-ku, Kyoto, 606-8507, Japan.
Research Fellow of the Japan Society for the Promotion of Science.
Br J Dermatol. 2017 Jul;177(1):229-237. doi: 10.1111/bjd.15282. Epub 2017 May 4.
In extramammary Paget disease (EMPD), Paget cells are sometimes detected outside the clinical border (subclinical extension). However, the spreading pattern of Paget cells in subclinical extension remains unclear. In addition, the macroscopic appearances of lesions accompanied by subclinical extension are totally unknown.
To characterize the spreading pattern of Paget cells as well as the macroscopic appearance of lesions of EMPD with subclinical extension.
Nineteen patients with primary anogenital EMPD underwent mapping biopsies and excisional surgeries; biopsy samples were then taken at the periphery of well-demarcated lesions. Samples were transparentized and subjected to whole-mount immunostaining with anticytokeratin 7 antibody to label Paget cells. The histological border was evaluated in three dimensions by two-photon microscopy. The shape and location of the histological border were compared with those of the clinical border.
In 21 samples taken at the lesion where subclinical extension was not shown by mapping biopsy, the shape and location of the histological border were almost identical to those of the clinical border. However, two samples exhibited small foci of Paget cells outside the clinical border, showing subclinically extended satellite lesions. In the two samples taken at the lesions where subclinical extension was shown by mapping biopsy, a continuous arrangement of Paget cells extending beyond the clinical border was identified. Subclinically extended Paget cells were detected solely outside hypopigmented patches with erythema.
In EMPD, at least two patterns of subclinical extension exist: continuous and satellite lesions. Subclinical extension might exist preferentially outside hypopigmented patches with erythema.
在乳房外派杰病（EMPD）中，派杰细胞有时会在临床边界之外（亚临床延伸）被检测到。然而，亚临床延伸中派杰细胞的扩散模式仍不清楚。此外，亚临床延伸伴随的病变的宏观表现完全未知。
描述亚临床延伸中派杰细胞的扩散模式以及 EMPD 病变的宏观表现。
19 例原发性肛门生殖器 EMPD 患者接受了定位活检和切除术；然后在边界清晰的病变周边取活检样本。样本经过透明化处理，并使用抗细胞角蛋白 7 抗体进行全组织免疫染色，以标记派杰细胞。通过双光子显微镜在三维空间评估组织学边界。将组织学边界的形状和位置与临床边界进行比较。
在 21 个未通过定位活检显示亚临床延伸的病变样本中，组织学边界的形状和位置几乎与临床边界相同。然而，有两个样本在临床边界之外显示出小的派杰细胞灶，表现为亚临床延伸的卫星病变。在 2 个通过定位活检显示亚临床延伸的病变样本中，发现了超出临床边界的派杰细胞连续排列。亚临床延伸的派杰细胞仅在外阴部红斑伴色素减退斑块外检测到。
在 EMPD 中，至少存在两种亚临床延伸模式：连续和卫星病变。亚临床延伸可能优先发生在红斑伴色素减退斑块外。
