title: Paget's disease of the oesophagus associated with mucous gland carcinoma of the lower oesophagus.
abstract: OBJECTIVE
  To report a rare case of oesophageal Paget's disease and its rarer combination with submucosal gland carcinoma of the lower oesophagus.
  
  
  RESULTS
  A 74-year-old Saudi female was admitted with the complaint of dysphagia. Endoscopic examination showed an ulcerated tumour at the gastro-oesophageal junction. Initial biopsy showed an undifferentiated carcinoma with pagetoid spread in the oesophageal stratified squamous epithelium. Oesophago-gastrectomy specimen showed a lobulated, poorly differentiated mucous gland carcinoma at the gastro-oesophageal junction. The tumour showed focal acinar differentiation and obvious cancerization of the submucosal glands, somewhat similar to the breast lobular carcinoma in situ. One of the isolated and cancerized submucosal glands also showed carcinoma in situ of its duct. Oesophageal surface epithelium showed extensive pagetoid spread, both over and away from the main tumour. The pagetoid tumour cells showed selective positivity for cytokeratin 7, cytokeratin Cam 5.2, BerEP4 and to a lesser extent for CEA.
  
  
  CONCLUSIONS
  As far as we know, this is the fifth case report of oesophageal Paget's disease and the first report of its association with the underlying mucous gland carcinoma.
authors.affiliation: Division of Histopathology, Department of Pathology, Armed Forces Hospital Riyadh, Saudi Arabia.
authors.forename: A
authors.initials: A
authors.lastname: Haleem
authors.forename: H
authors.initials: H
authors.lastname: Kfoury
authors.forename: M
authors.initials: M
authors.lastname: Al Juboury
authors.forename: H
authors.initials: H
authors.lastname: Al Husseini
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D002277:Carcinoma / Q000473:pathology; D002278:Carcinoma in Situ / Q000473:pathology; D018288:Carcinoma, Small Cell / Q000473:pathology; D003937:Diagnosis, Differential; D004938:Esophageal Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D004943:Esophagogastric Junction / Q000473:pathology; D005260:Female; D005743:Gastrectomy; D005753:Gastric Mucosa / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D008223:Lymphoma / Q000473:pathology; D008545:Melanoma / Q000473:pathology; D009363:Neoplasm Proteins / Q000032:analysis; D009378:Neoplasms, Multiple Primary / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D010145:Paget Disease, Extramammary / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D009363:Neoplasm Proteins