title: Clinically inapparent invasive vulvar carcinoma in an area of persistent Paget's disease: a case report.
abstract: BACKGROUND
  Invasive vulvar carcinoma is reported to occur in 5 to 20% of patients with vulvar Paget's disease. We report a case in which a clinically inapparent invasive lesion was discovered on reexcision of microscopically persistent vulvar Paget's disease.
  
  
  METHODS
  A 58-year-old woman presented with a diagnosis of vulvar Paget's disease. A wide local excision of the lesion was performed and pathologic analysis revealed microscopic Paget's disease at two of the margins. The patient returned for a follow-up 4 months later and a vulvar biopsy revealing persistent Paget's cells was obtained from the area of the prior microscopically positive surgical margin. A reexcision was performed from the normal-appearing vulva and invasive vulvar carcinoma was noted in this specimen.
  
  
  CONCLUSIONS
  This case demonstrates several concerning aspects of this disease, most important of which is that the clinically apparent lesion did not contain the clinically significant invasive lesion. Invasive vulvar carcinoma may occur in association with microscopically persistent vulvar Paget's disease, a condition often encountered after primary treatment with wide local excision.
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Awtrey
authors.forename: David S
authors.initials: DS
authors.lastname: Marshall
authors.forename: Robert A
authors.initials: RA
authors.lastname: Soslow
authors.forename: Dennis S
authors.initials: DS
authors.lastname: Chi
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D010145:Paget Disease, Extramammary / Q000150:complications / Q000473:pathology* / Q000601:surgery; D014846:Vulvar Neoplasms / Q000209:etiology / Q000473:pathology* / Q000601:surgery