title: Vulvar clear cells of Toker: precursors of extramammary Paget's disease.
abstract: Clear cells of Toker are intraepithelial cells with clear to pale staining cytoplasm and bland cytologic features found with H&E staining in approximately 10% of normal nipples. Toker cells have been hypothesized as a precursor of extramammary Paget's disease (EMPD), although Toker cells have not been identified as a normal component of genital skin. Using immunohistochemistry, we studied 11 vulvectomies for the presence of Toker cells in association with mammary-like glands of the vulva (MLG). A retrospective study of 11 vulvectomies was performed using routine hematoxylin and eosin staining, as well as immunohistochemical staining for cytokeratin 7 (CK7). Control sections of skin not involving the milk line from age-matched patients were also examined. Four of eleven vulvectomies (36%) demonstrated Toker cells with CK7 staining. Toker cells were associated with the openings of the ducts of mammary-like glands of the vulva. Toker cells were not seen in control tissues. Toker cells occur as a normal constituent of genital skin in association with mammary-like glands of the vulva. Previous morphologic, immunohistochemical, and ultrastructural evidence have pointed to Toker cells as a precursor of EMPD. The demonstration of Toker cells in genital skin strengthens the evidence of their role in the development of EMPD.
authors.affiliation: Department of Pathology, University of Colorado Health Sciences Center, Denver, CO 80262, USA.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Willman
authors.forename: Loren E
authors.initials: LE
authors.lastname: Golitz
authors.forename: James E
authors.initials: JE
authors.lastname: Fitzpatrick
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053552:Keratin-7; D007633:Keratins / Q000378:metabolism; D008875:Middle Aged; D010145:Paget Disease, Extramammary / Q000209:etiology*; D012189:Retrospective Studies; D012867:Skin / Q000166:cytology*; D014844:Vulva / Q000166:cytology*
chemical_list: C507497:KRT7 protein, human; D053552:Keratin-7; D007633:Keratins