title: Perianal Paget's disease: presentation of six cases and literature review.
abstract: OBJECTIVE
  Extramammary Paget's disease (EMPD) is frequently associated with adnexal or visceral synchronous or metachronous malignancies. Our purpose was to evaluate, retrospectively, the results obtained in six cases of EMPD and to review the literature.
  
  
  METHODS
  Six patients with the perianal Paget's disease had been treated in our division between March 1996 and December 2006. In three cases, the disease was confined in the epidermis; in one case, there was a microinvasion of the dermis, while in another one the dermis was infiltrated. The last case was associated to a low rectal adenocarcinoma. All patients underwent wide perianal excision and reconstruction with skin graft. We performed a transanal resection of the rectal adenocarcinoma. A review of the literature from 1990 to 2008 revealed 193 cases of perianal EMPD, 112 were intraepithelial/intradermal while 81 were associated with malignancies. Anorectal adenocarcinoma was already existing in two cases, synchronous in 48, and subsequent to diagnosis in 11.
  
  
  RESULTS
  In three cases, the disease recurred locally, but no patient developed metastatic spread. Five patients survived and are free of disease. The review of the literature allows a clear identification of the primitive EMPD and the form associated to anorectal adenocarcinoma and little information about cases associated with synchronous adnexal adenocarcinoma. The Paget's disease can relapse after radical surgery and has a capacity of metastatic spread.
  
  
  CONCLUSIONS
  Up to now, no clear guidelines have been established for the diagnosis of EMPD. The association with synchronous or metachronous carcinomas imposes a long-term follow-up with frequent clinical, radiological, and endoscopical controls.
authors.affiliation: II Scuola di Specializzazione in Chirurgia Generale, Ospedale Civile Maggiore, Università degli Studi di Verona, Italy. annaminicozzi@hotmail.com
authors.forename: Annamaria
authors.initials: A
authors.lastname: Minicozzi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Borzellino
authors.forename: Rostand
authors.initials: R
authors.lastname: Momo
authors.forename: Francesca
authors.initials: F
authors.lastname: Steccanella
authors.forename: Federica
authors.initials: F
authors.lastname: Pitoni
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Manzoni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000473:pathology*; D004817:Epidermis / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010145:Paget Disease, Extramammary / Q000473:pathology*
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