title: Pagetoid adenocarcinoma in situ of the cervix with pagetoid spread into the vagina.
abstract: BACKGROUND
  Pagetoid spread of adenocarcinoma in situ of the cervix into vaginal epithelium is a rare phenomenon, mimicking Paget's disease of the vulva.
  
  
  METHODS
  We report a case of in situ squamous cell and in situ adenocarcinoma of the cervix in a 44-year-old woman who underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and upper vaginectomy. Pathologic evaluation showed pagetoid endocervical adenocarcinoma in situ spreading into the vagina with positive margins. Malignant cells were positive for mucin, P16, CK-7, and carcinoembryonic antigen.
  
  
  CONCLUSIONS
  The asymptomatic occult finding of pagetoid changes in the vagina should raise the suspicion of vaginal extension of pagetoid genital or urothelial carcinoma in situ; however, it can be mistaken as vaginal dysplasia or primary Paget's disease. Immunohistochemical profiling may help in the differential diagnosis.
authors.affiliation: From the Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington; and the Departments of Pathology and Gynecologic Oncology, Virginia Mason Medical Center, Seattle, Washington.
authors.forename: Haider
authors.initials: H
authors.lastname: Mahdi
authors.forename: Melissa
authors.initials: M
authors.lastname: Thrall
authors.forename: Nicholas
authors.initials: N
authors.lastname: Agoff
authors.forename: Mark
authors.initials: M
authors.lastname: Doherty
mesh_terms: D000328:Adult; D002272:Carcinoembryonic Antigen / Q000032:analysis; D002278:Carcinoma in Situ / Q000473:pathology* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D019941:Cyclin-Dependent Kinase Inhibitor p16 / Q000032:analysis; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D053552:Keratin-7 / Q000032:analysis; D009077:Mucins / Q000032:analysis; D009361:Neoplasm Invasiveness; D010145:Paget Disease, Extramammary / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery; D014621:Vagina / Q000473:pathology*
chemical_list: D002272:Carcinoembryonic Antigen; D019941:Cyclin-Dependent Kinase Inhibitor p16; D053552:Keratin-7; D009077:Mucins