title: Primary extramammary Paget's disease of the vulva: the clinicopathological features and treatment outcomes in a series of 43 patients.
abstract: OBJECTIVE
  To characterize the clinicopathological features and evaluate the treatment outcomes for cases of primary extramammary Paget's disease of the vulva (EMPDV).
  
  
  METHODS
  The medical records and pathology slides were reviewed and analyzed for 43 patients with primary EMPDV.
  
  
  RESULTS
  The mean age of the patients was 68.6 years (range, 52-85). Intraepithelial EMPDV, invasive EMPDV and EMPDV with adnexal adenocarcinoma were observed in 33 (76.7%), 7 (16.3%) and 3 (7.0%) cases, respectively. Varied surgical procedures were initially performed in 35 (81.4%) cases. A positive incision margin was observed in 16 cases (47.0%). Definitive radiotherapy at a median dose of 60 Gy was performed in 8 (18.6%) patients. Six patients received postoperative radiotherapy due to a positive margin or lymph node metastasis after surgical excision. During a follow-up period of 6-169 months (median, 54), recurrence was observed in 12 (34.3%) patients. Nine (75.0%) patients underwent repeated surgery and 3 (25.0%) patients received radiotherapy. Long-term overall survival was observed in patients with intraepithelial EMPDV. The median overall survival was 124.5 months in intraepithelial cases, 70.8 months in invasive cases and 21.3 months in cases with adnexal adenocarcinoma (log rank, P=0.032).
  
  
  CONCLUSIONS
  Intraepithelial EMPDV accounted for the majority of primary cases and had a better prognosis. Surgical excision was the standard curative treatment for EMPDV. Radiotherapy was an alternative choice for patients with medical contradiction or surgical difficulties. Postoperative radiotherapy could be considered in cases with positive surgical margin or lymph node metastasis. Recurrence was common and repeated excision was often necessary.
authors: Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
authors: Yipin
authors: Y
authors: Cai
authors: Weiqi
authors: W
authors: Sheng
authors: Libing
authors: L
authors: Xiang
authors: Xiaohua
authors: X
authors: Wu
authors: Huijuan
authors: H
authors: Yang
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D005185:Fallopian Tube Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D010145:Paget Disease, Extramammary / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D018714:Radiotherapy, Adjuvant; D012086:Reoperation / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014846:Vulvar Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery