title: A clinical series and literature review of the management of inguinal nodal metastases in patients with primary extramammary Paget disease of the scrotum.
abstract: We describe a series of five patients with extramammary Paget disease of the scrotum with inguinal nodal metastases. These patients underwent combined groin dissection. All patients experienced invasion to the dermis. One patient had invasion of the dartos muscle, another had tumor invading into the skeletal muscle and femoral vein. Four patients had positive Cloquet node involvement on frozen section and formal histology, but only one patient had positive pelvic nodal disease. Another patient with pelvic nodal metastases seen on computed tomography scan had no Cloquet node identified intraoperatively but had positive pelvic nodal metastases. The mean disease-free survival and the overall survival were 28.6 months (range: 2-60 months) and 33.4 months (range: 2-60 months), respectively, for all patients. Three patients developed distant metastases and two patients were disease free to date. No locoregional recurrences were observed. Aggressive lymphadenectomy in selected cases can provide a long-term survival benefit. The use of Cloquet node in the prediction of pelvic nodal disease should be considered. Based on the literature review, sentinel lymph node biopsy can potentially diagnose occult metastases in otherwise nonenlarged nodes.
authors.affiliation: Department of Surgical Oncology, National Cancer Centre, Singapore.
authors.forename: Ye Xin
authors.initials: YX
authors.lastname: Koh
authors.affiliation: Department of Pathology, Singapore General Hospital, Singapore.
authors.forename: Timothy Kwang Yong
authors.initials: TK
authors.lastname: Tay
authors.affiliation: Department of Surgical Oncology, National Cancer Centre, Singapore.
authors.forename: Sheng
authors.initials: S
authors.lastname: Xu
authors.affiliation: Department of Surgical Oncology, National Cancer Centre, Singapore.
authors.forename: Chee Meng
authors.initials: CM
authors.lastname: Lee
authors.affiliation: Department of Surgical Oncology, National Cancer Centre, Singapore. Electronic address: melissa.teo.c.c@nccs.com.sg.
authors.forename: Melissa Ching Ching
authors.initials: MC
authors.lastname: Teo
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D005834:Genital Neoplasms, Male / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007264:Inguinal Canal / Q000473:pathology / Q000601:surgery; D008197:Lymph Node Excision / Q000401:mortality; D008207:Lymphatic Metastasis / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010145:Paget Disease, Extramammary / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011379:Prognosis; D012611:Scrotum / Q000473:pathology / Q000601:surgery*; D012846:Singapore; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed
keywords: cloquet node; extramammary paget disease; inguinal lymphadenectomy