Recurrent Paget disease of the vulva in a split-thickness graft

Article Abstract:

Paget disease occurring outside the breast (extramammary) is a rare cancer of unknown origin. The case is described of a 70-year-old woman who underwent vulvectomy (removal of the vulva, the female external genital organ) for this disorder, and then received a skin graft from her own left thigh. Five years later, Paget disease was detected in the groin region, and the affected area was surgically removed. Another graft was placed over the region; the initially grafted tissue, however, was not removed. Four years later, the patient again experienced symptoms (itching), and Paget disease was found in the original graft. Biopsy of specimens taken on this occasion revealed Paget disease confined to the original graft. Whether the disease was persistent, or recurrent, is discussed. Sixty-two such cases appear in the medical literature, and evaluation of these patients suggests that Paget disease occurs in several locations at once, and that the immediate vulvar environment can induce normal cells to differentiate (change) into diseased Paget cells. (Consumer Summary produced by Reliance Medical Information, Inc.)

Development and progression, Carcinoma, Ductal, Ductal carcinoma

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Primary adenocarcinoma of the breast arising in the vulva

Article Abstract:

Ectopic breast tissue (tissue occurring in an abnormal site in the body) can occur in the vulva, where it may develop cancer. The case of a 68-year-old woman with this rare disease is described. For three years, the patient had a mass on the vulva that produced no symptoms. When it was noted to increase in size, she went to a gynecologist and a vulvar biopsy was taken. The biopsy specimen was incorrectly interpreted as a different kind of cancer than the breast cancer that it was. The patient underwent radical vulvectomy (removal of the vulva and surrounding tissues), and analysis of those tissues revealed the presence of two kinds of breast cancer. No normal breast tissue was found. The patient had metastases (cancer spread) to nearby lymph nodes. Diagnostic problems associated with this rare cancer are discussed. The presence of tumor cells with receptors for estrogen and progesterone (female hormones) is helpful in formulating a diagnosis. At present, the optimal treatment for this rare cancer is not known. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Breast cancer, Vulva

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Use of ultrasonography in the difficult postmenopausal dilation and curettage

Article Abstract:

Dilation and curettage (D&C), a procedure to dilate the uterine cervix and scrape the endometrium of the uterus, is performed to diagnose disease of the uterus or to remove the contents of the uterus. In postmenopausal women, real-time ultrasound was used to complete the procedure, because anatomical distortions and the possibility of perforation suggested that the use of ultrasound would be preferable to conventional procedures. If a difficult D&C is even just anticipated, it is recommended that the procedure be done with ultrasonic guidance to ensure greater accuracy and reduced chance of complications.

Methods, Evaluation, Complications and side effects, Menopause, Diagnosis, Ultrasonic, Diagnostic ultrasonography, Dilatation and curettage

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