Klinik Araştırma
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Memenin Paget Hastalığında Klinik-Patolojik Bulgular ve Takip Sonuçları

Yıl 2020, Cilt: 3 Sayı: 3, 230 - 238, 31.12.2020

Öz

Amaç: Bu çalışmada, memenin Paget hastalığı (PH) tanısı olan hastaların klinik ve patolojik verilerini ve takip sonuçlarını incelemeyi amaçladık.
Gereç ve Yöntem: Ocak 2013 - Ekim 2018 tarihleri arasında Başkent Üniversitesi Tıp Fakültesi Genel Cerrahi Kliniği'nde PH tanısı ve tedavisi alan 49 hastanın tıbbi kayıtları retrospektif olarak incelendi.
Bulgular: Hastaların ortalama yaşı 52.9 ± 13.6 (26-90) idi. Hastaların çoğu kadındı (45/49, %91,8). Başvuru anında en sık görülen semptom ele gelen kitle idi (n: 22, %44,9). 31 hastaya (%63,3) modifiye radikal mastektomi (MRM), 16 hastaya (%32,6) basit mastektomi ve 2 hastaya (%4,1) meme koruyucu cerrahi uygulandı. Yedi (%14,2) hastaya sentinel lenf nodu biyopsisi (SLNB) ve bir hastaya aksiller lenf nodu diseksiyonu yapıldı. İnvazif duktal karsinom, PH (%89,8) ile birlikte görülen majör histolojiyi oluşturdu. Lenf nodu tutulumu (LNI) 29 (%59,2) hastada mevcuttu. Hasta tarafından fark edilen ele gelen kitle ve 20 mm'nin üzerindeki kitle boyutu LNI ile istatistiksel olarak ilişkiliydi (her ikisi için p: 0,004). 50 yaş üstü, daha düşük hastalıksız sağ kalım ile ilişkilendirildi (39,2 aya karşı 64,1 ay, p: 0,012). Hastalıksız sağ kalım, Her2 negatif hastalarda daha düşüktü (p: 0.002).
Sonuç: PH nadir görülen ancak gözden kaçmaması gereken önemli bir hastalıktır. Her2 pozitifliği genellikle meme kanserlerinde kötü prognostik faktör olarak kabul edilmekle birlikte, Her2 negatifliği olanların da PH'de kötü prognoza sahip olabileceğini düşünüyoruz.

Destekleyen Kurum

Başkent Üniversitesi Tıp ve Sağlık Bilimleri Araştırma Kurulu

Proje Numarası

KA20/439

Kaynakça

  • 1. Raivoherivony ZI, Feron J, Klijanienko J. The utility of nipple scraping in the diagnosis of Paget disease of the breast. Diagn Cytopathol. 2019 Mar;47(3):249-250. doi: 10.1002/dc.24033. Epub 2018 Nov 28. PMID: 30484956.
  • 2. Lim HS, Jeong SJ, Lee JS, Park MH, Kim JW, Shin SS, Park JG, Kang HK. Paget disease of the breast: mammographic, US, and MR imaging findings with pathologic correlation. Radiographics. 2011 Nov-Dec;31(7):1973-87. doi: 10.1148/rg.317115070. PMID: 22084182.
  • 3. Ikeda DM, Helvie MA, Frank TS, Chapel KL, Andersson IT. Paget disease of the nipple: radiologic-pathologic correlation. Radiology. 1993 Oct;189(1):89-94. doi: 10.1148/radiology.189.1.8396786. PMID: 8396786.
  • 4. Sek P, Zawrocki A, Biernat W, Piekarski JH. HER2 molecular subtype is a dominant subtype of mammary Paget's cells. An immunohistochemical study. Histopathology. 2010 Oct;57(4):564-71. doi: 10.1111/j.1365-2559.2010.03665.x. Erratum in: Histopathology. 2010 Dec;57(6):944. PMID: 20955381.
  • 5. Fu W, Mittel VK, Young SC. Paget disease of the breast: analysis of 41 patients. Am J Clin Oncol. 2001 Aug;24(4):397-400. doi: 10.1097/00000421-200108000-00019. PMID: 11474272.
  • 6. Tanaka VD, Sanches JA, Torezan L, Niwa AB, Festa Neto C. Mammary and extramammary Paget's disease: a study of 14 cases and the associated therapeutic difficulties. Clinics (Sao Paulo). 2009;64(6):599-606. doi: 10.1590/s1807-59322009000600018. PMID: 19578667; PMCID: PMC2705154.
  • 7. Sandoval-Leon AC, Drews-Elger K, Gomez-Fernandez CR, Yepes MM, Lippman ME. Paget's disease of the nipple. Breast Cancer Res Treat. 2013 Aug;141(1):1-12. doi: 10.1007/s10549-013-2661-4. Epub 2013 Aug 9. PMID: 23929251.
  • 8. Challa VR, Deshmane V. Challenges in Diagnosis and Management of Paget's Disease of the Breast-a Retrospective Study. Indian J Surg. 2015 Dec;77(Suppl 3):1083-7. doi: 10.1007/s12262-014-1167-6. Epub 2014 Sep 18. PMID: 27011515; PMCID: PMC4775644.
  • 9. Sripathi S, Ayachit A, Kadavigere R, Kumar S, Eleti A, Sraj A. Spectrum of Imaging Findings in Paget's Disease of the Breast-A Pictorial Review. Insights Imaging. 2015 Aug;6(4):419-29. doi: 10.1007/s13244-015-0415-z. Epub 2015 Jul 5. PMID: 26142549; PMCID: PMC4519816.
  • 10. Adams SJ, Kanthan R. Paget's disease of the male breast in the 21st century: A systematic review. Breast. 2016 Oct;29:14-23. doi: 10.1016/j.breast.2016.06.015. Epub 2016 Jul 6. PMID: 27394005.
  • 11. Lohsiriwat V, Martella S, Rietjens M, Botteri E, Rotmensz N, Mastropasqua MG, Garusi C, De Lorenzi F, Manconi A, Sommario M, Barbieri B, Cassilha M, Minotti I, Petit JY. Paget's disease as a local recurrence after nipple-sparing mastectomy: clinical presentation, treatment, outcome, and risk factor analysis. Ann Surg Oncol. 2012 Jun;19(6):1850-5. doi: 10.1245/s10434-012-2226-5. Epub 2012 Feb 10. PMID: 22322949.
  • 12. Kanwar AJ, De D, Vaiphei K, Bhatia A, Sharma RK, Singh G. Extensive mammary Paget's disease. Clin Exp Dermatol. 2007 May;32(3):326-7. doi: 10.1111/j.1365-2230.2006.02326.x. PMID: 17397359.
  • 13. Nicoletti G, Scevola S, Ruggiero R, Coghi AM, Toussoun GS. Gigantic Paget disease of the breast. Breast. 2004 Oct;13(5):425-7. doi: 10.1016/j.breast.2003.11.005. PMID: 15454200.
  • 14. Ucar AE, Korukluoglu B, Ergul E, Aydin R, Kusdemir A. Bilateral Paget disease of the male nipple: first report. Breast. 2008 Jun;17(3):317-8. doi: 10.1016/j.breast.2007.11.007. Epub 2008 Jan 2. PMID: 18171616.
  • 15. Yen PP, Sinha N, Barnes PJ, Butt R, Iles S. Benign and Malignant Male Breast Diseases: Radiologic and Pathologic Correlation. Can Assoc Radiol J. 2015 Aug;66(3):198-207. doi: 10.1016/j.carj.2015.01.002. Epub 2015 Jun 12. PMID: 26073217.
  • 16. Dominici LS, Lester S, Liao GS, Guo L, Specht M, Smith BL, Golshan M. Current surgical approach to Paget's disease. Am J Surg. 2012 Jul;204(1):18-22. doi: 10.1016/j.amjsurg.2011.07.010. Epub 2011 Oct 28. PMID: 22036205.
  • 17. Marshall JK, Griffith KA, Haffty BG, Solin LJ, Vicini FA, McCormick B, Wazer DE, Recht A, Pierce LJ. Conservative management of Paget disease of the breast with radiotherapy: 10- and 15-year results. Cancer. 2003 May 1;97(9):2142-9. doi: 10.1002/cncr.11337. PMID: 12712465.
  • 18. Ortiz-Pagan S, Cunto-Amesty G, Narayan S, Crawford S, Derrick C, Larkin A, Khan A, Quinlan R, Layeequr Rahman R. Effect of Paget's disease on survival in breast cancer: an exploratory study. Arch Surg. 2011 Nov;146(11):1267-70. doi: 10.1001/archsurg.2011.278. PMID: 22106318.

Paget's Disease Of The Breast: Clinical-Pathological Findings And Surveillance

Yıl 2020, Cilt: 3 Sayı: 3, 230 - 238, 31.12.2020

Öz

Aim: In this study we aimed to examine the clinicopathological findings and surveillance of patients with Paget’s disease of the breast (PD).
Materials and Method: The medical records of 49 patients diagnosed and treated with PD at Başkent University Faculty of Medicine, General Surgery Clinic between January 2013 and October 2018 were retrospectively analyzed.
Results: Mean age of the patients was 52.9±13.6 (26-90). The majority of the patients were women (n:45, 91.8%). The most frequent symptom at the time of admission was palpable mass (n:22, 44.9%). Modified radical mastectomy (MRM) was performed in 31 patients (63.3%), simple mastectomy in 16 patients (32.6%) and breast conserving surgery in 2 patients (4.1%). Sentinel lymph node biopsy (SLNB) in 7 (14.2%) patients and axillary lymph node dissection was performed in one patient. Invasive ductal carcinoma constituted the major histology concomitant with Paget Disease (89.8%). Lymph node involvement (LNI) was present in 29 (59.2%) patients. Palpable mass noticed by the patient and mass size over 20 mm was statistically associated with LNI (p:0.004 for both). Over 50 years of age was associated with a lower recurrence free survival (RFS) (39.2 months vs 64.1 months, p:0.012). RFS was lower in Her2 negative patients (p:0.002).
Conclusion: PD is rare, it is an important disease that should not be missed. Although Her2 positivity is generally considered as a poor prognostic factor in breast cancers, we think that those with Her2 negativity may also have a poor prognosis in PD.

Proje Numarası

KA20/439

Kaynakça

  • 1. Raivoherivony ZI, Feron J, Klijanienko J. The utility of nipple scraping in the diagnosis of Paget disease of the breast. Diagn Cytopathol. 2019 Mar;47(3):249-250. doi: 10.1002/dc.24033. Epub 2018 Nov 28. PMID: 30484956.
  • 2. Lim HS, Jeong SJ, Lee JS, Park MH, Kim JW, Shin SS, Park JG, Kang HK. Paget disease of the breast: mammographic, US, and MR imaging findings with pathologic correlation. Radiographics. 2011 Nov-Dec;31(7):1973-87. doi: 10.1148/rg.317115070. PMID: 22084182.
  • 3. Ikeda DM, Helvie MA, Frank TS, Chapel KL, Andersson IT. Paget disease of the nipple: radiologic-pathologic correlation. Radiology. 1993 Oct;189(1):89-94. doi: 10.1148/radiology.189.1.8396786. PMID: 8396786.
  • 4. Sek P, Zawrocki A, Biernat W, Piekarski JH. HER2 molecular subtype is a dominant subtype of mammary Paget's cells. An immunohistochemical study. Histopathology. 2010 Oct;57(4):564-71. doi: 10.1111/j.1365-2559.2010.03665.x. Erratum in: Histopathology. 2010 Dec;57(6):944. PMID: 20955381.
  • 5. Fu W, Mittel VK, Young SC. Paget disease of the breast: analysis of 41 patients. Am J Clin Oncol. 2001 Aug;24(4):397-400. doi: 10.1097/00000421-200108000-00019. PMID: 11474272.
  • 6. Tanaka VD, Sanches JA, Torezan L, Niwa AB, Festa Neto C. Mammary and extramammary Paget's disease: a study of 14 cases and the associated therapeutic difficulties. Clinics (Sao Paulo). 2009;64(6):599-606. doi: 10.1590/s1807-59322009000600018. PMID: 19578667; PMCID: PMC2705154.
  • 7. Sandoval-Leon AC, Drews-Elger K, Gomez-Fernandez CR, Yepes MM, Lippman ME. Paget's disease of the nipple. Breast Cancer Res Treat. 2013 Aug;141(1):1-12. doi: 10.1007/s10549-013-2661-4. Epub 2013 Aug 9. PMID: 23929251.
  • 8. Challa VR, Deshmane V. Challenges in Diagnosis and Management of Paget's Disease of the Breast-a Retrospective Study. Indian J Surg. 2015 Dec;77(Suppl 3):1083-7. doi: 10.1007/s12262-014-1167-6. Epub 2014 Sep 18. PMID: 27011515; PMCID: PMC4775644.
  • 9. Sripathi S, Ayachit A, Kadavigere R, Kumar S, Eleti A, Sraj A. Spectrum of Imaging Findings in Paget's Disease of the Breast-A Pictorial Review. Insights Imaging. 2015 Aug;6(4):419-29. doi: 10.1007/s13244-015-0415-z. Epub 2015 Jul 5. PMID: 26142549; PMCID: PMC4519816.
  • 10. Adams SJ, Kanthan R. Paget's disease of the male breast in the 21st century: A systematic review. Breast. 2016 Oct;29:14-23. doi: 10.1016/j.breast.2016.06.015. Epub 2016 Jul 6. PMID: 27394005.
  • 11. Lohsiriwat V, Martella S, Rietjens M, Botteri E, Rotmensz N, Mastropasqua MG, Garusi C, De Lorenzi F, Manconi A, Sommario M, Barbieri B, Cassilha M, Minotti I, Petit JY. Paget's disease as a local recurrence after nipple-sparing mastectomy: clinical presentation, treatment, outcome, and risk factor analysis. Ann Surg Oncol. 2012 Jun;19(6):1850-5. doi: 10.1245/s10434-012-2226-5. Epub 2012 Feb 10. PMID: 22322949.
  • 12. Kanwar AJ, De D, Vaiphei K, Bhatia A, Sharma RK, Singh G. Extensive mammary Paget's disease. Clin Exp Dermatol. 2007 May;32(3):326-7. doi: 10.1111/j.1365-2230.2006.02326.x. PMID: 17397359.
  • 13. Nicoletti G, Scevola S, Ruggiero R, Coghi AM, Toussoun GS. Gigantic Paget disease of the breast. Breast. 2004 Oct;13(5):425-7. doi: 10.1016/j.breast.2003.11.005. PMID: 15454200.
  • 14. Ucar AE, Korukluoglu B, Ergul E, Aydin R, Kusdemir A. Bilateral Paget disease of the male nipple: first report. Breast. 2008 Jun;17(3):317-8. doi: 10.1016/j.breast.2007.11.007. Epub 2008 Jan 2. PMID: 18171616.
  • 15. Yen PP, Sinha N, Barnes PJ, Butt R, Iles S. Benign and Malignant Male Breast Diseases: Radiologic and Pathologic Correlation. Can Assoc Radiol J. 2015 Aug;66(3):198-207. doi: 10.1016/j.carj.2015.01.002. Epub 2015 Jun 12. PMID: 26073217.
  • 16. Dominici LS, Lester S, Liao GS, Guo L, Specht M, Smith BL, Golshan M. Current surgical approach to Paget's disease. Am J Surg. 2012 Jul;204(1):18-22. doi: 10.1016/j.amjsurg.2011.07.010. Epub 2011 Oct 28. PMID: 22036205.
  • 17. Marshall JK, Griffith KA, Haffty BG, Solin LJ, Vicini FA, McCormick B, Wazer DE, Recht A, Pierce LJ. Conservative management of Paget disease of the breast with radiotherapy: 10- and 15-year results. Cancer. 2003 May 1;97(9):2142-9. doi: 10.1002/cncr.11337. PMID: 12712465.
  • 18. Ortiz-Pagan S, Cunto-Amesty G, Narayan S, Crawford S, Derrick C, Larkin A, Khan A, Quinlan R, Layeequr Rahman R. Effect of Paget's disease on survival in breast cancer: an exploratory study. Arch Surg. 2011 Nov;146(11):1267-70. doi: 10.1001/archsurg.2011.278. PMID: 22106318.
Toplam 18 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Cerrahi
Bölüm Makaleler
Yazarlar

Tevfik Avcı 0000-0001-5225-959X

Hakan Yabanoğlu 0000-0002-1161-3369

Murathan Erkent 0000-0002-3592-5092

Pelin Börcek Bu kişi benim 0000-0001-8565-0667

Murat Kuş 0000-0001-6529-7579

Proje Numarası KA20/439
Yayımlanma Tarihi 31 Aralık 2020
Kabul Tarihi 23 Aralık 2020
Yayımlandığı Sayı Yıl 2020 Cilt: 3 Sayı: 3

Kaynak Göster

APA Avcı, T., Yabanoğlu, H., Erkent, M., Börcek, P., vd. (2020). Paget’s Disease Of The Breast: Clinical-Pathological Findings And Surveillance. Çukurova Anestezi Ve Cerrahi Bilimler Dergisi, 3(3), 230-238.
https://dergipark.org.tr/tr/download/journal-file/11303