Clinical Analysis Of Mammary And Extramammary Paget’s Disease And Study On COX-2, HER2and Related Proteins

Objective:Retrospective study of clinicopathological data of Paget’s disease. Study the expression, correlation and clinical significance of Proteins such as COX-2and HER2in Mammary and Extramammary Paget’s disease.Methods:Retrospective review of the clinicopathological data from the PD patients between January2009and December2013in PUMCH. Follow up to April2014, and evaluate their health status with KPS. Investigate the immunoreactivity of COX-2, HER2and CK7with histopathologic samples from20MPD and20EMPD patients, and analysis their value combined with clinical statistics by SPSS20.0software. There’s a significant difference when P<0.05.Results:1.Clinical data:(1)MPD:All22patients were female with mean age at diagnosis55.3years and72.7%(16/22) patients were postmenopausal. The mean time for accurate diagnosis is18.8months.90.9%of their nipples were unilateral involved and72.7%were on the left side.81.8%of their skin had eczematoid appearance, and18.2%patients had nipple discharge.68.2%patients complained itch or pain.13.6%patients presented with a palpable mass in breast and13.6%of their axillary lymph nodes were palpable.85%(17/20) patients were associated with underlying breast tumor. Mammography and MRI can well detect the changes. Ultrasound can be useful in discover the multifocal and multicentric breast tumor(31.6%,6/19), but also had false-negative results.20%of the underlying tumor were in external-superior quadrant.60%of them were received radical mastectomy.15patients were followed-up, and no one had regional recurrence and lymph nodes metastasis.13.3%(2/15) had distant metastasis. All KPS were equal or greater than90.(2)EMPD:Total32patients.30of them were male with mean age at diagnosis61.3years and mean time for accurate diagnosis51.4months.78.1%lesions were on scrotum and92.6%had eczematoid changes with81.5%complained with itch or pain.7.4%of their Lymph nodes could be touched and3.7%patient had lymph nodes metastasis.7.4%patients had a second tumor. The main therapy for EMPD is extensive resection with2cm margin.35%of their margins were nearly positive.21patients were followed-up,4.7%was dead, and33.3%had local recurrence mainly during the first year after operation. Nobody had regional recurrence and distant metastasis. Nearly all of KPS were equal or greater than90.(3)Comparison:There was significant statistical difference between MPD and EMPD in gender, age, diagnosis time, underlying tumor, incisal margin and recurrence rate.2. Histopathology:5%(1/20) MPD patients had adnexal involvement, and65%MPD patients were in stage0and35%in stage I according to the7th edition of AJCC.10%(2/20) EMPD patients had dermal infiltration and25%(5/20) had adnexal involvement.3.ICH:(1) HER2was expressed in85%MPD and60%EMPD patients. Its expression in nipple Paget cells were in accordance with those tumor cells in the underlying breast cancer. There was no statistical difference between HER2and CK7in MPD.(2) COX-2was expressed in20%MPD and25%EMPD patients. It was related to multifocal or multicentral breast cancer in MPD and positive incisal margin in EMPD.(3) There was statistical significant correlation between COX-2and HER2in MPD and EMPD.Conclusion:(1) There was significant difference between MPD and EMPD in some clinicopathological characters.(2) Ultrasound can be false-negative in detecting MPD. MRI and Mammography have good diagnostic value.(3) HER2may be useful in the diagnosis of MPD and correlates with COX-2in MPD and EMPD.(4) COX-2has low expression in Paget’s disease, which is lower than the known results from abroad. MPD patients who overexpress COX-2are more possible to combine with multifocal or multicentral breast cancer. COX-2may paly a role in incisal margin, but it still needs for further research.