Prognostic Factors in Paget’s Disease of the Vulva: A Study of 21 Cases
Notice bibliographique
Résumé
A review of the surgical pathology files of the British Columbia Cancer Agency and the Vancouver Hospital and Health Sciences Center found 21 cases of Paget’s disease over the last 31 years. Possible prognostic factors, including presence and depth of invasion, status of resection margins, tumor DNA cell content, and immunoreactivity for p53 and estrogen receptor proteins were identified. Additional testing and immunostaining were performed using paraffin block samples, which were available for 20 of the 21 cases. The median age of the patients at diagnosis was 67 years (range, 45–82 years). Noninvasive vulvar Paget’s disease was seen in 11 patients; minimally invasive vulvar Paget’s disease (invasion of ≤1 mm), in 7 patients; and invasive disease with invasion of 2, 3, and 8 mm, in 3 patients. All three patients with invasive disease underwent radical vulvectomy and inguinal node dissection. Noninvasive disease and minimally invasive disease were treated with wide local excision or some form of vulvectomy. The three patients with invasive disease all had positive nodes but negative specimen margins. Positive margins were seen in 5 of the 11 patients with noninvasive disease and in 6 of the 7 patients with minimally invasive disease. After 1.8 months to 31 years of follow-up, recurrences of in situ Paget’s disease have been seen in five patients with noninvasive disease (mean time to recurrence, 106 months; range, 1–28 years). One patient had negative margins at her initial treatment. Three patients with minimally invasive disease, all with positive margins, had local recurrence of in situ Paget’s disease 15 to 106 months (mean, 72 months) after treatment. One of the three patients with tumor invasion died of metastatic Paget’s disease 4.4 years after treatment. At the close of the study period, the second patient with invasive tumor was alive and well at 25 months, and the third had died of unknown causes. Five of seven patients with minimal invasion were alive with no evidence of disease, and one died of myocardial infarction. The other woman was alive with in situ recurrence over most of the vulva after declining additional surgery. Seven of the 11 patients with noninvasive Paget’s disease were alive with no evidence of disease, one had recurrence of in situ disease 17.6 years after her initial diagnosis and was preparing for treatment, and three died of other causes. Immunohistochemical analysis showed strong immunoreactivity for CK7, which facilitated identification of Paget’s disease in the dermis. The immunohistochemical profiles were GCDFP+/CK7+/CK20− in 14 specimens, GCDFP+/CK7+/CK20+ in 4, and GCDFP−/CK7+/CK20− in 2. All lesions were estrogen receptor positive. Sixteen tumors were positive for p53 on immunostaining, and four were negative. Diploid tumors did not recur more often than aneuploid tumors (3 of 5 and 4 of 10, respectively). Int J Gynecol Pathol 1999;18;351–359
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,022 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».