4. Hrvatski kongres kliniËke citologije 4th Croatian Congress ... - Penta

4. Hrvatski kongres kliniËke citologije / 1. Hrvatski simpozij analitiËke citologije / 2. Hrvatski simpozij citotehnologije
VULVAR PAGET’S DISEASE - CASE REPORT
Katalenić Simon S, Krivak Bolanča I, Šentija K, Kukura V* Škrtic A**
Laboratory for Cytology and Clinical Genetics
*Department of Gynecology and Obstetrics
**Department of Pathology and Cytology
“Merkur“ University Hospital, Zagreb, Croatia
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Klinička citologija - Posteri
Vulvar Morbus Paget’s (MP) represents a rare intraepithelial adenocarcinoma. It appears
in less than 5% of all vulvar neoplasia usually in postmenopausal women. Histological
it is analogous to Paget’s disease of the breast. The most common clinical symptom is
pruritus.The lesions appear as an erythematous or eczematous lesion with islands of
hyperkeratosis. Occasionally, single anaplastic Paget’s cells can be found on the vulvar
smears which make cytological diagnosis of the disease possible. However, the disease
can be diagnosed only by biopsy. MP is classified into three distinct type based upon the
origin of the neoplastic cell: type I - primary vulvar cutaneus Paget disease; type II - MP
as a manifestation of an associated adjacent primary anal or rectal adenocarcinoma and
type III - pagetoid urothelial intraepithelial neoplasia. To distinguish these subtypes the
panel of immunohistochemistry markers must be done. We present a case of 49-year
old woman with vulvar symptoms of pruritus, who had liver and kidney transplatation a
two years ago. During the standard gynaecological examination the vulvar smear was
taken for cytological evaluation. The smear was scanty, overload with squamae, with two
kinds of cells: dysplastic squamous cells from lower layer of the epithelium and the single,
anaplastic cells with enlarged nuclei, visible nucleoli and pale indistinct cytoplasm.
According to that cytological diagnosis was vulvar intraepithelial lesions III (VIN III) with
differential diagnosis of vulvar Paget disease. The pathological verification support the
diagnosis of MP and an immunohistochemistry panel confirm type III of Paget disease
so a evaluation of bladder was suggested.
suzana.simon@kb-merkur.hr