A CLINICOPATHOLOGICAL STUDY OF 30 PATIENTS WITH PAGETS-DISEASE OF THEVULVA

Clinical and pathologic analyses were performed in 30 patients with Pa get's disease of the vulva to investigate the risk factors for recurre nce. From 1971 to 1993, we carried out histologic examinations in 27 r esected vulvae to detect Paget's cells at the surgical margin. Prior t o 1981, 9 patients underwent the examination, and 6 of them had positi ve surgical margins, and 2 of these 6 patients had local recurrence. A fter 1982, the pre-operative multiple biopsy and intraoperative frozen section diagnosis of the surgical margins were performed, and as a re sult, cases of the lesions remaining as stumps on the vaginal side dec reased in 7 of 18 examined patients. In these 7 cases, 2 cases had loc al recurrence. The patients were further divided into three groups acc ording to histologic findings to investigate their prognosis: 10 patie nts with intraepithelial Paget's disease (IEP), 9 patients with minima lly invasive Paget's disease (MIP), and 11 patients with underlying ca rcinoma (UC) including 2 cases of carcinoma in situ. Four locally recu rrent cases were found in IEP or MIP, and the longest period from surg ery to recurrence was 8 years and 4 months. The invasive UC lesions pe rsisted or recurred shortly after surgery (median, 10 months) in 5 of the 6 patients with general metastasis. For IEP and MIP, surgical marg ins of the vaginal side should be carefully examined with preoperative multiple biopsy and intraoperative frozen section, and also a long-te rm follow-up is necessary. With regard to invasive UC patients, their prognosis was found to be very poor for general metastasis. (C) 1995 A cademic Press, Inc.