• Jena Martin MD

Diagnosis Decisions - Pagets

***Great Moments in Pathology TM***

This cancer carpets the underside of your skin. It grows over, up, down and sometimes out. ⠀⠀ ⠀ It’s called Paget’s disease and it’s always seemed to me to be the sneakiest of cancers. It's an adenocarcinoma of your skin, which is a really strange cancer. On your skin it will look like a red raw rash. It can arise almost anywhere but usually on the breast or genitals. Only under the microscope do we see it’s true nature. ⠀ ⠀

The most sinister part of Pagets? It may come from either the underlying organs or be native to the skin. We can’t tell by looking. And the cell of origin in the skin (the Toker cell) is also mysterious, rarely seen on routine sections. We do immunohistochemical stains to determine the origin. If the cancer occurs in the groin area, we'll look for underlying prostate cancer, bladder cancer, colon cancer, cervical, endometrial or ovarian cancer. ⠀If the cancer occurs on the breast or armpit, we'll look for underlying breast cancers. ⠀ Pictured : extramammary Pagets of the scrotum. ⠀ Immunohistochemical stains indicated a primary skin tumor. ⠀ Cause: unknown ⠀ Prevention: unknown⠀ Next step: complete removal with negative margins. ⠀

***TM - This phrase: "Great Moments in Pathology" is my personal term for those amazing cases where we, the pathologist, clinches an unexpected diagnosis. It's a fist-pumping, celebratory moment when one recognizes these rarities. A Great Moment.

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