【摘要】 目的:探讨阴囊巨大的乳腺外派杰氏病(extramammary Paget’s disease,EMPD)手术治疗及预后影响因素。方法:回顾性分析2004年至2017年潞河医院诊治的乳房外派杰氏病5例,并文献复习。结果:1例巨大EMPD患者,男性,65岁,有糖尿病病史,阴囊左侧出现浸润性红色斑块,大小约11cm×9cm,累及阴茎、阴阜及同侧腹股沟,表面潮红,附着黄色痂皮。同侧腹股沟可触及多个肿大淋巴结。组织病理检查诊断为EMPD。免疫组化结果:细胞角蛋白(CK) 7、细胞角蛋白(CK) 18、癌胚抗原(CEA)、上皮膜抗原(EMA)、c-erbB2均为阳性,巨囊性病的液状蛋白(GCDFP)-15、细胞角蛋白(CK) 5/6、P63、细胞角蛋白(CK)20均为阴性。外科手术扩大切除,并行同侧腹股沟区肿大淋巴结清扫,手术切除范围较大,行皮瓣结合局部植皮整形修复,效果良好。其余4例患者,年龄范围73岁～88岁,皮损长径5～6cm,活检及免疫组化结果诊断EMPD,患者放弃手术治疗,失访。结论:巨大阴囊EMPD手术并整形修复治疗效果满意,预后较好,影响预后的主要因素为皮损浸润的深度和淋巴结转移情况。更多还原

【Abstract】 Objective: To explore surgical treatment and prognostic factors of large extramammary Paget’s disease occured on scrotum. Methods: Retrospective analysis of 5 cases of EMPD dignosed from 2004 to 2017 in Luhe Hospital and literature review were applied. Results: A 65-year-old male diabetic patient suffered a giant lesion of a infiltrating erythematous plaques on his left scrotum about a size of 11 cm × 9 cm. Examination showed the lesion extending to penis,mons pubis and groin with light yellow crust. Enlarged lymph nodes were detected in affected groin.Histopathological examination revealed EMPD and Immunohistochemical studies showed that cytokeratin-7,cytokeratin-18,carcino-embryonic antigen,epithelial membrane antigen were positive and gross cystic disease fluid protein-15,cytokeratin-5/6,P63,cytokeratin-20,were negative. Skin flap in combination with skin grafting were adopted after extensive excision of skin lesions. Groin lymphadenectomy was performed. The other 4 patients,aged from 73 to 88 years old,had the long diameter of scrotum lesions ranging from 5 to 6 cm. The biopsy and immunohistochemical results conformed EMPD. The patients gave up the surgical treatment and failed to visit. Conclusions: Surgical treatment with wide local excision and cerebral sursery repair can cured giant lesion of EMPD and its Prognosis is good.Tumor infiltration depth and metastases of lymph node maybe the main factors associated with bad prognosis.更多还原