Paget's disease of the scrotum

Scrotal Paget's disease is also known as scrotal eczematoid carcinoma or scrotal inflammatory carcinoma. It is a tumor originating from the skin appendages (including hair, sebaceous glands, skin glands and fingers/nails). It is an intraepithelial gland carcinoma. Let's discuss the situation of scrotal Paget's disease.

Causes

The cause of Paget's disease of the scrotum is unknown, but it may be related to inflammation, chronic irritation, or human papillomavirus infection16.

Clinical symptoms

This disease mostly occurs in the elderly over 50 to 60 years old. In the early stage of the disease, the scrotal skin is red, rough, and has small blisters. Accompanied by itching and burning sensation of the skin, there may also be no symptoms. Due to scratching the skin, exudate, scarring, and scaling are caused. In this way, the symptoms progress slowly. The current history of the disease can be as long as many years to more than ten years, and there are reports of more than 30 years at most. The skin lesions have clear characteristics, mainly manifested as erythematous scaling patches or soft plaques. The surface of the diseased skin may have erosion, exudate, scarring, and even ulcers. It is often misdiagnosed as scrotal eczema. If it is not cured, the scope of skin damage will gradually expand. Some patients have inguinal lymphadenopathy on the affected side, but most inguinal lymphadenopathy is caused by infectious factors rather than metastasis.

Confirmed

Diagnosis of this disease requires pathophysiological examination of the lesion tissue. Finding Paget cells under the microscope in the dermis or spinous layer of the epidermis is the basis for diagnosis. Pathophysiological characteristics: Paget cells are large, atypical somatic cells with large nuclei, obvious nucleoli, rich and colorful cytoplasm, and light eosinophilic staining. Tumor somatic cells are scattered alone or in small clusters throughout the epidermal cell layer.

Healing

Excision of the skin of the scrotal lesion is the preferred treatment. The excision area should be the scrotal wall cell layer 2 cm outside the normal skin around the tumor lesion, including the epidermis, dermis and even the wall of the testicular vagina. If the deeper tissues are affected, the testicles and spermatic curves should be removed together. When the excision area is too large, the damaged area can be repaired by autologous skin grafting or pedicled skin flap transplantation. It has been reported that for smaller lesions, Nd:YAG laser surgery can be considered.

Inguinal lymph node enlargement on the affected side is often caused by inflammation. Anti-infection treatment can be given priority for 1 week before surgical treatment. After the disease is removed, lymph node biopsy is taken during the operation and sent for frozen pathological examination. If it is negative, anti-infection treatment is given again after the operation. Protective inguinal lymph node dissection is not required. Inguinal lymph node dissection is performed only for those with positive lymph node biopsy, and the male testicles and spermatozoa in the same direction are removed at the same time. Inguinal lymph node dissection surgery can be performed immediately or 2 to 3 weeks after the primary disease is removed. It can reduce the occurrence of wound infection, flap transplant necrosis and lymph node fistula.

Scrotal Paget's disease is not sensitive to radiotherapy, chemotherapy or radiotherapy, so it is not treated with simple radiotherapy, chemotherapy or radiotherapy. However, for patients with metastasis, radiotherapy, chemotherapy or/and radiotherapy can be used before and after surgery to improve the efficacy. The chemotherapy drugs used are cyclophosphamide, daunorubicin, cisplatin and methotrexate, which have a certain practical effect on the palliative treatment of terminal patients.

Prognosis

The malignant level of scrotal Paget's disease tumor cells is low and most of them do not metastasize, so most scrotal Paget's disease patients have a good prognosis after surgery. Most patients can be cured through surgical treatment, and the recurrence rate after surgery is 15% to 33%. About 10% of patients with relapses can progress to invasive cancer or even metastasis. Very few patients are accompanied by regional cancer metastasis or distant metastasis. Such patients have a poor prognosis and rarely survive for more than 5 years after surgery.