PMC4322830_01
((a) and (b)) Skin and left scrotum involved by extramammary Paget's disease with invasive component: (c) cytokeratin 7 highlights adenocarcinoma cells.
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fig1
Immunostaining was positive for CAM5.2, CK7, focally positive for BRST-2, negative for CK20, MART-1, and S100 (Figure 1).
Lymph node H&E stain: (a) central necrosis tumor island in the subcapsular area, (b) adenocarcinoma cells with morphological features similar to Figure 1, and (c) complete membranous staining by HER2/neu immunohistochemical stain.
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fig2
The slides were examined in our institution which revealed that the lymph node tissue was entirely replaced by metastatic poorly differentiated adenocarcinoma associated with necrosis (Figure 2). According to HER2 test guideline recommendations for breast cancer, this HER2 result would be considered to be positive (3+) (Figure 2).
(a) Pretherapy enlarged left supraclavicular lymph node, (b) posttherapy normalized left supraclavicular lymph node, (c) pretherapy enlarged left axillary lymph nodes, (d) posttherapy normalized left axillary lymph nodes, (e) pretherapy enlarged left axillary lymph node, and (f) posttherapy normalized left axillary lymph node.
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Restaging CT after 4 doses or 3 months (Figures 3 and 4) revealed left axillary and left supraclavicular lymphadenopathy that had resolved, returning to normal size, consistent with treatment effect, and no new measurable disease in the chest, abdomen, or pelvis, and noted previously lytic bone metastases in the left seventh rib and spine now sclerotic, consistent with treatment effect.
(a) Pretherapy T10 vertebral body lytic metastasis, (b) posttherapy T10 vertebral body becoming sclerotic, (c) pretherapy left 7th rib lytic metastasis, and (d) posttherapy left 7th rib met becoming sclerotic.
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fig4
Restaging CT after 4 doses or 3 months (Figures 3 and 4) revealed left axillary and left supraclavicular lymphadenopathy that had resolved, returning to normal size, consistent with treatment effect, and no new measurable disease in the chest, abdomen, or pelvis, and noted previously lytic bone metastases in the left seventh rib and spine now sclerotic, consistent with treatment effect.