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Pagetoid Adenocarcinoma In Situ of the Cervix With Pagetoid Spread Into the Vagina

Mahdi, Haider MD; Thrall, Melissa MD; Agoff, Nicholas MD; Doherty, Mark MD

doi: 10.1097/AOG.0b013e3182164af8
Case Reports
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BACKGROUND: Pagetoid spread of adenocarcinoma in situ of the cervix into vaginal epithelium is a rare phenomenon, mimicking Paget's disease of the vulva.

CASE: We report a case of in situ squamous cell and in situ adenocarcinoma of the cervix in a 44-year-old woman who underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and upper vaginectomy. Pathologic evaluation showed pagetoid endocervical adenocarcinoma in situ spreading into the vagina with positive margins. Malignant cells were positive for mucin, P16, CK-7, and carcinoembryonic antigen.

CONCLUSION: The asymptomatic occult finding of pagetoid changes in the vagina should raise the suspicion of vaginal extension of pagetoid genital or urothelial carcinoma in situ; however, it can be mistaken as vaginal dysplasia or primary Paget's disease. Immunohistochemical profiling may help in the differential diagnosis.

The finding of pagetoid changes in the vagina should be evaluated carefully to rule out nearby urothelial or genital carcinoma in situ.

From the Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington; and the Departments of Pathology and Gynecologic Oncology, Virginia Mason Medical Center, Seattle, Washington.

Corresponding author: Haider Mahdi, MD, Department of Obstetrics and Gynecology, University of Washington School of Medicine, 1959 Pacific NE, Seattle, WA 98195; e-mail: mahdih@uw.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2011 The American College of Obstetricians and Gynecologists