Arch Hand Microsurg.  2022 Jun;27(2):166-170. 10.12790/ahm.22.0007.

Extramammary Paget’s disease involving the bilateral axillae followed by adhesive capsulitis of the shoulder: a case report

Affiliations
  • 1Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Busan, Korea
  • 2Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
  • 3Department of Pathology, Pusan National University School of Medicine, Busan, Korea
  • 4Department of Rehabilitation Medicine, Pusan National University Hospital, Busan, Korea
  • 5Busan Cancer Center, Pusan National University Hospital, Busan, Korea

Abstract

Few cases of bilateral axillary extramammary Paget’s disease (EMPD) have been reported. We performed surgical excision and reconstruction in a patient with bilateral axillary EMPD after consultation with dermatology. A dermatologist determined the boundaries of the lesion through Mohs micrographic surgery, and a plastic surgeon excised the lesion and reconstructed the resulting defect. Skin grafts were simultaneously performed to reconstruct the bilateral axillae. After the operation, the reconstructed site healed well, but the range of motion of both shoulders was reduced. After referral to a doctor specializing in rehabilitation, the patient was diagnosed with adhesive capsulitis and received additional treatment. Since no previous reports have presented a case of adhesive capsulitis after the reconstruction of bilateral axillary EMPD using skin graft, this case is noteworthy.

Keyword

Skin; Neoplasms; Plastic surgery; Axilla

Figure

  • Fig. 1. Preoperative picture showing extramammary Paget’s disease in the bilateral axillae. The patient visited our clinic with bilateral axillary erythematous brownish patches that had developed 1 to 2 years ago.

  • Fig. 2. Microscopic findings of extramammary Paget’s disease. (A, B) Hematoxylin and eosin-stained slides (A, ×100; B, ×400). (C) Immunohistochemical staining for cytokeratin 7 (×400).

  • Fig. 3. Posture of the patient maintained for 7 days after skin graft surgery. The patient maintained shoulder elevation and abduction with both hands above the head.

  • Fig. 4. Ultrasonography of the shoulder area performed 1 month after surgery. On ultrasonography, capsular thickening in the synovial capsular layer was confirmed, and adhesive capsulitis was diagnosed with physical symptoms.

  • Fig. 5. A photograph taken 3 months after surgery, showing successful healing of the skin grafts in both axillae.

  • Fig. 6. After 1 year of treatment at the Department of Rehabilitation Medicine, the range of motion had still not fully recovered.


Reference

References

1. Hatta N, Yamada M, Hirano T, Fujimoto A, Morita R. Extramammary Paget’s disease: treatment, prognostic factors and outcome in 76 patients. Br J Dermatol. 2008; 158:313–8.
Article
2. Karam A, Dorigo O. Treatment outcomes in a large cohort of patients with invasive extramammary Paget’s disease. Gynecol Oncol. 2012; 125:346–51.
Article
3. Ewald A. Adhesive capsulitis: a review. Am Fam Physician. 2011; 83:417–22.
4. Crocker HR. Paget’s disease affecting the scrotum and penis. Trans Pathol Soc London. 1889; 40:187–91.
5. Youn HJ, Jung SH, Kim JC. A case of extramammary Paget’s disease of the axilla. J Breast Cancer. 2008; 11:156–9.
Article
6. Stefano C, Giuseppe del T, Romano M, Carmine A. Primary bilateral extramammary Paget’s disease of the axillae: another case of this strange disease. J Cutan Aesthet Surg. 2014; 7:131–4.
Article
7. Koorevaar RC, Van’t Riet E, Ipskamp M, Bulstra SK. Incidence and prognostic factors for postoperative frozen shoulder after shoulder surgery: a prospective cohort study. Arch Orthop Trauma Surg. 2017; 137:293–301.
Article
8. Chuaychoosakoon C, Suwannaphisit S. The relationship between arm abduction position and the risk of iatrogenic anterior branch of the axillary nerve injuries: a cadaveric study. Orthop J Sports Med. 2021; 9:23259671211008834.
Article
9. Yang S, Park DH, Ahn SH, et al. Prevalence and risk factors of adhesive capsulitis of the shoulder after breast cancer treatment. Support Care Cancer. 2017; 25:1317–22.
Article
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