A case of triple Paget's disease: The usefulness of immunostaining with CK18 antibody

Abstract

A 68-year-old Japanese man noticed erosive scaly erythemas in his genital area 4 years ago. As the lesion gradually extended, he consulted our department. Physical examination revealed that multiple erythemas and depigmentations had intermingled in the genital area and right axilla, but clinically, there was no obvious lesion in the left axilla. Histological examination with HE staining revealed typical Paget's cells in the epidermis in the genital area and right axilla; however, only a limited number of Paget s cells were scattered in the left axilla. On immunohistochemical study, sparsely distributed Paget's cells in the left axilla were stained clearly by using a monoclonal antibody against CK 18 rather than CEA. We finally diagnosed triple Paget's disease. The skin lesion in the left axilla was so-called occult Paget's disease. Our case clearly suggests that immunostaining with CK 18 antibody is suitable for easy detection of the presence of Paget's cells in the lesional skin. [Skin Cancer (Japan)2008; 23: 367-370]