Complications in Surgical Management of Recurrent Vulvar Paget’s Disease: Treatment and Follow-up

Aleksandar Šipka; Marina  Đurić; Miroslav Tomić; Aljoša  Mandić

doi:10.2298/AOO241023001S

Aleksandar Šipka Oncology Institute of Vojvodina, Sremska Kamenica, Serbia https://orcid.org/0009-0005-5995-193X
Marina Đurić Oncology Institute of Vojvodina
Miroslav Tomić Faculty of Medicine, University of Novi Sad; Clinical Center of Vojvodina, Novi Sad, Serbia
Aljoša Mandić Oncology Institute of Vojvodina, Sremska Kamenica, Serbia; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia

DOI: https://doi.org/10.2298/AOO241023001S

Keywords: vulvar extramammary Paget's disease, EMPD, V-Y flap, Tiersch-type skin graft

Abstract

Introduction: Paget's disease of the vulva is an intraepithelial adenocarcinoma, primarily arising from vulvar skin glands, with or without an underlying invasive adenocarcinoma. It brings low mortality and a high local recurrence rate and mainly affects postmenopausal women.

Case outline: This is a case report of a 57-year-old postmenopausal woman, who had histopathological (HP) verified Extramammary Vulvar Paget's disease (EVPD) in 2014, and underwent a radical vulvectomy with a right-sided inguinofemoral lymphadenectomy and V-Y flap at the Oncology Institute of Vojvodina. Nine years later, in 2023, the patient was presented with a biopsy HP proven EVPD recurrence. The recurrence was surgically treated with vulvectomy and bilateral fasciocutaneous V-Y flaps reconstruction. The operative HP specimen proved the EVPD recurrence with atypical cells on one edge of the specimen. Due to the infection-complicated healing and wound dehiscence, the first reoperation was performed, which included wound debridement and left-sided rotational flap. We carried out the wound care and toileting in the postoperative course, with antibiotic treatment. Due to infection-complicated healing, tissue necrosis and consequent dehiscence, the second reoperation was performed, which included wound debridement with granulation tissue excochleation and Tiersch-type skin graft.

Conclusion: The patient was discharged 21 days after the second reoperation in good condition. A regular oncological postsurgical follow-up on the 3^th and 6^th month revealed no recurrence or deterioration of the general condition or local findings. The patient subjectively feels well and has no complaints or unwanted effects of the applied treatment.

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