(7) This finding is of particular concern if it occurs across the breadth of the lesion, if the cells are cytologically atypical, or if there is evidence of proliferative activity within the pagetoid cells. (8) For it to be useful as a criterion, it is important to be precise as to what constitutes true pagetoid scatter.
In these benign lesions, the pagetoid cells are typically limited to the central portions, often with associated nest formation.
It is also reported that a few cases of classic BD arise in the preexisting skin lesions such as seborrheic keratosis. Histologically, pagetoid BD is characterized by nests of atypical keratinocytes with round nuclei and abundant pale cytoplasm located either singularly or in groups within the epidermis, and the main differential diagnosis of pagetoid cells
includes extra-mammary pagetoid disease (EMPD) and malignant melanoma in situ (MIS).
Vacuolated cells characteristic of Paget's disease (Pagetoid cells
) are not seen.
Although pagetoid cells
(ample cytoplasm and dusty melanin) are rare, compared with the spindle pattern, pagetoid spreading is common; however, because of the small size of the nucleus, that spreading is not as obvious as it is in other locations.
Friction has been suggested as the most probable inductor of the lesion. Pagetoid dyskeratosis has been found incidentally in the squamous epithelium of the skin in various locations[4-6] and in the ectocervix in uterine prolapse. When these pagetoid cells are unusually abundant, they may cause concern in inexperienced pathologists.
We have recently observed several cases with pagetoid cells in the squamous epithelium of surgically resected hemorrhoids.
Pagetoid cells were more numerous in the parabasal and midzone layers than in the superficial layers of the squamous epithelium.
The pagetoid cells did not stain with special stains such as periodic acid-Schiff, Alcian blue, Mayer mucicarmine, and Fontana-Masson silver.
The term pagetoid cells includes all discrete non-malpighian or abnormal malpighian intraepidermal cells that resemble cells of Paget disease occurring singly or in small groups in the squamous epithelium.