乳房外Paget氏病ニ就テ

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1. Paget's disease was first described in 1874 by Sir James Paget, a surgeon in England, as a chronic disease occurring mainly at the nipples of aged women. Afterwards, cases with the same clinical symptoms, course and histological characteristics but occurring at the extra-mammary parts were diagnosed and called "extra-mammary Paget's disease". 2. About three hundred cases of Paget's disease (of the nipple) have already been reported; but as far as the writer can ascertain, only 64 cases of extra-mammary Paget's disease have been reported. 3. Morris, in 1880 reported a case in which the neck had been affected. This is the first known case of extra-mammary Paget's disease. Dubreuilh, in 1891 reported the first instance of it affecting the pudenda of women. 4. In Nippon, Satoh (1917) described for the first time extra-mammary Paget's disease at the scrotum, and Shinoda's account is the first reporting it as affecting the pudenda of woman. 5. The writer chanced upon a case of extra-mammary Paget's disease, at the mons pubis and its neighbourhood of a nine-year old girl. 6. This case, occurring at the mons pubis and its lower part and attaining to the labium, is a light red, itchy skin disease. At the time of examination the disease was already five years advanced. The affected part was circular in shape, about 3.5cm in diameter, merely protruding from the surrounding skin, with a slightly rugged surface and a clear border. The lesion generally is covered with scales and crusts, the middle of which has a light erosive, moist surface producing a small amount of secretion. When we palpate the part, infiltration occurs and we find it somewhat hard. 7. As to the histological features, the horny layer of the lesion remains, or partly sloughs off and so forms the slight erosion. We can ovserve only atrophy of the basal cells of the epidermis and hyperplasie of the melanin-pigment. Under the epithelial layer, we can see the expansion of vesculars. Many cellnests are composed mainly of prickle-cells; and there are the so-called "Pagetcells" and the intracellular hyaline granules. 8. All the cases of extra-mammary Paget's disease that have been studied, total 64, viz., in Nippon, men 13 cases, women 10 cases; and in foreign countries, men 21 cases, women 20 cases. 9. The total of cases in Nippon and foreign countries, is men 34 and women 30; therefore, the difference between men and women is but little. 10. In Nippon, with regard to the age of patients, we find 6 cases each among the 61-70 and 31-40 years old groups, while among the groups of 41-50, 51-60 and 71-80 years old, there have been 3 cases each. 11. In foreign countries, there have been 15 cases among people 51 to 60 years of age, 10 cases among those 61 to 70, 6 cases among those 71 to 80, 4 cases among those 41 to 50, two cases each among the 31-40 and 81-90 year old groups, and one case in the 20-30 year old group. 12. Generally speaking, there have been reported 18 cases among those 51-60 years old, 16 cases among those 61-70 years old, 9 cases among those 71-80 years old, 7 cases among those 41-50 years old, 5 cases among those 31-40 years old, 2 cases among those 81-90 years old and 1 case among those 20-30 years old. 13. With regard to the diseased part, in 43 known cases the pudenda and its neighbourhood habe been affected, three cases each of the back and the axilla, two cases each of the nose, umbilicus, abdominal wall, and cheek, and one case each of the lip, neck, gluteal muscle, knee, forearm, thigh and the neighbourhood of the sternum. 14. Instances in which the pudenda and its neighbourhood have been affected total 14 in the case of women and 29 in the case of men. The former is thus very small in comparison with the latter. 15. The average age of patients afflicted with the extra-mammary Paget's disease at the pudenda and its neighbourhood is: women 55, in Nippon 47, and in foreign countries 63. 16. Judging from the above summary, I believe that my case is both interesting and rare. 17. There is a theory which denies the existence of extra-mammary Paget's disease. Because of the observations listed above, I cannot accept this theory.
京都府立医科大学の論文

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小森繁
京都府立醫科大學生理學教室

乳房外Paget氏病ニ就テ

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