O dogma conventionala separa astazi in doua unitati formele mamare si extramamare ale bolii Paget, datorita unor particularitati clinico-evolutive si histogenezei controversate a celulei Paget.

Un caz recent internat in clinica - o pacienta de 68 de ani cu o forma relativ rara de boala Paget cu localizare perianala - a ridicat probleme de diagnostic, confirmarea fiind adusa de examenul histopatologic si histochimic. Examenele clinice amanuntite si investigatiile paraclinice inclusiv CT au exclus atat o neoplazie subiacenta cat si un adenocarcinom primitiv rectal, cervical sau uretral. Pana cand o excizie Mohs a intregului placard va aduce alte dovezi, putem incadra cazul nostru in categoria formelor de boala Paget extramamara neasociata unui cancer subiacent.

Ca o lege a seriilor, alte doua cazuri internate in clinica noastra aproape in acelasi timp, ce prezentau leziuni perianale foarte asemanatoare clinic pana la similitudine, au ridicat probleme de diagnostic diferential. In final acestea s-au dovedit a fi, dupa studiul histopatologic, boala Bowen si respectiv displazie de tip neoplazie intraepiteliala indusa de H.P.V.

Se fac aprecieri clinico-evolutive, terapeutice si prognostice cu referire la cazurile prezentate.

Conventionally, Paget's disease is nowadays divided in 2 units - the mammary and extramamary forms - due to certain clinical and evolutive particularities, and to the controversial histogenesis of Paget cell.

A case recently admitted to our clinic - a 68 years old woman presenting with a relatively rare form of perianal Paget's disease - raised difficulties of diagnosis, the confirmation being finally brought by histopathological and histochemical findings. Careful clinical examination and laboratory and imaging investigations - including CT scan - excluded an underlaying malignancy as well as a primitive rectal, cervical or urethral adenocarcinoma.

Untill a Mohs excision of the plaque brings further evidences for the diagnosis, this case can be considered an extramammary form of Paget's disease not associated with an underlyng malignancy.

As according to a series law, 2 other cases admitted in our clinic, in almost the same time, presenting with similar, almost identical perianal lesions, also raised certain problems of differential diagnosis. Finally, histopathological studies have confirmed these to be Bowen's disease and respectively, displasia of HPV induced intraepithellial neoplasia type.

The authors make clinical and evolutive, therapeutical and prognostic considerations in regard with the presented cases.