ABSTRACT Paget's disease most commonly affects the breast. Extramammary involvement is rare, and the most commonly affected sites are the vulva, anus, perianal region, and axilla. The disease may progress to invasive adenocarcinoma or synchronous cancers. Due to the lack of distinctive features and nonspecific presenting symptoms, Paget's disease may be misdiagnosed as other conditions, thus delaying the correct diagnosis. We report a case of extramammary Paget's disease in the perianal region that initially presented as an irregular, circumferential, scaling lesion with eczematous eruptions. Immunology and immunohistochemistry confirmed the diagnosis. Although surgery is the standard treatment, the patient opted for pelvic radiotherapy associated with radiosensitizing chemotherapy.
RESUMO A doença de Paget acomete mais comumente a mama. Os focos extramamários são raros e os locais mais habitualmente acometidos são vulva, ânus, região perianal e axila. A patologia envolve a evolução da doença para adenocarcinoma invasivo ou neoplasias sincrônicas. Devido à singularidade e sua aparência inespecífica, a doença pode ser confundida com outras comorbidades, retardando o diagnóstico. O objetivo foi relatar um caso de doença de Paget extramamária na região perianal, a qual inicialmente apresentou lesão circunferencial com erupção eczematosa, descamativa e irregular. A confirmação diagnóstica foi por meio de exames imuno-histoquímico e imunológico. O tratamento padrão da doença é cirúrgico, porém optou-se por radioterapia pélvica associada à quimioterapia radiossensibilizante.
Abstract Food production within the context of solidarity economy is an alternative way to offer employment and income for a significant part of the Brazilian population. The purpose of this study was to carry out a business diagnosis in order to evaluate the facilities, the production process and hygiene practices of seven solidarity economy enterprises located in the city of Novo Hamburgo, Southern Brazil, that work with food production and sales. Visits took place at the enterprises and a check-list was used to record data. Although food production happens in places with space and setting restrictions, it guarantees distinctive foods with aggregate value, where handlers follow the whole process, from raw materials selection to sales. Basic hygiene principles are followed, as they guarantee the production of food with quality, which contributes towards income generation for participating families. Specific laws that apply to the characteristics and needs of small-scale food production must be written in order to regulate solidarity economy enterprises.