A 57-year-old male presented with a 1.5cm tumor on the scrotum.

    Sebasstian Verne, a 3rd year medical school student, Miller School of Medicine, Univ of Miami is presenting this case report.

     

    Clinical History:

    The patient is a 57-year-old male who presented with a 2-month history of an evolving lesion on the scrotum. The lesion initially appeared as a red patch shortly after shaving the area. When the lesion progressed, he presented to the Emergency Department on two occasions and was prescribed trimethoprim/sulfamethoxazole without resolution and then azithromycin and topical ketoconazole without resolution. The lesion continued to progress until presenting to Dermatology with a non-tender 1.5cm x 1.5cm friable tumor with surrounding hyperpigmented patches. There were no palpable testicular masses or lymphadenopathy.

    Microscopic examination:

    Histologic sections of one specimen show primarily invasive intradermal poorly differentiated carcinoma showing a nodular pattern of growth. Small gland formation is noted within the tumor. There are minimal inflammatory cell infiltrates. A second specimen shows pagetoid spreading of poorly differentiated carcinoma along the epidermis and eccrine ducts. The cells are morphologically very similar to those found in the first specimen. Immunohistochemistry shows the tumor cells are positive for CK7 and GATA3. The tumor cells are negative for S100, Malan A, CK5/6, TTF-1, p63, and CDX2. Alcian blue staining shows small alcian blue positive mucin containing gland formation within the tumor.

    Diagnosis:

    Extramammary Paget’s disease of the scrotum

     

    Conference: