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SKINDIA QUIZ
Year : 2017  |  Volume : 8  |  Issue : 3  |  Page : 227-228  

SkIndia Quiz 37: A persistent plaque in the pubic region


Department of Dermatology, Venereology and Leprology, RNT Medical College, Udaipur, Rajasthan, India

Date of Web Publication11-May-2017

Correspondence Address:
Lalit Kumar Gupta
Department of Dermatology, Venereology and Leprology, RNT Medical College, Udaipur - 313 001, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5178.202362

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How to cite this article:
Gupta LK, Beniwal R, Khare AK, Mittal A, Mehta S, Balai M. SkIndia Quiz 37: A persistent plaque in the pubic region. Indian Dermatol Online J 2017;8:227-8

How to cite this URL:
Gupta LK, Beniwal R, Khare AK, Mittal A, Mehta S, Balai M. SkIndia Quiz 37: A persistent plaque in the pubic region. Indian Dermatol Online J [serial online] 2017 [cited 2019 Nov 22];8:227-8. Available from: http://www.idoj.in/text.asp?2017/8/3/227/202362

A 70-year-old man presented with an itchy eczematous well-defined plaque of size 10 × 7 cm involving the pubic region, penis, and scrotum. It was eroded at places and covered with grayish-white scales and crusts [Figure 1]. The lesion had persisted almost unchanged for 15 years despite treatment. Skin biopsy stained with hematoxylin and eosin stain showed characteristic features [Figure 2]a and [Figure 2]b. Special stain with mucicarmine was positive [Figure 3]. Immunohistochemistry markers were positive for CK7 and negative for CK20 and CEA [Figure 4]. Whole body positron emission tomography scan did not reveal any abnormality.
Figure 1: An erythematous, eczematous plaque over pubic region, penis, and scrotum

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Figure 2: (a and b) Histology showing large cells with abundant pale-staining cytoplasm and pleomorphic nuclei in the epidermis. (H and E, ×40 and ×100)

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Figure 3: Characteristic cells showing mucicarmine stain positivity (×20)

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Figure 4: Immunohistochemistry showing positive staining with CK7 (×40)

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   Question Top


What is your diagnosis?

Histology showed circumscribed collections of large cells with abundant pale-staining cytoplasm and pleomorphic nuclei in the epidermis [Figure 2]. Some of the cells had a “signet ring” appearance. Staining with mucicarmine was positive [Figure 3]. On immunohistochemistry [Figure 4], these cells were positive for cytokeratin 7(CK7) but negative for cytokeratin 20(CK20) and carcinoembryonic antigen (CEA).



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   References Top

1.
Rao VR, Henry DH. Extramammary Paget's disease. Commun Oncol 2004;1:109-14.  Back to cited text no. 1
    
2.
Isrow D, Oregel KZ, Cortes J, Gomez H, Milikowski C, Feun L, et al. Advanced extramammary Paget's disease of the groin, penis and scrotum. Clin Med Insights Oncol 2014;8:87-90.  Back to cited text no. 2
    
3.
Chandawarkar RY, Ricchuti D, Amjad I, Marisco RE Jr, Wells MD. Extramammary Paget's disease of the perineum: Avoiding pitfalls in diagnosis and management. Can J Plast Surg 2003;11:205-8.  Back to cited text no. 3
    
4.
Reddy IS, Swain M, Gowrishankar S, Murthy DB. Primary extramammary Paget's disease with extensive skeletal metastases. Indian J Dermatol Venereol Leprol 2012;78:89-92.  Back to cited text no. 4
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  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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