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SKINDIA QUIZ
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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 Publication16-Mar-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



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 [Epub ahead of print] [cited 2017 May 1]. Available from: http://www.idoj.in/preprintarticle.asp?id=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]. 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).


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

 
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