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Year : 2013  |  Volume : 58  |  Issue : 3  |  Page : 237-238
Long-standing erosion on the perineum: What could it be?


1 Nirvana Skin Clinic, Makarpura Main Road, Vadodara, Gujarat, India
2 Department of Dermatology and Venereology, Sheth G.S. Medical College, KEM Hospital, Mumbai, India

Date of Web Publication20-Apr-2013

Correspondence Address:
Shyam B Verma
Nirvana Skin Clinic, Makarpura Main Road, Vadodara, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.110837

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How to cite this article:
Verma SB, Khopkar U. Long-standing erosion on the perineum: What could it be? . Indian J Dermatol 2013;58:237-8

How to cite this URL:
Verma SB, Khopkar U. Long-standing erosion on the perineum: What could it be? . Indian J Dermatol [serial online] 2013 [cited 2019 May 20];58:237-8. Available from: http://www.e-ijd.org/text.asp?2013/58/3/237/110837


A 74-year-old woman came to this clinic with complaints of discomfort in the perineal region for the past 20 days. She said that she had noticed hardening in a small area, which she had ignored for the past few months, but she had experienced some burning during passing urine and stool. On examination there was small, well-defined erosion on her perineum [Figure 1]. There was no bleeding, pruritus, pus discharge, or tenderness. There was no palpable mass. She was a well-controlled diabetic. A potassium hydroxide (KOH) and Gram-stain smear did not reveal any abnormality. Owing to its essentially asymptomatic nature, long duration, and the pigmentation around it, we considered a differential diagnosis of pigmented basal cell carcinoma, malignant melanoma, and pigmented Bowen's disease. A skin biopsy revealed large intraepithelial cells, with a pale staining cytoplasm and large pale staining nuclei [Figure 2] and [Figure 3]. The immunohistochemistry was positive for cytokeratin 7 (CK7), but was negative for cytokeratin 20 (CK20), S 100, and β-Hydroxy β-methylbutyric acid (HMB) 45 [Figure 4]. Serum carcinoembryonic antigen (CEA) was normal. A Papanicolaou (PAP) smear, pelvic X-ray, pelvic ultrasound, a gynecologic examination, and colonoscopy did not reveal anything abnormal. Integrating the results of the clinical findings, routine histology and immunohistochemistry, a diagnosis of XXX was made.
Figure 1: Well-defined erosion in the perineum


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Figure 2: Markedly hyperplastic epidermis with 'bulbous' ridges proliferating downward. The cells near the basal epithelium are rather pale and sharply delineated from the dermis by a basal layer of the epidermis. (H and E, ×10)

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Figure 3: High Power Image showing pale cells filling up the epidermis but sparing the basal layer

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Figure 4: Expression of CK7 by the tumor cells in the epidemis

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   References Top

1.Al Hallak MN, Zouain N. Extramammary perianal paget's disease. Case Rep Gastroenterol 2009;3:332-7.   Back to cited text no. 1
    
2.Pang J, Assaad D, Breen D, Fialkov J, Antonyshyn O, Balogh J, et al. Extramammary Paget's disease: Review of patients seen in a non-melanoma skin cancer clinic. Curr Oncol 2010;17:43-5.   Back to cited text no. 2
    
3.Banerjee S, Chatterjee M, Chand K. Extramammary Paget's disease. Indian J Dermatol Venereol Leprol 2005;71:417-20.   Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.Lloyd J, Flanagan AM. Mammary and extramammary Paget's disease. J Clin Pathol 2000;53:742-9.   Back to cited text no. 4
    
5.Zollo JD, Zeitouni NC. The Roswell Park. Cancer institute experience with extramammary Paget's disease. Br J Dermatol 2000;142:59-65.  Back to cited text no. 5
    


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



 

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