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Year : 2013  |  Volume : 58  |  Issue : 5  |  Page : 402-403
Greyish verrucous plaque with erosions on the perianal area


Department of Dermatology, Venereology and Leprosy, Grant Medical College, Mumbai, India

Date of Web Publication30-Aug-2013

Correspondence Address:
Mahendra M Kura
Department of Dermatology, Venereology and Leprosy, Grant Medical College, Mumbai
India
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Source of Support: None, Conflict of Interest: None


PMID: 24082192

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How to cite this article:
Kura MM, Rane VK, Singh VD. Greyish verrucous plaque with erosions on the perianal area. Indian J Dermatol 2013;58:402-3

How to cite this URL:
Kura MM, Rane VK, Singh VD. Greyish verrucous plaque with erosions on the perianal area. Indian J Dermatol [serial online] 2013 [cited 2017 Jun 23];58:402-3. Available from: http://www.e-ijd.org/text.asp?2013/58/5/402/117330


A 70-year-old male presented with a mildly pruritic elevated lesion discharging sticky serous fluid in perianal region since 2 years. The lesion had progressed despite local applications of 25% podophyllin, steroids, and antifungal agents. There was no history of bowel or bladder disturbances, weight loss, or homosexual practices.

Dermatological examination revealed a grayish, sharply marginated verrucous plaque with superficial erosions present circumferentially around the anal opening. Per rectum examination revealed its extension into the anal canal at 3, 6, and 12 O'clock position [Figure 1] but not beyond the margins of the anal canal. There was no regional or distant lymphadenopathy. Skin biopsy revealed hyperkeratosis, papillomatosis, and irregular acanthosis. Numerous large cells with pale cytoplasm and hyperchromatic nucleus were seen in epidermis [Figure 2], few of which were also extending into the hair follicle [Figure 3]. Surgical opinion and ultrasonography of abdomen and pelvis ruled out bowel involvement.
Figure 1: Greyish verrucous plaque with erosions extending from 2 O'clock to 6 O'clock position at the perianal area

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Figure 2: Large cells with pale cytoplasm and hyperchromatic nuclei in epidermis (H and E stain, 400×)

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Figure 3: Pale staining large - sized cells extending into the hair follicle (H and E stain, 100×)

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1.Lloyd J, Flanan AM. Mammary and Extramammary Paget's disease. J Clin Pathol 2000;53:742.  Back to cited text no. 1
    
2.Lupton GP, Graham JH. Mammary and Extramammary Paget's disease. In: Friedman RJ, Rigel DS, Kopf AW, Harris MN, Baber D, editors. Cancer of the Skin. Philadelphia: WB Saunders; 1991. p. 217.  Back to cited text no. 2
    
3.Fanning J, Lambert HC, Hale TM, Morris PC, Schuerch C. Paget's disease of the vulva: Prevalence of associated vulvar adenocarcinoma, invasive Paget's disease, and recurrence after surgical excision. Am J Obstet Gynecol 1999;180:4.  Back to cited text no. 3
    
4.Nowak MA, Guerriere-Kovach P, Pathan A, Campbell TE, Deppisch LM. Perianal Paget's disease: Distinguishing primary and secondary lesions using immunohistochemical studies including gross cystic disease fluid protein-15 and cytokeratin 20 expression. Arch Pathol Lab Med 1998;122:1077-81.  Back to cited text no. 4
    
5.Zamponga JC, Flowers FP, Roth WI, Hassenein AM. Treatment of primary limited cutaneous extramammary Paget's disease with imiquimod monotherapy: Two case reports. J Am Acad Dermatol 2002;47:229-35.  Back to cited text no. 5
    


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