EXTRAMAMMARY PAGET'S DISEASE THAT HAD BEEN TREATED BY RADIATION
The pictures of this biopsy probably would not enable one to make a definitive diagnosis. As a matter of fact, examination of the entire slide was misleading in the absence of clinical information. I was not informed that this patient had a diagnosis of extramammary Paget's disease of the scrotum established nine years ago. He had refused surgical treatment but received radiation therapy seven years ago. He has not developed a palpable tumor.

I misinterpreted the slide as an atypical melanocytic proliferation associated with dermal fibrosis, possibly lichen sclerosus et atrophicus. I was informed of the clinical history several weeks later. Upon reviewing the slide at that time, the diagnosis became obvious.  I then had a section stained by the periodic acid Schiff method for confirmation. In retrospect, a telephone call requesting clinical information would have saved me some embarrassment.

This case illustrates the importance of clinical information in dermatopathology. Parenthetically, I have numerous cases of metastatic breast carcinoma in my files where the skin biopsy was submitted without a history of the patient having had breast carcinoma.


This is the biopsy from the scrotum of an 82 year old male.
 
Composite medium power view. Cells can be seen distributed singly within the epidermis. Telangiectasia is associated with glassy appearing superficial dermis.
A high power view from the above.
A high power view from another area. It is difficult to distinguish between atypical melanocytic hyperplasia and extramammary Paget's disease in this picture or in the picture above it..
A PAS stain following diastase digestion.

This is not as sophisticated as doing a CEA, S100, AE1/AE3 panel, but it is a lot cheaper and suffices in this setting to confirm extramammary Paget's disease.

 

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