case_images: PMC11152018_01
case_images: a The skin lesion manifestation. b Marking the surgical margin. c The 2 cm outside the skin lesion was used as the initial surgical margin to excise the lesion. d Skin flap is obtained from the medial thigh near the inguinal region. e Free skin flap transplantation was used to repair the surgical wound. f Postoperative manifestation.
case_images: uin-2024-0108-0003-536654_F01.jpg
case_images: PMC11152018_01_uin-2024-0108-0003-536654_F01.jpg
case_images: F1
case_images: There were clear boundaries between the lesion and surrounding tissue (Fig. 1).
case_images: a Metabolic status of bilateral inguinal lymph nodes. b The metabolism of the left inguinal lymph node is increased. c, d The scrotal skin on both sides was thickened and the metabolism was increased, especially on the left side. e The density and metabolism of left testis were increased, considering tumor invasion. f Metabolic status of whole body tissues. a-f PET/CT results showed that the skin of bilateral scrotum was slightly thickened with increased metabolism, and the density and metabolism of the left testis were increased, which were considered as tumor invasion.
case_images: uin-2024-0108-0003-536654_F02.jpg
case_images: PMC11152018_01_uin-2024-0108-0003-536654_F02.jpg
case_images: F2
case_images: PET/CT results showed that the skin of bilateral scrotum was slightly thickened with increased metabolism, which was consistent with the appearance of malignant tumor, and the density and metabolism of the left testis were increased, which were considered as tumor invasion (Fig. 2).
case_images: a Pathological images of the lesion showed Paget disease involving the epithelium of the skin (HE satin x100 magnification). b Many scattered vacuolated Paget cells (black arrow) were observed in the epidermal layer, which have large cell bodies, abundant and light-stained cytoplasm, large and dark-stained nuclei. Moreover, abnormal mitotic images were observed in Paget cells.
case_images: uin-2024-0108-0003-536654_F03.jpg
case_images: PMC11152018_01_uin-2024-0108-0003-536654_F03.jpg
case_images: F3
case_images: Besides, abnormal mitotic images were observed in Paget cells (Fig. 3).
case_images: Immunohistochemical staining of EMPD lesion (x200 magnification). a Weakly positive staining for GCDFP-15. b Positive staining for CK7. c Positive staining for KI-67. d Positive staining for MUC5AC. e Positive staining for CK20. f Positive staining for CEA. g Positive staining for GATA3 (x100 magnification). h Negative staining for CK5/6. i Negative staining for Ber-EP4.
case_images: uin-2024-0108-0003-536654_F04.jpg
case_images: PMC11152018_01_uin-2024-0108-0003-536654_F04.jpg
case_images: F4
case_images: Immunohistochemical results showed GCDFP-15(focal +), CK7(+), CK20(+), EMA(+), MUC5AC(+), CEA(+), GATA3(+), CK5/6(-), P40(-), P63(-), Ber-EP4(-), KI-67(+30%), P53(+5%), CD56(-), Syn(-), AR(+) (Fig. 4).