Scrotal Apocrine Adenocarcinoma with Pagetoid Phenomenon and Inguinal Lymph Node Metastases.

Aristeidis Hristos Zibis,Sotirios Sotiriou,Georgios Kotakidis,Sophia Havaki,Dimitrios Leonidas Arvanitis,Apostolos Haralampos Fyllos

doi:10.1155/2016/8353745

Abstract

We report a case of scrotal apocrine adenocarcinoma in a 72-year-old Caucasian male which was initially presented as a reddish superficial lesion which in time became an ulcerated nodule. The initial pathological examination showed an apocrine adenocarcinoma with pagetoid phenomenon. The tumor recurred after four months and then excision biopsy showed tumor with pagetoid phenomenon which reached all the surgical margins. Three months later an ulcerated nodule in the scrotum and greatly enlarged ipsilateral inguinal lymph nodes were noticed. The final pathological examination showed multiple separated malignant foci, some with overlying pagetoid phenomenon and inguinal lymph node metastases. Immunohistochemistry showed positivity for Gross Cystic Disease Fluid Protein-15 (GCDFP-15), androgen receptors, and score 3+ for the Human Epidermal growth factor Receptor-2 (HER2). The aggressive behavior of the present tumor goes along with previous reports showing that HER2 high score cases exhibit a worse prognosis.

Highlights

Scrotal apocrine adenocarcinoma is a rare and insidious malignancy with prolonged clinical course, because of belated diagnosis and its high probability for local recurrence
The pagetoid phenomenon is derived from the underlying apocrine carcinoma, which is a rarely published entity [2, 3]
In a follow-up visit at 4 months postoperatively, there was a possible recurrence of the carcinoma

Summary

Introduction

Scrotal apocrine adenocarcinoma is a rare and insidious malignancy with prolonged clinical course, because of belated diagnosis and its high probability for local recurrence. An apocrine gland carcinoma sometimes can show epidermotropism forming intraepidermal spread which is called pagetoid phenomenon, an uncommon feature. The difference between pagetoid phenomenon and Paget’s disease is that in the former there is an underlying tumor which spreads upwards and infiltrates the epidermis with malignant cells which lie either isolated or in small clusters within the epidermis, whereas in Paget’s disease there is no underlying tumor to begin with. The pagetoid phenomenon is derived from the underlying apocrine carcinoma, which is a rarely published entity [2, 3]

Case Presentation

Findings

Discussion