Extramammary Paget's cancer recognizing funicular induration. A case of extramammary Paget's carcinoma recognizing advanced funicular induration in the central scrotum.

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The patient was an 87-year-old male. He noted mild reddening and induration at the flexor base of the penis since the end of December, 1991. It enlarged as a continuous subcutaneous funicular induration of the size of a finger extending from the middle to the lower part of the scrotum. A biopsy was obtained by a local physician in March, 1992, but the pathologist overlooked tumor cells in the epidermis and dermis, and the patient was referred to our department in August, 1992. Examination of biopsy specimens at our department indicated extramammary Paget's carcinoma, but on close examination, no metastasis to other organs was noted, and the CEA value was normal. In September of the same year, extensive resection was performed, followed by split thickness skin grafting. The bilateral shallow and deep inguinal lymph nodes were dissected about 1 month later. In the resected specimen, most of the Paget's cells were arranged in cords from the dermis to subcutaneous tissues, and few Paget's cells were observed in the epidermis. Edema developed in the femoral region from April, 1995, but the CEA level was normal. CT revealed metastasis in para-aortic lymph nodes and common iliac lymph nodes, and radiation therapy was performed.
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