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A 65-year-old male had noticed a pruritic eruption on his scrotum about 3 months previously. In spite of initial clinical diagnosis having eczema, topical corticosteroid application was not effective. However, he came to our department after an operation, which was performed due to transverse colonic adenocarcinoma unexpectedly found. Physical examination at that time revealed a flat-elevated, welldemarcated erythema with numerous rice-sized firm papules on his scrotum. Biopsy specimen revealed irregularly-shaped tumor nests or strands both in the epidermis and the dermis. Tumor cells had large, pale cytoplasm with atypical nuclei, and occasionally formed lumina.Immunohistochemical analysis of cytokeratin expression in our case was performed in order to compare with that of primary extramammary Paget's disease. CK20 expression was recognized diffusely in the skin lesion, and focally in the colonic lesion. CK7 expression was also observed focally in the skin lesions. Because primary extramammary Paget's disease showed immunophenotype CK7+/CK20-consistently, immunophenotypes other than CK7+/CK20- in Paget cells suggest underlying regional internal malignancy.
日本皮膚悪性腫瘍学会の論文