摘要
患者男,71岁。阴囊右侧皮肤肿物1年余,阴囊水肿1个月。皮肤科检查:阴囊右侧可见5 cm×4 cm乳头瘤样增生性肿块,界限清楚,中央潮红、糜烂,伴白色分泌物,部分区域上覆秽黄色厚痂及米粒至绿豆大薄壁水疱,触之易出血,基底及周围有浸润感,质硬,阴阜可见散在米粒大浸润性暗红色丘疹,阴囊及阴茎明显水肿。皮损组织病理:表皮内Paget细胞团,真皮内可见浸润的肿瘤细胞,免疫组化示细胞角蛋白(CK)7及巨囊性病液体蛋白(GCDFP)-15阳性,CK20阴性。辅助检查:PET-CT示左颈部淋巴结、双肺门、纵膈、腹膜后、盆腔及左髂骨转移可能。诊断:乳房外Paget’s病伴多发转移。治疗:至成形科行右侧阴囊病变扩大切除、左侧腹股沟淋巴结部分清扫术,目前正在术后放疗中。
A case of right scrotal extramammary Paget’s disease with multiple metastases is reported.A 71-year-old male presented with a right scrotal skin mass for more than 1 year and scrotal edema for 1 month.Dermatological examination showed a 5 cm×4 cm papilloma-like hyperplastic mass in the right scrotum with clear boundaries,flushing and erosion in the center,and white discharge.The lesion was partially covered with obscene yellow thick crust and thin-walled blisters of ricegrain to green bean size,and bled easily when touched,with a hard texture and infiltration at the base and the surrounding area.Rice-grain large infiltrative dark red papules were scattered in the scrotal mound and obvious edema was observed in the scrotum and penis without pressure pain.Histopathological examination revealed Paget cell mass in the epidermis and infiltrating carcinoma in the dermis.Immunohistochemistry showed tumor cells were positive for CK7 and giant cystic disease fluid protein(GCDFP)-15,and negative for CK20.PET-CT showed possible retroperitoneal,pelvic,bilateral hilar,mediastinal,left cervical lymph nodes,and left iliac bone metastasis.The diagnosis of extramammary Paget’s disease with multiple metastases was made.Enlarged resection of the right scrotal lesion and partial dissection of the left inguinal lymph nodes were performed.The patient is currently undergoing postoperative radiotherapy.
作者
李婷婷
杨欣
张公杰
张芊
关欣
王文慧
张春雷
郭金竹
LI Ting-ting;YANG Xin;ZHANG Gong-jie;ZHANG Qian;GUAN Xin;WANG Wen-hui;ZHANG Chun-lei;GUO Jin-zhu(Department of Dermatology,Peking University Third Hospital,Bejing 100191,China;Department of Plastic Surgery,Peking University Third Hospital,Beijing 100191,China)
出处
《临床皮肤科杂志》
CAS
CSCD
北大核心
2022年第12期728-731,共4页
Journal of Clinical Dermatology
