A 75-year-old man visited with complaints of an ulcerative tumor developing on the suprapubic area. The clinical manifestation was a slow-growing ulcerative nodule without any symptoms for 3 months. He had no specific past history or any physical findings such as enlarged lymph nodes. Physical examination showed a 2 x 2 cm2 nodule with an erythematous ulcerated surface on the suprapubic area (Fig. 1). Chest X-ray and the laboratory test results were normal. Deep biopsy was done on the ulcerating margin of the skin. Histopathologic findings showed marked acanthosis and a well-demarcated tumor area.
Fig. 1. A 2 x 2 cm sized nodule with erythematous ulcerated surface on the suprapubic area.
Some tumor nests were connected to the epidermis and others freely floated without connection to the epidermis (Fig. 2A). When highly magnified, the nest was found to be a mixture of cells with small, relatively regular sized nuclei and cells with large, hyperchromatic atypical nuclei. Some cells had vacuoles in the cytoplasm (Fig. 2B). On immunohistochemistry, the nests showed positivity for PAS and EMA (Fig. 2C, D).
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Fig. 2. (A) Irregular acanthosis and well-defined, various-sized tumor cell nests in the dermis (H&E stain, x 40). (B) Tumor cells have large, hyperchromatic nuclei, atypical mitoses, intracytoplasmic vacuoles and undifferentiated ductular structures (H&E stain, x 400). (C) Positive staining with PAS in tumor cells (PAS stain, x 400). (D) Positive staining with EMA in tumor nest (x 200).