A 71-year-old man visited our hospital with a raised nodular mass of size 2×3×1 cm in his left groin and an erythematous area of 9×10 cm over the left groin (). He had first noticed the erythema and nodules 6 months before he visited our hospital. The erythema had gradually expanded in size. Ulceration with intermittent bleeding was noted within the nodular mass. On physical examination, edema of the left leg was observed, and lymph nodes in both inguinal regions were palpable. The results of routine hematological and biochemical examinations were normal. Examination of skin biopsies from the inguinal folds revealed features of EMPD in the epidermis and underlying glandular neoplastic foci in the reticular dermis and in the subcutaneous adipose tissue (). Moreover, focal angiovascular invasion was noted. Typical Paget cells were scattered in the epidermis (). The glandular neoplastic foci resembled carcinoma in situ. Some foci showed accumulation of secretion in central regions (). The tumor cells exhibited abundant eosinophilic cytoplasm and large vesicular nuclei.\nThe tumor and Paget cells showed strong positive immunohistochemical staining for carcinoembryonic antigen (CEA), epithelial membrane antigen, cytokeratin 7 (CK7), and gross cystic disease fluid protein-15 (GCDFP-15) () but were negative for melanin-A, S-100, and CK20 (). The patient was diagnosed with apocrine carcinoma related with extensive EMPD. Chest radiography, abdomino-pelvic computed tomography (CT), a gallium scan, a bone scan, and positron emission tomography-CT were performed to exclude the presence of internal malignancy. The results showed multiple lung, bone, and lymph node metastases. After consultation with a urologist and a surgeon, we concluded that this patient was inoperable, and opted for conservative treatment; however, the patient refused any treatment.
A 70-year-old male noticed a swelling near the the left canthus since one-and-a-half years. The swelling was gradually increasing in size. On examination, a raised, freely mobile, firm skin mass of approximately 3.0 × 2.5 cm was present on the lateral canthal region on the left eye . The patient's extraocular eye movements were unaffected. Examination revealed no other suspicious skin lesions or palpable lymph nodes. The case was clinically diagnosed as fibroma. Excision biopsy was done and the specimen was sent for histopathological examination. Gross examination revealed a well-circumscribed, spherical soft tissue mass, partially skin covered, measuring 2 cm in diameter. The cut surface of the tumor had a gray-brown gelatinous appearance []. Microscopically, the sections revealed a tumor in the dermis composed of tumor cells arranged in nests, glands, and cribriform patterns []. The individual tumor cells were columnar and had a hyperchromatic nucleus. The cells were seen floating in large pools of mucin separated by thin fibrovascular septa []. The mucin was periodic acid schiff (PAS) positive and diastase-resistant. [] Further investigations, including a colonoscopy, ultrasonographic examination of the abdomen, and computerized tomography (CT) scans of the chest, abdomen, and pelvis were found to be normal. Thus, the lesion in the skin was reported to be PMC of the skin.