PMC5301092_01
An extensive erosive erythema with a red, easy-to-bleed nodule on the scrotum (a). Atypical cells mainly proliferated in the dermis forming solid pattern nests (b). Paraffin-embedded tissue samples from the right shoulder were deparaffinized and stained with anti-RANKL antibody (c).
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F1
At his initial visit, physical examination revealed extensive erosive erythema with a red, easy-to-bleed nodule on the scrotum (Fig. 1a). Skin biopsy from the nodule revealed tumor cells mainly proliferating in the dermis, forming solid pattern nests and upward pagetoid epidermal migration (Fig. 1b). Immunohistochemical staining revealed that these tumor cells were positive for CK7, gross cystic disease fluid protein (GCDFP)-15, receptor activator of nuclear factor kappa-B ligand (RANKL) (Fig. 1c), and MMP7 and negative for CK20 and CDX2.
T1-weighted MRI before the treatment (a). Physical examination revealed that all primary tumors had disappeared (b). T1-weighted MRI after the treatment (c).
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F2
Since magnetic resonance imaging (MRI) revealed that the tumor mass developed adjacent to the urethra (Fig. 2a), we consulted an urologist and found that the tumor infiltrated into the urethra, corpus cavernosum of the penis, and testis. Two months after administrating this combination therapy, all primary tumors had disappeared histologically (primary site) (Fig. 2b) and on the MRI (Fig. 2c).