PMC8599444_01
A 67-year-old patient with EMPD. An ulcerative and eczematous lesion was shown on his left scrotum (A). A lesion with irregular margin ( ) was found at his left scrotum in T2WI fat-suppressed sequences of MR (B). Scattered epidermal Paget cells with a pleomorphic and hyperchromatic nucleus and abundant clear cytoplasm were located throughout the epidermis in nest-like structures in histopathologic examination of the excised specimen (x200; H&E stain) (C). In the preoperative conventional US, a 3.6 x 2.9 x 1.4 cm lesion on the left side scrotal wall appeared to be hypoechogenicity, infiltrative margin, and presence of profuse vascularity (D, E). Elastography showed blue color in and around the lesion, which was valued to be hard in a score of 4 (F). The preoperative CEUS showed hyper-enhancement ( ) in the main part and non-enhancement (*) in the superficial area of the lesion (G), which was larger than that shown in the conventional US. In the upper part of the lesion (H), the green line represents the upper boundary confirmed by the conventional US, and the red line represents the upper boundary confirmed by CEUS. In the lower part of the lesion (I), the green line represents the lower boundary confirmed by the conventional US, and the red line represents the lower boundary confirmed by CEUS.
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f1
Hard and diffuse eczematous changes and ulcerations were revealed on his left scrotum by physical examination ( Figure 1 ).