16 GAUGE BELLY BUTTON RING

The patient was an 80-yr old male with a history of lymphoma (in remission), status-post chemotherapy. He gave history of long-standing, non-healing psoriatic area on scrotal skin which recently developed drainage.

The biopsy revealed an infiltrate of malignant intraepidermal tumor cells with signet ring cell morphology. An invasive component was also present in the dermis. The tumor cells were positive for mucicarmine and polyclonal CEA (see following slides) and negative for Melan-A, HMB-45 and CDX-2.

Paget's Disease of the anogenital region may be a primary malignancy derived from the local sweat glands or it may represent an epidermotrophic metastasis from a visceral malignancy such as carcinoma of the rectum, bladder, urethra, or prostate. The patient is undergoing further clinical evaluation at this time.

The patient presented with hilar lymphadenopathy, and no tumor was seen on bronchoscopy. The pulmonologist did a transbronchial fine needle aspiration and obtained innumerable groups of tumor cells, other showing better glandular differentiation than those shown here, including signet ring cells. This slide shows an illustrative juxtaposition of tumor cells and normal nodal lymphocytes in the background. I have no idea what the primary site is, but I would want to look first in the stomach.