Inguinal ulcerated sebaceous carcinoma: an unusual presentation
A 63-year-old male patient, with a two-year history of painful inguinal mass,\nprogressively increasing in volume. Subsequently, the inguinal mass to the left\nfistulized and the ulcerated lesion grew, reaching 12cm. The pathological background\nincluded reports of pulmonary tuberculosis treated 15 years before. The physical\nexamination revealed an ulcer in the left inguinal region with malodorous and purulent\nexudate containing live larvae; hard right inguinal lymph node, adhered to deep plans,\nalong with multiple yellowish papules in the posterior region of the penis ( and ). Serology tests were carried out for syphilis, HIV and Chlamydia\ntrachomatis, as well as screening for acid-alcohol-resistant bacilli and a\nPPD exam, and all the tests were negative. A histology of the ulcer's border revealed\natypical cells with prominent nucleoli, eosinophilic cytoplasm with multiple\nmicro-vacuolizations and atypical mitoses ( and ). A Sudan III test showed\nvacuoles containing fat inside the tumoral cells (). The immunohistochemical exam came back positive for the epithelial\nmembrane antigen (EMA) and CK-7. The EMA revealed transmembrane positivity in sebaceous\ncells (). The biopsies of the papules\nlocated on the penis and the right lymph node, revealed the presence of atypical cells\nwith similar characteristics. Thus, our diagnostic conclusion was moderately\ndifferentiated sebaceous carcinoma with lymphatic and skin of the penis metastases as\nwell as secondary myiasis associated with the ulceration brought about by sebaceous\ncarcinoma. An investigation was conducted to check for Muir-Torre syndrome. A complete\ncolonoscopy, thorax radiograph and urine analysis did not show any pathological\nalterations. The possibility of neoplasias in other organs was explored and then\ndiscarded. However, the abdominal and pelvic computerized axial tomography showed\nextensive damage to retroperitoneal lymphatic chains and multiple contralateral inguinal\nadenopathies and the tumor inside the deep muscular plan.