Qap (Anatomical Pathology) 

QAP Peer Review

AP181
Case History: M/72 Scrotal skin lesion, frozen section
Intended diagnosis: Extramammary Paget's disease. Contributed by:USK
Code Diagnosis Comment Score
anonymous Extramammary Paget's disease (100%) Immunostains for cam 5.2, EMA and monoclonoal CEA to confirm diagnosis. Stains for melanocytic markers (S100 and HMB45) to exclude melanoma.  100
anonymous Bowen disease nil  50
anonymous Frozen section diagnosis: positive for lesion, await paraffin section for definitive diagnosis. Differentials include extramammary Paget's disease and malignant melanoma. Special stains to confirm Paget's (mucin, pCEA, Cam 5.2) Immunos to rule out melanoma (S-100 protein and HMB45)  80
anonymous Extramammary Paget's disease Confirm by immunostaining for Cam5.2 (+). Also exclude malignant melanoma (Cam5.2 negative, S100 positive) and Pagetoid Bowen's disease (Cam5.2 negative)  100
anonymous Suspicious cells consistent with extramammary Paget's disease. 100% To correlate with clinical findings eg any underlying carcinoma such as rectal carcinoma. Immunostains: S100 to rule out melanoma. Paget's disease should be +ve for CAM5.2 and CEA.  100
anonymous Extramammary Paget's disease. (100%) Nil.  100
anonymous Scrotal skin - Extramammary Paget's disease 100% To be supported by positive stains for mucin and CEA.  100
anonymous Malignant cells in dermo-epidermal junction and dermis (100%), defer for paraffin for definitive diagnosis. DD'x include 1) Extramammary Paget's disease, Bowen's disease and 3) melanocytic neoplasm. IH panel : CAM5.2 (for Paget's cells), Cytokeratins (for Bowenoid cells) and S100/HMB45 (for melanoma/melanocytic cells).  100
anonymous Malignant tumor: 1) extramammary Paget's disease? 2) Superficial spreading malignant melanoma? nil  50
anonymous EXTRAMAMMARY PAGET'S DISEASE (100%) nil  100
anonymous Paget's disease 100% Cam 5.2, CK7/20 to confirm BRST-2 to support primary appendageal origin S100/HMB45 to exclude melanoma LCA to exclude lymphoma  100
anonymous Extramammary Paget’s disease Suggest excluding underlying genital malignancy  100
anonymous Paget’s disease, extramammary. Probability: 100% nil  100
anonymous Extramammary Paget's disease (90%), Bowen'sdisease (10%) Extramammary Paget's disease can be confirmed by performing mucin stain and immunostains for CEA and EMA; Bowen's disease is negative.  100
anonymous Extramammary Paget's disease (100%) S-100 protein to exclude melanoma.  100