Rehan Wazir Khawaja, Sabeen Arif
Department of Pathology, AJK Medical College, Muzaffarabad, Pakistan
A 42-year-old Pakistani male presented in surgical Outpatient Department at Abbas Institute of Medical Sciences, Muzaffarabad with history of ulcerated, painful and discharging soft tissue swelling in left groin. The swelling had started from upper border of inguinal ligament and bulges out as mass with skin denudation at the tip along with serosanguinous and puss mixed discharge. He was referred to Pathology Department of AJK Medical College for Fine Needle Aspiration Cytology. He was married 22-years back and has five children. There is positive history of extramarital affairs with known heterosexual partners and commercial sex workers, smoking 1½ pack/day for 22 years and substance (Alcohol, Marijuana) abuse which patient claims that he had quit 2-years back. No foreign travelling or intravenous (I/V) addiction. He was forcedly retired from his job as driver at Deputy Commissioner’s office, Muzaffarabad. He noticed a small ulcerative lesion and swelling in the left inguinal region 12-years back that gradually became painful with increase in size. In these 12-years he received treatments from various medical, surgical specialists and once from a dermatologist at a private clinic in Rawalpindi with temporary relief and with-out significant improvement. Now that the swelling had markedly increased in size with skin ulceration, dis-charge, pain and difficulty walking as the swelling touches his thighs and scrotum. On Examination he is vitally stable with unilateral big swelling in the left inguinal region 10 inches in length starting from upper border of inguinal ligament and bulging out as soft swelling between scrotum and left thigh (Fig.1) with pain, skin ulceration, redness and pus mixed serosanguinous discharge. No other skin or mucosal lesions or lymphadenopathy was observed elsewhere. Rest of systemic examination was normal. Screening for Hepatitis B & C was normal. Laboratory investigations showed normal blood picture, liver and renal functions. Chest x-ray was not significant. Fine Needle Aspiration Cytology was performed with 24 Gauge 5 & 10cc BD Syringe. Three passes were made with scant hemorrhagic aspirate and material was spread on 8 slides. 5 were stained with Haematoxylin and Eosin and 3 with Field Stain and submitted for microscopy.