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Case Reports

Abstract

Adenosquamous carcinoma (ASC) of the scrotum is a rare and aggressive malignancy with no established staging criteria.  We present an unusual case of scrotal ASC in a 68-year-old male with a complex medical history, including ileocolonic Crohn’s disease (status post bowel resection in 2000) and p16-positive anal squamous cell carcinoma (T4N1) diagnosed in 2023.  The patient underwent chemoradiation therapy, complicated by radiation burns involving the buttocks, penis and scrotum. Subsequently, the patient presented with a 1-2 cm ulcerated nodule on the midline scrotum, excised in 2024. Histopathologic examination revealed an invasive carcinoma with both squamous and mucinous morphologic features consistent with adenosquamous carcinoma.  Intralesional mucin was confirmed with mucicarmine and PAS-diastase stains.  Multifocal lymphovascular and perineural invasion were identified.  Immunohistochemistry showed strong positivity for p16 and p40, supporting HPV-related squamous differentiation.  This rare case of scrotal adenosquamous carcinoma arising in the setting of Crohn’s disease, HPV-associated anal squamous cell carcinoma and pelvic chemoradiation, suggests a multifactorial etiology including both HPV-infection and radiation exposure.  Furthermore, it emphasizes the need for close clinical surveillance and early intervention in high-risk patients.