Brownish tumor lesion on a cesarean scar

Abstract

A 30-year-old female patient with no significant medical history, other than a Cesarean section performed three years prior, presented to our department with a skin lesion. She reported occasional pain, as well as inflammation and bleeding that coincided with her menstrual cycle. Physical examination of the pubic region revealed a Cesarean section scar. Overlying the scar was a 2 cm tumorous lesion that appeared nodular, was brownish-black in color, had a smooth, shiny surface, and felt firm upon palpation (Photo 1). A punch biopsy was performed for histopathological analysis. This revealed mild epidermal acanthosis and, in the mid- and deep dermis, irregular glands accompanied by a hypercellular stroma with extravasated blood. The classic histology of these glands was observed: a monolayer of columnar basophilic cells with intraluminal erythrocytes, alongside a stroma characterized by marked vascularization, hypercellularity, and hemosiderin-laden macrophages—findings indicative of prior hemorrhages (Photo 2). Additionally, immunohistochemistry showed estrogen receptor positivity in 100% of the nuclei evaluated (Photo 3), while CK7 (cytokeratin) staining was positive, showing expression on the membranes of the glandular cells (Photo 4).