Bowenoid Changes Research Articles

Mycosis fungoides with plantar involvement and bowenoid changes

Mycosis fungoides with plantar involvement and bowenoid changes

Epidermotropic pagetoid spread and squamous cell carcinoma in situ in the overlying epidermis of Merkel cell carcinoma

Sir, A 71-year-old female visited the Department of Dermatology at Tokyo Metropolitan Bokuto Hospital, complaining of a nodule in the face. She was diagnosed as Merkel cell carcinoma by a skin biopsy in another clinic, and referred to our hospital for operation. A physical examination revealed a dome-shaped reddish nodule, sized 1-cm in diameter, in the center of the left cheek. Cervical lymph nodes were not palpable. The nodule was totally removed with a margin. Histological examination revealed the tumor nests extending from the dermoepidermal junction into the deep dermis. The tumor cells had uniform small round or spindle-shape cells with hyperchromatic nuclei and numerous mitoses, which were consistent with Merkel cell carcinoma (Fig. 1, 2). Tumor cells were immunoreactive for neuron-specific enolase (NSE). Also, tumor nests were scattered within the overlying epidermis (Fig. 3). In addition, bowenoid changes were recognized within the overlying epidermis or at the border of MCC, showing many atypical disarrayed cells and clusters of large hyperchromatic nuclei (Fig. 4). EPIDERMOTROPIC PAGETOID SPREAD AND SQUAMOUS CELL CARCINOMA IN SITU IN THE OVERLYING EPIDERMIS OF MERKEL CELL CARCINOMA

Bowen's disease with high telomerase activity

We describe an 81-year-old Japanese woman who had a palm-sized, erythematous plaque with a nodular lesion on the lateral abdomen. The biopsy specimens taken from the erythematous plaque and reddish nodule show that bowenoid changes were present in the epidermis and epidermis to dermis, respectively. A sentinel lymph node biopsy (SNB) was performed with blue dye and radioisotope in her right groin region and two lymph nodes were found to be occupied by many atypical cells. The erythematous plaque with nodular lesion was completely removed with a 3-cm margin under general anesthesia, and complete regional lymph node dissection was also performed. In addition, high telomerase activity was seen in the erythema plaque while using a telomeric repeat amplification protocol assay. In conclusion, some instances of Bowen's disease might have high telomerase activity in the atypical cells and can progress to Bowen's carcinoma. The SNB was regarded as a useful method to detect early lymph node metastases in this case.

Nudging Epidermal Field Cancerogenesis by Imiquimod

Background: The coexistence of malignancies close to each other on the skin has been occasionally reported. The concept of field cancerogenesis applies to such cases. Given the purported mechanism of action of imiquimod, it should not be surprising that this treatment could inhibit epidermal field cancerogenesis. Aim: To assess the effect of imiquimod applied twice weekly on incipient bowenoid changes disclosed in the vicinity of basal cell carcinomas. Materials and Method: Biopsies were taken before treatment and after 4–6 weeks and 12 weeks of imiquimod treatment. Results: Large atypical bowenoid keratinocytes and dyskeratotic cells were cleared in time while factor-XIIIa-positive dermal dendrocytes appeared boosted and admixed with a brisk lymphocytic infiltration. Conclusion: Epidermal field cancerogenesis appears to be controlled by imiquimod. Dermal dendrocytes might play a pivotal role in this regression phenomenon.

5-Fluorouracil iontophoretic therapy for Bowen's disease

Topical 5-fluorouracil (5-FU) is an accepted therapy for Bowen's disease. Recurrences with this method have been attributed to deep follicular involvement and poor patient compliance because of the prolonged treatment time required. We sought to determine whether iontophoresis of 5-FU is an effective therapy for Bowen's disease. Twenty-six patients with biopsy-proven Bowen's disease received eight 5-FU iontophoretic treatments in 4 weeks. Local excision was done 3 months after the last treatment. The specimens were step-sectioned and evaluated for any histologic evidence of bowenoid changes. Only 1 of 26 patients showed histologic evidence of Bowen's disease 3 months after treatment. 5-FU iontophoresis appears to be a safe, effective, and well-tolerated therapy for Bowen's disease.

Ｂｏｗｅｎ病病変部に生じた小結節がＭｅｒｋｅｌ ｃｅｌｌ ｃａｒｃｉｎｏｍａであった１例

A 82-year-old male patient with Merkel cell carcinoma (MCC) associated with Bowen's disease was reported. The patient developed a clearly demarcated tumor 14×17×3mm which has erythematous plaque 22×30mm at the flexor surface of the right thigh. Histologically, the epidermis showed Bowenoid changes. There were tumor nests consisting of round and oval cells in the dermis. Atypical nuclei and mitoses were markedly seen, with a trabecular pattern. Immunohistochemistry revealed positivity to NSE. Electron microscopically, dense core granules and intermediate filaments were observed. Based on these findings, the diagnosis was made.

Bowenoid change in association with graft-versus-host disease: A cyclosporine toxicity?

dex finger (Fig. 2, B) was biopsied to exclude infection. The cyclosporine whole blood level had fallen to 1405 ng/ml by fluorescence polarization immunoassay. During the next 4 weeks, the patient's eruption became scaly and hyperpigmented and a third skin biopsy specimen was obtained. After his first biopsy showed GVHD, he was treated with high-dose systemic corticosteroids but his condition progressively deteriorated and he died 8 weeks after receiving the BMT. Light microscopic examination of the original skin biopsy specimen (Fig. 2, A) revealed acute GVHD (grade 1)7 accompanied by marked epithelial dysplasia resembling Bowen's disease (bowenoid changes) that included the following: (l) mitoses (some atypical) above the basal layer; (2) peculiar large, vacuolated squamous cells similar to those seen in Bowen's disease; (3) numerous dyskeratotic cells above the basal layer; (4) loss of orderly polarity in the lower half of the epidermis; (5) acanthosis; and (6) variation in the size and shape of keratinocytes in the basal and spinous layers of the epidermis. Full-thickness atypia as in typical Bowen's disease was not present. A biopsy specimen obtained I day after cyc1osporinewas withheld (Fig. 2, B) showed acute GVHD (grade 3)7 with mild epithelial dysplasia and regenerative changes in the lower epidermis. Examination of the skin biopsy specimen Fig. 1. Acute GVHD. Forearm of patient shows macular erythematous eruption on day 11 after BMT. Cyclosporine whole blood levels were at their highest (1529 ng/rnl).

Development of human papillomavirus-associated Buschke-Löwenstein penile carcinoma during cyclosporine therapy for generalized pustular psoriasis

Buschke-Lowenstein-type giant penile condyloma developed in a human immunodeficiency virus-negative, 25-year-old man after 4 years of intermittent cyclosporine therapy (5 mg/kg/day) for pustular psoriasis. Microscopic examination showed multifocal areas of invasive squamous cell carcinoma. Dot blot analysis of amplified polymerase chain reaction products with primers directed at the LI region demonstrated signals for several human papillomavirus genotypes, including human papillomavirus type 16, that correlated with different histologic patterns consisting of verrucous and bowenoid changes and invasive carcinoma. This case conforms to the enhanced risk of cutaneous carcinogenesis from either papillomavirus infection or chronic actinic damage that has become evident in patients with organ allografts and cyclosporine therapy.

Development of human papillomavirus-associated Buschke-Löwenstein penile carcinoma during cyclosporine therapy for generalized pustular psoriasis

Buschke-Löwenstein-type giant penile condyloma developed in a human immunodeficiency virus-negative, 25-year-old man after 4 years of intermittent cyclosporine therapy (5 mg/kg/day) for pustular psoriasis. Microscopic examination showed multifocal areas of invasive squamous cell carcinoma. Dot blot analysis of amplified polymerase chain reaction products with primers directed at the L1 region demonstrated signals for several human papillomavirus genotypes, including human papillomavirus type 16, that correlated with different histologic patterns consisting of verrucous and bowenoid changes and invasive carcinoma. This case conforms to the enhanced risk of cutaneous carcinogenesis from either papillomavirus infection or chronic actinic damage that has become evident in patients with organ allografts and cyclosporine therapy.

Seborrheic keratosis-like lesions in epidermodysplasia verruciformis.

A light microscopic study of 6 verrucous lesions with clinical features of seborrheic keratoses (SK) occurring on sun-exposed skin of 4 patients with epidermodysplasia verruciformis (EV) was performed. We observed the typical histological findings of SK in all cases. In addition, koilocytotic effects suggestive of EV were observed in the upper prickle layer and stratum granulosum. In 2 lesions, we also noted bowenoid changes suggesting possible early malignant transformation. Immunohistochemical study confirmed the presence of HPV in these lesions.

Large-cell acanthoma is a distinctive condition.

We have studied the clinical and histopathologic features of 44 biopsy specimens of large-cell acanthoma (LCA) from 35 patients. There were 19 women and 16 men, 34-88 years of age (mean 75). The lesions were mainly located on the head and extremities, usually solitary, less than or equal to 10 mm in diameter, and of greater than or equal to 1 year's duration. However, there were also cases of multiple and larger lesions, and those of shorter duration. The most frequently offered clinical diagnoses were seborrheic keratosis, Bowen's disease, and LCA; two cases had the clinical features of stucco keratosis. Histologically, 41 of the specimens could be classified into three patterns: 16 lesions showed a basic pattern (mild to moderate acanthosis, hyperkeratosis, large cytoplasms and nuclei, hyperpigmentation, and bulbous rete ridges); 12 specimens showed a verrucous pattern (papillomatosis and hyperkeratosis resembling church spires); and 13 lesions exhibited a flat-hyperkeratotic pattern (compact hyperkeratosis arranged in horizontal layers of corneocytes lying on a band-like acanthotic stratum malpighii that lacks both rete ridges and papillae). Some cases exhibiting this latter pattern showed focal bowenoid changes. Some mixed and intermediate lesions demonstrated the existence of a spectrum. We have concluded that LCA is a distinctive condition with various stages of development and is probably related to stucco keratosis. It can clearly be separated histologically from solar lentigo and from solar keratosis. As other epidermal tumors, LCA can sometimes exhibit features of Bowen's disease.

Early dermato‐pathological signs during bath‐puva therapy

The combination of trioxsalen bath and long-wave UV-A is used in dermatology to treat selected patients with psoriasis. Such treatment induces side effects whose clinical aspects have already been described. We report the histological aspects of these lesions. The most striking features occur in the epidermis, where we found vacuolar alterations, disorganization of the stratum malpighi, necrotic cells, and Bowenoid changes. Langerhans cells are reduced in number, and melanocytes may become large and atypical. In addition, factor XIIIa-positive dendrocytes of the superficial dermis increase in size, and some of them migrate into the epidermis, which is a rare location for these cells.

Occupational risk and the development of premalignant skin lesions among paraquat manufacturers.

The objective of this study was to determine the prevalence rate and possible aetiological factors of premalignant skin lesions observed among paraquat manufacturers. A total of 228 workers in 28 factories were interviewed and independently examined by a dermatologist during site inspection in 1985. Information concerning past working experience, current toxic exposures, other risk factors of hyperpigmented macules and keratosis, and the past and present manufacturing processes of each factory was collected. Sixty nine cases of hyperpigmented macules and 17 of hyperkeratosis were found. Typical macules were irregular in shape, pin head size, hyperpigmented, with or without hyperkeratosis, and usually distributed symmetrically over the forearms, hands, neck, and upper chest, where exposure to sunlight was maximal. Six patients with hyperkeratotic lesions subsequently had biopsies performed and two showed Bowenoid changes. Eighty per cent (28 cases) and 67% (38 cases) of workers developed hyperpigmented macules if they had ever been engaged in bipyridine centrifugation and crystallisation, respectively; there were three workers 3% with such lesions among those who performed packaging or administrative jobs, or both. There was a significant trend (p less than 0.0001) for workers to develop hyperpigmented macules and hyperkeratosis the longer they had been exposed to centrifugation or crystallisation, or both, independent of age and the duration of exposure to sunlight. Evidence is presented to suggest that sunlight is a necessary cofactor and that the aetiological agent was produced during high temperature sodium process of bipyridine synthesis, and possibly bipyridine isomer(s).

Merkel cell carcinoma

A 82-year-old male patient with Merkel cell carcinoma (MCC) associated with Bowen's disease was reported. The patient developed a clearly demarcated tumor 14×17×3mm which has erythematous plaque 22×30mm at the flexor surface of the right thigh. Histologically, the epidermis showed Bowenoid changes. There were tumor nests consisting of round and oval cells in the dermis. Atypical nuclei and mitoses were markedly seen, with a trabecular pattern. Immunohistochemistry revealed positivity to NSE. Electron microscopically, dense core granules and intermediate filaments were observed. Based on these findings, the diagnosis was made.