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Bowen's disease: An unusual clinical presentation.

Dandale A, Mantri MD, Thakkar V, Dhurat RS, Ghate S - Indian Dermatol Online J (2014)

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, Maharashtra, India.

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Sir, Bowen's disease is an intra-epidermal squamous cell carcinoma that is carcinoma in situ... On clinical examination, a single painless, minimally scaly, slightly erythematous plaque with a hyperpigmented border of size 2 cm × 0.5 cm was seen on the dorsolateral aspect of the shaft of the penis [Figure 1]... Hence, histopathological examination should be done in all doubtful lesions on the penis to rule out carcinoma in situ... Flattening of the basal layer by nests of cells, Pagetoid cells within the stratum corneum and acinar structures within epidermis are present in Paget's disease while intercellular bridges are visible between cells in Bowen's disease... Immunohistochemistry stains help in distinguishing the two diseases... The neoplastic cells in pagetoid variant of Bowen's disease are negative for cytokeratin 7, carcinoembryonic antigen and gross cystic disease fluid protein 15, whereas the neoplastic cells (Paget's cells) in EPD are positive for them... In a dermoscopic study of Bowen's disease, the characteristic dermoscopic features found were glomerular vessels (90.5%) and a scaly surface (90.5%)... Various treatment modalities used are topical imiquimod cream, topical 5-fluorouracil cream, cryotherapy, surgical excision, curettage and electrocautery and photodynamic therapy (PDT), lasers and topical diclofenac... PDT has been shown to be an effective treatment option for Bowen's disease with 80-95% complete response rates and an excellent cosmetic outcome especially for large lesions.

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Epidermis shows acanthosis with elongation and thickening of the rete ridges with crowding of keratinocyte. Throughout the epidermis, the cells lie in complete disorder, resulting in a “wind-blown” appearance (H and E, ×40)
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Figure 2: Epidermis shows acanthosis with elongation and thickening of the rete ridges with crowding of keratinocyte. Throughout the epidermis, the cells lie in complete disorder, resulting in a “wind-blown” appearance (H and E, ×40)

Mentions: A differential diagnosis of discoid lupus erythematosus, lichen sclerosus et atrophicus and extramammary Paget's (EPD) disease was considered. A biopsy was drawn from the lesion. On histopathological examination, the epidermis showed acanthosis, and elongation and thickening of the rete ridges with crowding of keratinocytes. Throughout the epidermis, the cells were in complete disarray, reflecting a “wind-blown” appearance [Figure 2]. Anisocytosis, loss of polarity and few mitotic figures were seen. The dyskeratotic cells were large, round and had homogeneous, strongly eosinophilic cytoplasm with hyperchromatic nuclei. Basal cell layer and basement membrane were intact [Figure 3]. Dermis showed an inflammatory infiltrate of lymphocytes [Figure 3]. These findings were consistent with Bowen's disease. Surgical excision with a wide margin was done and patient was followed-up for one year with no recurrence til date.


Bowen's disease: An unusual clinical presentation.

Dandale A, Mantri MD, Thakkar V, Dhurat RS, Ghate S - Indian Dermatol Online J (2014)

Epidermis shows acanthosis with elongation and thickening of the rete ridges with crowding of keratinocyte. Throughout the epidermis, the cells lie in complete disorder, resulting in a “wind-blown” appearance (H and E, ×40)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4228663&req=5

Figure 2: Epidermis shows acanthosis with elongation and thickening of the rete ridges with crowding of keratinocyte. Throughout the epidermis, the cells lie in complete disorder, resulting in a “wind-blown” appearance (H and E, ×40)
Mentions: A differential diagnosis of discoid lupus erythematosus, lichen sclerosus et atrophicus and extramammary Paget's (EPD) disease was considered. A biopsy was drawn from the lesion. On histopathological examination, the epidermis showed acanthosis, and elongation and thickening of the rete ridges with crowding of keratinocytes. Throughout the epidermis, the cells were in complete disarray, reflecting a “wind-blown” appearance [Figure 2]. Anisocytosis, loss of polarity and few mitotic figures were seen. The dyskeratotic cells were large, round and had homogeneous, strongly eosinophilic cytoplasm with hyperchromatic nuclei. Basal cell layer and basement membrane were intact [Figure 3]. Dermis showed an inflammatory infiltrate of lymphocytes [Figure 3]. These findings were consistent with Bowen's disease. Surgical excision with a wide margin was done and patient was followed-up for one year with no recurrence til date.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, Maharashtra, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Sir, Bowen's disease is an intra-epidermal squamous cell carcinoma that is carcinoma in situ... On clinical examination, a single painless, minimally scaly, slightly erythematous plaque with a hyperpigmented border of size 2 cm × 0.5 cm was seen on the dorsolateral aspect of the shaft of the penis [Figure 1]... Hence, histopathological examination should be done in all doubtful lesions on the penis to rule out carcinoma in situ... Flattening of the basal layer by nests of cells, Pagetoid cells within the stratum corneum and acinar structures within epidermis are present in Paget's disease while intercellular bridges are visible between cells in Bowen's disease... Immunohistochemistry stains help in distinguishing the two diseases... The neoplastic cells in pagetoid variant of Bowen's disease are negative for cytokeratin 7, carcinoembryonic antigen and gross cystic disease fluid protein 15, whereas the neoplastic cells (Paget's cells) in EPD are positive for them... In a dermoscopic study of Bowen's disease, the characteristic dermoscopic features found were glomerular vessels (90.5%) and a scaly surface (90.5%)... Various treatment modalities used are topical imiquimod cream, topical 5-fluorouracil cream, cryotherapy, surgical excision, curettage and electrocautery and photodynamic therapy (PDT), lasers and topical diclofenac... PDT has been shown to be an effective treatment option for Bowen's disease with 80-95% complete response rates and an excellent cosmetic outcome especially for large lesions.

No MeSH data available.


Related in: MedlinePlus