DERMATOPATHOLOGY CASES: Self-Assessment Cases: Editor - Dr Sampurna Roy MD

Digital Images of interesting cases that will include the full spectrum of Dermatopathology, presented in the form of quiz.

The answer of the cases include related links and recent abstracts of articles.

Tuesday, December 22, 2009

Answer of Dermatopathology Case 21

Bowen's Disease

Visit: Pathology of Bowen's Disease
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Bowen's disease of the nipple in a young man with AIDS: a case report.Clin Breast Cancer. 2009 Feb;9(1):53-5.
Bowen's disease, or squamous cell carcinoma in situ (SCCIS) of the skin, is a malignant neoplasm restricted to the epidermis, without evidence of dermal invasion. It usually develops in sun-exposed area of skin, but other sites can also be affected. Bowen's disease of the nipple is extremely rare and has thus far been reported only in women. We present the case of Bowen's disease of the nipple in an HIV-positive male patient who presented with a scaly lesion on nipple for one year. He also had past genital infection with human papillomavirus, but he was found to be negative for high-risk subtypes. Biopsy of the lesion revealed SCCIS of the nipple areola complex, with extension into the underlying lactiferous ducts of the breast. There was no evidence of invasive carcinoma. The patient was treated with a simple mastectomy with sentinel lymphnode biopsy. With the advent of highly active antiretroviral treatment, chronicnon-HIV related conditions have become more important, male breast cancer beingone of them. To the best of our knowledge, this is the first reported case in the worldwide literature of Bowen's disease of the nipple in a young immunocompromised male patient. More aggressive therapy in HIV-positive malepatients presenting with precancerous and cancerous breast lesions is recommended.

Expression of p53 and p16 in actinic keratosis, bowenoid actinic keratosis and Bowen's disease.J Eur Acad Dermatol Venereol. 2009 Jun 8.
Introduction Bowen's disease (BD) and bowenoid actinic keratosis (bAK) have traditionally been differentiated according to the presence or absence of dysplasia in the follicular epithelium. p16 has been suggested to be a useful tool to make the differential diagnosis between BD and AK and as a marker of bad prognosis. Materials Five biopsies of BD, five of AK and five of bAK where stained for p53 and p16. Results All lesions showed positive immunostaining of p53, affecting to the lower two thirds of the epidermis in BD and bAK, and only the basal layer in non-bAK. All the BD and bAK cases were positive for p16, showing a similar immunostaining pattern, whereas no staining was observed in non-bAK. Discussion and conclusion These findings suggest a common pathogenicmechanism for BD and bAK. bAK might have worse prognosis than AK. p16 might not be useful as a tool for differential diagnosis between AK and BD because bAK and BD show an extremely similar immunohistochemical pattern. Conflicts of interest None declared.

Immunohistology is valuable in distinguishing between Paget's disease, Bowen's disease and superficial spreading malignant melanoma.Histopathology. 1990 Jun;16(6):583-8.
Thirty-nine lesions, originally diagnosed as Paget's disease (19), superficial spreading melanoma (13) or Bowen's disease (7), were reviewed. Supplementary immunohistochemistry on routine processed tissue, using antibodies to cytokeratins (PKK1 and M717) and to S-100 protein, was carried out. Two of the lesions, originally classified as Bowen's disease and superficial spreading type malignant melanoma respectively, were reclassified as Paget's disease based on the immunohistochemical findings. Both lesions contained pagetoid cells positive with PKK1. The results indicate that immunohistochemistry may sometimes be valuable in establishing the correct diagnosis in such lesions.