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Pigmented Bowen's disease and review of 420 Bowen's disease lesions.

Pigmented Bowen's disease is rare. We report an unusual case of pigmented Bowen's disease of the ring finger, which clinically presented as a superficial, spreading melanoma. Records of 420 lesions of Bowen's disease were reviewed; 7 lesions (1.67%) were pigmented and all occurred outside the anogenital area. We conclude that Bowen's disease should be considered in the differential diagnosis of pigmented lesions.

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Human papillomaviruses of the mucosal type are present in some cases of extragenital Bowen's disease.

BACKGROUND: Bowen's disease in the genital area is generally considered to be caused by mucosal high-risk human papillomaviruses (HPVs). However, the detection rate and spectrum of HPVs in extragenital Bowen's disease are various and it is not clear to what extent HPV is involved in its pathogenesis. OBJECTIVES: To assess the degree of association of HPV in extragenital cases by examining detection rates, types, quantities and localization of HPV. METHODS: A polymerase chain reaction (PCR) approach that we had previously established, which can give sensitive detection of a broad range of HPVs from cutaneous [including epidermodysplasia verruciformis-related HPVs (EV-HPVs)] to mucosal HPVs, was applied to samples from 41 patients with extragenital Bowen's disease and normal skin samples from 48 individuals. Semiquantitative L1-PCR and tyramide-based in situ hybridization (ISH) were also employed for positive cases. RESULTS: HPVs belonging to the mucosal high-risk group were detected in three patients with Bowen's disease (7%; two HPV 16 and one HPV 33), with 10(1)-10(3) copy equivalents per diploid amount of cellular DNA. They were distributed among most nuclei of tumour cells but in none of the cells of adjacent normal skin. HPVs belonging to the cutaneous group were detected in two patients (5%; HPV 27 and HPV 76) at 10(-2)-10(-3) copy equivalents, the same level as in a normal skin specimen positive for type 23 EV-HPV. No positive signals were observed by ISH. CONCLUSIONS: HPVs belonging to the mucosal high-risk group may participate in the development of extragenital Bowen's disease.

Aged↗

Correlation of p16 and pRb expression with HPV detection in Bowen's disease.

BACKGROUND: Bowen's disease is a form of cutaneous squamous cell carcinoma which may be caused by ultraviolet radiation, human papilloma virus (HPV) infection, or other causes. Although p16 over-expression is a surrogate marker of HPV E7-mediated catabolism of pRb in premalignant and malignant lesions of the cervical mucosa, the correlation of p16 and pRb expression with HPV detection in Bowen's disease has not been well characterized. METHODS: A retrospective study on formalin-fixed tissues was performed. Immunohistochemistry for p16 and pRb was performed on 32 cases. DNA was successfully extracted from 20 cases, and polymerase chain reaction was performed to amplify a highly conserved region of the HPV L1 open reading frame. RESULTS: Twenty-eight of 32 (88%) cases showed strong diffuse staining for p16 but were negative for pRb; two of 32 cases (6%) were negative for p16 but were diffusely positive for pRb; one case was strongly positive for both p16 and pRb, and one case was negative for both p16 and pRb. Three of 20 cases (15%) contained HPV DNA. All three of these cases showed strong p16 expression and lack of pRb staining. CONCLUSIONS: Most cases of Bowen's disease strongly express p16 but not pRb. In contrast to HPV-associated lesions of the cervical mucosa, p16 overexpression in cutaneous Bowen's disease appears to be unrelated to HPV status. The p16 overexpression in Bowen's disease may reflect disruption of the G1/S checkpoint, resulting in unregulated cell cycle progression.

Adult↗

Disseminated porokeratosis accompanying multicentric Bowen's disease. Characterization of porokeratotic lesions progressing to Bowen's disease.

Multicentric Bowen's disease developed in a 73-year-old man in areas involved with disseminated porokeratosis. The porokeratotic lesions were brownish; some were small and solitary, and others were coalesced and of variable size. Some lesions were erythematous. The histologic findings of the small, solitary or brownish, coalesced lesions were those of porokeratosis without apparent dysplasia; however, the erythematous coalesced lesions revealed epidermal dysplasia. Study revealed DNA ploidy abnormalities in the epidermal cells of these porokeratotic skin lesions. The skin lesions progressed in their degree of DNA ploidy abnormality from small solitary lesions to brownish coalesced ones and further to erythematous, coalesced ones. These observations suggest the direct and sequential growth of potentially malignant neoplastic clones in the patient's porokeratotic skin lesions and explain the multicentric development of Bowen's disease.

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Bowen's disease with invasive adnexal carcinoma: the pluripotential nature of Bowen's disease cells.

Bowen's disease rarely exhibits multiple combinations of premalignant and/or malignant skin lesions. Bowen's disease with invasive adnexal carcinoma was originally described by Kao, but is not well recognized by clinicians due to its rarity and lack of specific clinical features of this condition. Herein, we describe three unusual cases of Bowen's disease with invasive adnexal carcinoma. The two distinct neoplastic areas exhibited continuity both clinically and histologically. The plaque lesions possessed clinical features typical of Bowen's disease. In cases 1 and 3, we confirmed the adnexal tumor within tumors of Bowen's disease, the diagnosis of which is eccrine porocarcinoma. The tumor in case 2 was characteristic to trichilemmal carcinoma. Immunohistochemically, the tumor cells of Bowen's disease and the adnexal carcinoma differed in antigenicities. The present cases support a notion that Bowen's disease maintains a pluripotential nature.

Acrospiroma↗

Bilateral Bowen's disease.

Multiple Bowen's disease may be difficult to differentiate from bowenoid papulosis because of its clinicopathological resemblance to bowenoid papulosis. We experienced a case of bilaterally and symmetrically developed multiple bowenoid lesions in a 71-year-old man previously diagnosed as having chronic lymphocytic lymphoma (CLL). Based on histological findings and the results of human papillomavirus examinations, we finally diagnosed this case as bilateral Bowen's disease. We speculate that the underlying immunosuppressive state due to CLL may have been associated with onset of the disease. We report the unique clinical picture, the differential diagnosis and the aetiology.

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CD1a+, CD3+, CD4+, CD8+, CD68+ and cutaneous lymphocyte-associated antigen-positive cells in Bowen's disease.

BACKGROUND: Bowen's disease (BD) is a squamous cell carcinoma in situ that rarely invades into the underlying dermis. However, little is known about its immunohistology. Objectives To evaluate the relationship between the cytological properties of the tumour cells in BD and the host immune response. METHODS: We examined the expression of p53, proliferating cell nuclear antigen (PCNA) and Ki67 antigen, and the number of mitotic cells, together with the number of intratumoral and dermal infiltrating CD1a+, CD3+, CD4+, CD8+, CD68+ and cutaneous lymphocyte-associated antigen (CLA)+ cells in 18 cases of genital BD. RESULTS: When compared with normal genital skin (n = 10), there was a significantly higher number of mitotic cells as well as higher expression of p53+, PCNA+ and Ki67+ cells in BD. There was significant mutual correlation between CD3+, CD4+ and CD68+ cells in the tumoral epidermis. The number of CD1a+ Langerhans cells significantly decreased in BD epidermis; however, dermal CD1a+ cells were increased. Interestingly, numbers of dermal CD1a+ cells significantly correlated with those of intratumoral CD3+, CD4+ and CD68+ cells. In situ hybridization for human papillomavirus (HPV) demonstrated that HPV-infected BD had significantly less infiltration of intratumoral CD3+ cells and CLA+ cells. CONCLUSIONS: The present data suggest that dermal CD1a+ cells may participate in the immune surveillance and that HPV infection may interfere with the intratumoral infiltration of CLA+ cells in BD.

Antibody Formation↗