Pathology
Images
Atlas of dermatopathology
Josef Feit, Hana Jedličková, Günter Burg, Luděk Matyska, Spasoje Radovanovic et al.
Index
Contents
Authors
ExpSys: non-tumors
ExpSys: tumors
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+ Introduction
+ Literature
+ Support
+ Skin biopsy
+ Non-tumorous skin diseases
+ Skin tumors
+ Cysts of the skin and subcutis
+ Soft tissue lesions
+ Some lesions of the oral cavity
+ Dermatovenerology
+ Collection of histological slides by prof. Günter Burg
+ Collection of histological slides by prof. Werner Kempf
+ Collection of histological slides of dr. Ram Chandra Adhikari
Bowen's intraepidermal carcinoma
Clinical signs
  • location: anywhere
  • flat, laterally spreading lesions
  • color: pink or red, sometimes with melanin pigmentation
  • scaling, sometimes crusts

Morbus Bowen (977)

Pictures

Morbus Bowen, detail: Bowen's disease, Clinical picture (977)

Morbus Bowen, calf: Bowen's disease, Clinical picture (978)

Morbus Bowen, temple: Bowen's disease, Clinical picture (979)

Multiple foci of Bowen's disease, changing into squamous cell carcinoma: Spinalioma, Clinical picture (983)

Further examples of Bowen's carcinoma:

Histology

Dysplastic epithelium of high mitotic activity, usually within the full thickness of the epidermis, but the changes are sometimes less pronounced within the basal layer. Parakeratosis, hyperkeratosis, spread into the epithelium of hair follicles and sweat glands. After some time infiltrative growth.

Epidermis is often acanthotic and thickened. Malignant keratinocytes are sometimes pale (glycogen) and may form variable, usually irregular nests within the epidermis.

Morbus Bowen (3569)

Morbus Bowen (10759)

Pictures

Bowen's intraepidermal carcinoma: Bowen's carcinoma, HE 20x (1944)

Another case: Bowen's carcinoma, HE 40x (1946)

Another case: Bowen's carcinoma, HE 20x (2614) Bowen's carcinoma, HE 100x (2613)

Another case: Bowen's carcinoma, HE 40x (2831)

Another case: Bowen's carcinoma, ear, HE 20x (5997)

Another case: Bowen's carcinoma, HE 40x (2615)

Another case: Bowen's carcinoma, HE 60x (12025)

Another case: Bowen's carcinoma, HE 40x (12801)

Another case: Bowen's carcinoma, HE 40x (12802)

Another case: M. Bowen, HE 60x (10759) M. Bowen, HE 60x (10760)

Another case: Bowen's carcinoma, HE 60x (10789) Bowen's carcinoma, HE 60x (10790)

Another case: Bowen's carcinoma, HE 60x (14037)

Hypertrophic m. Bowen: M. Bowen, hypertrophic, HE 40x (12656)

Bowen's intraepidermal carcinoma, clear cells: Bowen's intraepidermal carcioma, clear cell variant, HE 2.5x (1213) Bowen's intraepidermal carcioma, clear cell variant, HE 20x (1212)

Another case: Bowen's carcinoma, HE 100x (3569) Bowen's carcinoma, HE 40x (3570)

Clonal Bowen's disease: Bowen's carcinoma, nested, HE 40x (5406) Bowen's carcinoma, nested, CK7 40x (5405) Bowen's carcinoma, nested, S100 40x (5407) Bowen's carcinoma, nested, Ki67 40x (5434)

Pale cell Bowen's carcinoma: M. Bowen, pale cell, HE 60x (14238)

Cornu cutaneum caused by Bowen's carcinoma: Bowen's carcinoma in the form of the cutaneous horn, HE 20x (4732)

Case study
Pigmented Bowen disease
MUDr. Jana Jedličková, PhD.
Introduction

Morbus Bowen was described in 1912 by John T. Bowen and is regarded as a squamous cell carcinoma in situ. It is spreading superficially, progression to the invasive squamous cell carcinoma and metastases are rare. There are several variants of the disease:

  • Bowen disease of the skin associated with actinic damage, radiotherapy or exposition to arsenic or paraquat
  • Bowen disease of anogenital mucous membranes (erythroplasia of Queyrath, bowenoid papulosis)

Pigmented variant on extra-genital skin is uncommon; clinically it can be misdiagnosed as melanoma. A subungual variant with melanonychia was described, too.

History

A 60-year-old man presented with many actinic keratoses of the sun-exposed areas. He was a phototype II, he suffered sunburn repeatedly in his active years (he had worked in Africa). At the clinical examination a red flat lesion with some brown pigment was found on his right arm. The patient had the lesion for many years; it was growing slowly, and was asymptomatic. Dermatoscopically there was no pigment net. The lesion was excised completely.

Clinical signs

Red flat lesion 35×20 mm with irregular, sharply demarcated borders, some scaling, and a rim of brown pigment on the right arm. There was no lymphadenopathy. The patient had multiple actinic keratoses on the face, dorsal aspects of the hands, and upper back.

Pigmentovaný Bowenův karcinom (4173)

Pictures

Pigmented Bowen disease, simulating melanoma: Bowen's intraepidermal carcinoma, pigmented, Clinical picture (4173) Bowen's disease, pigmented, Clinical picture (6154)

Histology

Irregular nests of atypical cells with pigment and mitotic activity in the epidermis. The cells are AE1/AE3 positive, Melan A is positive only in solitary cells. In some parts the tumor bears resemblance to superficial basal cell carcinoma, however the nests are intraepidermal, formed by bowenoid cells.

Diagnosis: Clonal pigmented variant of Bowen intraepidermal carcinoma.

Clonal m. Bowen, HE (4116)

Clonal m. Bowen, AE1/3 (4115)

Pictures

Clonal Bowen carcinoma, forming intraepidermal nests of slightly pigmented keratinocytes, simulating melanoma: Bowen's carcinoma, clonal, HE 40x (4116) Bowen's carcinoma, clonal, AE13 40x (4115) Bowen's carcinoma, clonal, Melan A 40x (4117)

Bowen's disease, pagetoid
Queyrat's disease
Vulval intraepithelial neoplasia (VIN III.)
Dysplasia/in situ carcinoma from basaloid cells