Nihal KILINÇ, Zeki Özden PINAR

Bowen's disease: An uncommon presentation

Amaç:İlk olarak 1912'de Bowen tarafından tanımlanan bowen hastalığı bir intraepidermal yassı hücreli karsinomdur. Olgu: 65 yaşında erkek hasta 5-6 yıldan beri karın cildinde bulunan lezyon ile başvurdu. Bu asemptomatik deri lezyonu aylar içinde ilerlemiş. Değişik merkezlerde yanlış tanı alan ve tedavi edilen lezyonda kısmi bir gerileme olmuş ancak tekrar büyümeye başlamış. Dermatolojik muayenesinde; göbeğin sağ tarafında, 7cm x 7cm boyutlarında, plak şeklindeki izlenen lezyonun iyi sınırlı, eritemli, pigmentli ve değişik büyüklükte papüller yapıların lezyonun periferine ve merkezine yerleşmiş olduğu izlendi. Histopatolojik muayenesinde; epidermiste kalınlaşma, bazal tabakanın sağlam olduğu, keratinositlerde polarite kaybı ile atipi izlendi. Bowen hastalığı tanısı alan lezyon cerrahi olarak çıkarıldı ve deri grefti konuldu. Sonuç: Nadir yerleşimli Bowen hastalığı olgusunu ilgili kaynakların ışığında tartışarak sunmayı amaçladık.

Nadir yerleşimli bir Bowen hastalığı

Objective: Bowen's disease described by bowen originally in 1912 is an intradermal squamous cell carcinoma. We aimed to discuss a case of bowen's disease with uncommon presentation in the light of recent literature. Observation a 65-year-old male presented with a lesion over the skin of the abdomen for 5-6 years duration. The lesion gradually enlarged over the years and was asymptomatic. It had been treated and misdiagnosed by different centers, which had resulted in partial regression; however, it started to enlarge again. Dermatologic examination revealed a plaque, 7cmX7cm in size, on the right side of the umbilicus. It was well defined, and erythematous, pigmented, with firm papules of various sizes at the periphery and center of the lesion. Histopathology showed that the lesion was extending through the whole thickness of the epidermis. The basement membrane zone was intact. Keratinocytes showed a loss of polarity and atypia. A diagnosis of "bowen's disease" was made, the lesion was surgically excised, and skin grafting was performed. Conclusion: Bowen's disease should be considered when a skin lesion not responded to treatment or lesion mimics papulosquamous disorders.

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1. Bowen JT. Precancerous dermatoses: A study of two cases of chronic typical epithelial proliferation, Journal of Cutaneous Disases, 1912;30:242-55.
2. Bowen JT. Precancerous dermatoses: A sixth case of a type recently descriebed,journal of Cutaneous disease, 1915,;33:787-802.
3. Darier J. La dermatose precancereuse de Bowen-dyskeratose lenticulaire et en disques,Annal de dermatologie 1914;5:449-71.
4. Sarveswari KN. Bowen's disease of the palm. Int J Dermatol 1998; 37:157-58.
5. Mehregan AH, Hashimoto K. Pincus’ Guide to Dermatohistopathology. 5th ed. London: Appleton&Lange 1991:507-9.
6. Yerebakan O, Ermis O, Yılmaz E, ve ark. Treatment of arsenical keratosis and Bowen's disease with acitretin. Int J Dermatol 2002; 41:84-7.
7. Marschall SF, Ronan SG, Massa MC. Pigmented Bowen’s disease arising from pigmented seborrhoeic keratose. J Am Acad Dermatol 1990;23:440-44.
8. Lee M, Wick MM. Bowen’s disease. Clin Dermatol 1993;11:43-6.
9. Mitsuishi T, Kawashima M, Matsukura T, et. al. Human papillomavirus type 58 in Bowen's disease of the elbow. Br J Dermatol 2001;144:384-6.
10. Strayer DS, Santa Cruz DJ. Carcinoma in situ of the skin: A review of histopathology.J Cutan Pathol 1980;7:244.
11. Miki Y, Kawatsu T, Matsuda K, et. al. Cutaneous and pulmonary cancerss associated with Bowen's disease. J Am Acad Dermatol. 1982;6:26-31.
12. Reymann F, Ravnborg L, Schou G, et. al. Bowen’s disease and internal malignant diseases, A study of 581patients. Arch Dermatol 1988; 124:677-79.
13. Kettler AH, Rutledge M, Tschen JA, et. al. Detection of human papillomavirus in nongenital Bowen’s disease by in situ hybridization. Arch Dermatol 1990; 126:777-81.
14. Kovacs A Yonemoto K, Katsuoka K, Nishiyama S, Harhai I. Bowen’s disease: Statistical study of a year period. J Dermatol 1996; 23: 267-74.
15. Eedy DJ, Gavin AT. Thirteen-year retrospective study of Bowen’s disease in North Ireland. Br J Dermatol 1987;68:715-20.
16. Köse O, Safalı M, Taştan MS, ve ark. Genital yerleşimli Bowen’s hastalığı. Turk J Dermatopathol 2000; 9:118-20.
17. Krishnan R, Lewis A, Orengo IF, et. al. Pigmented Bowen's disease (squamous cell carcinoma in situ): a mimic of malignant melanoma. Dermatol Surg 2001; 27:673-4.
18. Tae Jung Jang. Expression of CD40 and Fas Ligand in Bowen's Disease, Squamous cell carcinoma and Basal cell carcinoma Yonsei Med J 2002; 43:304-308.
19. Chuang T, Reizner GT. Bowen's disease and internal malignancy, a matched casecontrol studies. J Am Acad Dermatol 1988; 19:47-51.
20. Dave R, Monk B, Mahaffey P. Treatment of Bowen's disease with carbon dioxide laser. Lasers Surg Med 2003; 32:335