Clinico-pathologic Findings and Correlations in Anogenital Bowen Disease
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Clinico-pathologic Findings and Correlations in Anogenital Bowen Disease. Irina Tudose1, M adalina Geanta2, Sabina Zurac3, Florica Staniceanu3, Simona Roxana Georgescu2, V Benea2 1 The Pathology Department, “Prof. Scarlat Longhin” Clinical Hospital

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Clinico-pathologic Findings and Correlations in Anogenital Bowen Disease

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Clinico pathologic findings and correlations in anogenital bowen disease

Clinico-pathologic Findings and Correlations in Anogenital Bowen Disease

Irina Tudose1, Madalina Geanta2, Sabina Zurac3, Florica Staniceanu3, Simona Roxana Georgescu2, V Benea2

1 The Pathology Department, “Prof. Scarlat Longhin” Clinical Hospital

2 The Dermatology Department, “Prof. Scarlat Longhin” Clinical Hospital

3 The Pathology Department, Colentina Universitary Clinical Hospital

  • 1912 – John T. Bowen described “squamous intraepithelial disorders” or “Bowen disease” (BD)

  • 1943 – Knight et. al reported vulvar BD

  • According to WHO Tumor Classification, BD is “a form of squamous cell carcinoma in situ, a distinct clinicopathologic entity of the skin and mucocutaneous junction”

  • The suggested association with internal malignancy was not confirmed in long-term follow-up

BD:

Aspect: usually asymptomatic erythematous and (slightly) scaly patch or plaque (sometimes verrucous or crusted), with a sharp, but often irregular border, of variable size (mm → cm); pigmentary forms have been described; +/- erosions and/or ulceration; can occur in both sun-exposed and sun-protected sites

Evolution: slow & gradual increase; no spontaneous resolution;

Development of invasive squamous cell carcinoma in 3-5% (some sources: up to 10%) of cases; development of nodules or ulceration usually signals progression towards invasion

  • BD:

  • Therapeutic options:

  • Complete surgical excision (classical/ Mohs)

  • Cryotherapy

  • CO2 laser therapy

  • Topical 5-FU

  • Topical imiquimod

  • PDT

  • Curettage & Electrodesiccation

  • Local radiotherapy

  • Combined therapy

  • The anogenital BD can be misdiagnosed as:

  • Psoriasis

  • Chronic eczema/allergic contact dermatitis

  • Lichen planus

  • Fixed drug eruption

  • Superficial (pigmented) basal cell carcinoma

  • Extramammary (genital) Paget’s disease

  • Malignant melanoma in the anogenital area

  • Invasive squamous cell carcinoma

  • Vulvitis/balanitis circumscripta plasmacellularis (Zoon)

  • Tinea

  • consensus regarding efficiency has not been reached, but:

  • complete eradication (surgical) is essential in patients where adequate follow-up cannot be done

  • a meticulous, regular follow-up (doctor visits + self-examination) is very important; it has been sugested that dermatoscopy could play a role in monitoring BD


Clinico pathologic findings and correlations in anogenital bowen disease

Study: materials and methods

  • retrospective analysis

  • we selected 11 patients with histopathological confirmed ano-genital BD and 20 patients with cutaneous BD

  • all the biopsies were fixed in formaldehyde solution and embedded in paraffin; all the paraffin sections were stained with H-E; immunohistochemestry markers (Ki67, p16, p21, p53) were used for the ano-genital cases

  • mean age for ano-genital BD was 60,09 years (range 44-74)

Most of the patients with ano-genital BD pertained to the age group 60-69, consistent with the literature data (“commonly affects patients in the 6-8th decade”)

  • The presence of ulceration was evident in 64% of the cases

Ano-genital BD cases

  • In 27% of cases only the labia major was involved, and the rest was equally divided between the labia minor, labia minor+labia major, the frenulum, the perineal region or “the genital region”


Clinico pathologic findings and correlations in anogenital bowen disease

The treatment of ano-genital BD cases consisted of:

  • Complete initial surgical excision (in 3 cases)

  • Biopsy and HP confirmation, followed by complete surgical excision or curettage and electrodesiccation were surgery was not an option

The treatment of extragenital BD cases consisted of:

Complete initial surgical excision (in 10 cases)

Biopsy and HP confirmation, followed by complete surgical excision in the other 10 cases

  • Extra-anogenital BD Cases:

  • Our retrospective study included 20 cases of BD with extragenital location, during last year, with the following features:

  • mean age 73.8 years (range 55-91); sex ratio 1:1

  • most frequent location: the face (40%)

  • The clinical diagnoses which accompanied the biopsy specimens were:

  • Bowen’s disease (in 8 cases; the concordance between the clinical and pathological dgn was of 72.72%)

  • Lichen sclerosus et atrophicus

  • Genital wart

  • Erosive genital lichen planus

- The concordance between the clinical and pathological diagnosis was of 30%, smaller compared to the situation observed for ano-genital BD

- The most frequent clinical confounder was BCC (in 55% of cases)


Clinico pathologic findings and correlations in anogenital bowen disease

p53

p16

Ki67

p21

  • Histopathological aspects for both ano-genital and cutaneous BD were similar with some particularities regarding ano-genital cases: almost all the lesions were ulcerated, the inflammation was higher consisting in lymphocytes and plasma cells, there were more dyskeratotic cells and a high mitotic rate

  • Immunohistochemestry analysis for the ano-genital BD cases revealed a high Ki67 value (from 25% to 50%), predominant the lower part of the epithelium, apparently related with p21 high values (from 10% to 60%); p16 presented high positivity (over 20%) in only 3 cases; p53 showed over 10% positivity in 3 cases (8 cases presented less than 5% positivity)

  • Apparently there is no connection between immunohistochemistry markers values, except for the Ki67 and p21, both with similar positivity in 7 cases of ano-genital BD

  • The concordance between the clinical and pathological diagnosis was of 30% for the extra-ano-genital cases, smaller compared to the situation observed for ano-genital BD

  • Having in mind the fact that the observation period was only one year and all the data were collected in a hospital dedicated almost exclusively to dermatology, 11 patients is not such a small number for ano-genital location of BD


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