Vulvar Sarcomatoid Squamous Cell Carcinoma: A Rare Entity.

Vulvar squamous cell carcinoma with sarcomatoid features is an extremely rare histological variant of squamous cell carcinoma with co-existence of both epithelial and mesenchymal features. A 70-year-old woman presented with genital lesions for 4 months with associated burning and pain. Examination revealed well-defined bilaterally symmetrical hyperpigmented plaques on labia majora, fleshy erythematous growth on labia minora. Biopsy from the fleshy mass was suggestive of sarcomatoid malignancy. However, immunohistochemistry was positive for cytokeratin AE1/AE3 and negative for desmin and smooth muscle actin. Biopsy from hyperpigmented plaque was suggestive of Bowens disease. On the basis of histopathology and immunohistochemistry findings, diagnosis of vulvar sarcomatoid squamous cell carcinoma with Bowens disease was made and patient was started on external beam radiation therapy. Sarcomatoid squamous cell carcinoma of vulva is very rare cancer that has an aggressive and fatal course. Diagnosis has traditionally been difficult due to a large ratio of sarcomatous to squamous cell component. Due to its rarity, there are no distinct guidelines to direct therapy and care.

Acantholytic Variant of Bowen's Disease with Micro-invasive Squamous Cell Carcinoma: A Case Report of a Unique Variant.

Bowen's disease is generally regarded as premalignant dermatoses. The disease affects both skin and the mucosa and has the potential to progress to invasive squamous cell carcinoma. There are descriptions of several histological variants of Bowen's disease like psoriasiform, atrophic, pagetoid, etc. Acantholysis of anaplastic keratinocytes with bullae/cleft formation is described in premalignant condition like actinic keratosis and adenoid variant of squamous cell carcinoma, but there is lack of report describing this phenomena in Bowen's disease. We present a case of unusual acantholytic variant of Bowen's disease with focus of micro-invasive carcinoma.

Squamous cell carcinoma (Bowens disease) in situ in three cats

Três casos de carcinoma multicêntrico in situ de células escamosas (doença de Bowen) são descritos na espécie felina. As neoplasias ocorreram em gatos idosos e acometeram a região pré-auricular, cervical, abdominal e flancos. Um gato apresentou lesão única e os demais apresentaram lesões multifocais, que se caracterizaram por placas que variavam de hiperceratóticas a verruco-crostosas e eram hiperpigmentadas. Algumas eram ulceradas, com fissuras que sangravam facilmente. Histologicamente, as células neoplásicas encontravam-se confinadas à epiderme e aos folículos pilosos, sem o envolvimento da membrana basal. Em um dos casos houve melhora significativa das lesões após terapia oral com acitretina.

A Case of Bowen' s Disease of the Nail Bed Presenting as Longitudinal Melanonychia / 대한피부과학회지

Bowens disease is an intraepithelial squamous cell carcinoma. It occur s anywhere on the surface of the body. Bowens disease involving the nail bed epithelium is very rate. Recently, some literatures showed that human papillomavirus is sssociated with squamous cell carcinoma of the finger by in situ hybridization or polymerase chain reaction. A 30-year-old housewife deve]oped longitudinal melanonychia with as imptomatic fissured nail plate on her right third finger. The hiat,ologic specimen showed diffuse anaplastic change confined to the nail bed epithelium. The subungual eyithelium was found to contain human papillomavirus DNA type 31/33/35 with the use of in situ hybridization.

A Case of Bowen' s Disease Showing Transformation into Invasive Squanmous Cell Carcinoma / 대한피부과학회지

Bowens disease is a precaicerous lesion and may transform into in asive squamous cell carcinoma. We present a case of a 67 year-old male with Bowens disease on the buttock from which squamous cell carcinoma developed. He had anerythematous, scaly and crusted slaque with a nodule on the left buttock. Skin biopsy specimen taken from the plaque and nodule revealed typical histopathological findings of Bowens disease and squlamous cell carcinoma, respectieels. The patient was treated with excision and skin graft under general anesthesia.

Detection of Human Papillomavirus DNA in Bowen' s Disease and Squamous Cell Carcinoma of the Skin / 대한피부과학회지

BACKGROUND: It has been suggested that human papillomavirua(HPV) infection has been implicated in the pathogenesis of between disease and squamous cell cacoma of the skin, particularly of snogenital area. There is little knowledge about etiologic characteriscs of the development of Bowens disease and squamous cell earcinoma of the skin in Korean patients. OBJECTIVE: This study is intended to evaluate Bowens disease and squamous cell carcinoma of the skin in Korean patients for the presence of HPV. METHODS: Fifteen cases of Bowens disease and fifteen cases of cutaneous squamous cell carcinoma were investigated. All cases developed on a nongenital site. In situ lybridization and polymerase chain reaction(PCR) were used for detection of HPV DNA in paraffinem bedded tissue sections. The clinical records and slides of these cases were reviewed for the analysis of clinicopathologic characteristiqs of HPV DNA positive eases. RESULTS: By in situ hybidization HPV 16 was detected in thrw cases(20%) with Bowens disease. By PCR HPV 16 was detected in six cases(40% ) of Bowens digreae and five cases(33.3) of squamous cell carcinoma of the skin. No specific clinicopathologic fetetues were found to be indicative of the presence or absence of HPV. CONCLUSION: These data suggest a role for HPV in the evolution of Bowens disease and squamous cell carcinoms of the skin in Korean patients.

Experimental Study of Calcinosis Cutis after Extravasation of Calcium Gluconate / 대한피부과학회지

BACKGROUND: Neonatal hypocalcemia is not an infrequent condition, especially in the premature neonate. It is effectively treated by intravenous administration of calcium gluconate. Complications of extravasation during intraveous infusion included calcification and, occasionally necrosis. But the exact mechanism of calcinosis cutis following extravasation of calcium gluconate remains unknown and there is no specific mode of treatment except cold packs and skin graft. OBJECTIVE: Our purpose was to evaluate the clinical and histological features in rabbits after subcutaneous injection of 10% calcium gluconate and a mixed solution of gluconate and triamcinolone acetonide. METHODS: Two rabbits were divided into 3 groups and were subcutaneously injected with the following materials on the back; 10% calcium gluconate, a mixed solution of calcium gluconate and triamcinolone acetonide, and 25% normal saline as controls respectively. The injection site including the skin and subcutaneous fat was excised and fixed with natural buffered formalin. The biopsied specimens were stained with Hematolxylin and Eosin. RESULTS: 1) In the 10% calcium gluconate injected group, there was some erthema and induration after three days. By the fifth to the seventh days there was more erythema and firm induration. At 15 days, nodules and large ulcreated lesions developed. Multiple, linear shaped, ulcreative surfaced and indurated masses were noted at 37days.l from 45days to 2months there was progressive healing with decrease in ulceration, and gradual disapppearance of the mass. Histologically, at the 8th day calcium was seen in the walls of the arteries and veins, after 15days, the reaction was at its peak and epidermal necrosis was seen on the injected site. From 30 to 3days, calcium deposition and granuloma formation were seen in the dermis. In addition discharge of calcium deposits began to place by means of transepidermal elimination. After 45days, although the response was subsiding, the calcium and mucin deposition was observed focally in the dermis. 2. In the 10% calcium gluconate and triamcinolone acetonide adjuvant injected group, there was development of some erythema at 8days. After 15days, some erythema and induration were seen of the injected site ad this gradually disappeared. By 37days, the injection site was normal in appearance. Histologically, at 15days calcium deposition was seen on the upper dermis and the injection site was histologically normal after one month. 3. In 25% normal saline injected group, the injection site was clinically normal. Histologically there was no reaction except for focal perivascular eosinophilia after 24horus. CONCLUSION: We conclude that the important mechanism of calcinosis cutis appears to be elevated concentration as well as the tissue damage at the site of the extravasation of calcium gluconate. The final common pathway of calcification is the formation of crystalline and insoluble calcium phosphate mineral, in the form of hydroxyapatite. The intralesional injection of triamcinolone for the treatment of calcinosis cutis in our study was effective due to its antiinflammatory effect and the reabsorption of calcium in the tissues.

Experimental Study of Calcinosis Cutis after Extravasation of Calcium Gluconate / 대한피부과학회지

BACKGROUND: Neonatal hypocalcemia is not an infrequent condition, especially in the premature neonate. It is effectively treated by intravenous administration of calcium gluconate. Complications of extravasation during intraveous infusion included calcification and, occasionally necrosis. But the exact mechanism of calcinosis cutis following extravasation of calcium gluconate remains unknown and there is no specific mode of treatment except cold packs and skin graft. OBJECTIVE: Our purpose was to evaluate the clinical and histological features in rabbits after subcutaneous injection of 10% calcium gluconate and a mixed solution of gluconate and triamcinolone acetonide. METHODS: Two rabbits were divided into 3 groups and were subcutaneously injected with the following materials on the back; 10% calcium gluconate, a mixed solution of calcium gluconate and triamcinolone acetonide, and 25% normal saline as controls respectively. The injection site including the skin and subcutaneous fat was excised and fixed with natural buffered formalin. The biopsied specimens were stained with Hematolxylin and Eosin. RESULTS: 1) In the 10% calcium gluconate injected group, there was some erthema and induration after three days. By the fifth to the seventh days there was more erythema and firm induration. At 15 days, nodules and large ulcreated lesions developed. Multiple, linear shaped, ulcreative surfaced and indurated masses were noted at 37days.l from 45days to 2months there was progressive healing with decrease in ulceration, and gradual disapppearance of the mass. Histologically, at the 8th day calcium was seen in the walls of the arteries and veins, after 15days, the reaction was at its peak and epidermal necrosis was seen on the injected site. From 30 to 3days, calcium deposition and granuloma formation were seen in the dermis. In addition discharge of calcium deposits began to place by means of transepidermal elimination. After 45days, although the response was subsiding, the calcium and mucin deposition was observed focally in the dermis. 2. In the 10% calcium gluconate and triamcinolone acetonide adjuvant injected group, there was development of some erythema at 8days. After 15days, some erythema and induration were seen of the injected site ad this gradually disappeared. By 37days, the injection site was normal in appearance. Histologically, at 15days calcium deposition was seen on the upper dermis and the injection site was histologically normal after one month. 3. In 25% normal saline injected group, the injection site was clinically normal. Histologically there was no reaction except for focal perivascular eosinophilia after 24horus. CONCLUSION: We conclude that the important mechanism of calcinosis cutis appears to be elevated concentration as well as the tissue damage at the site of the extravasation of calcium gluconate. The final common pathway of calcification is the formation of crystalline and insoluble calcium phosphate mineral, in the form of hydroxyapatite. The intralesional injection of triamcinolone for the treatment of calcinosis cutis in our study was effective due to its antiinflammatory effect and the reabsorption of calcium in the tissues.