Oka Masahiro, Yamamoto Yuki, Fujii Miki
Department of Dermatology, Kita-Harima Medical Center, Ono City, Japan.
Department of Pathology, Kita-Harima Medical Center, Ono City, Japan.
Case Rep Dermatol. 2020 Feb 4;12(1):19-24. doi: 10.1159/000505530. eCollection 2020 Jan-Apr.
We report a case of seborrheic keratosis (SK) that transformed into bowenoid actinic keratosis (AK) via three steps of histological change in a 77-year-old woman. The patient presented with a multiple-year history of a brownish lesion on the right cheek. She reported that some months earlier she had noted a pinkish lesion developing within the brownish lesion. She had also been treated with several immunosuppressants for rheumatoid arthritis for many years. Physical examination revealed a nodule measuring 13 × 12 mm on the lateral side of the right upper cheek. The lesion comprised three regions: a brownish hyperkeratotic region in the upper portion; a pinkish region in the lower portion; and a slightly dented, band-like region between the other two regions. Histopathologically, the specimen consisted of four zones: SK comprising basaloid cells; SK composed of squamoid cells; atrophic AK; and bowenoid AK. The zones of SK with basaloid cells and squamoid cells clinically corresponded to the brownish hyperkeratotic region. Atrophic and bowenoid AK zones corresponded to the dented, band-like region and pinkish region, respectively. Collectively, the nodular skin lesion was diagnosed as SK associated with atrophic and bowenoid AK within the SK lesion. The present case suggests that bowenoid AK developed from SK by malignant transformation via three steps of histological change. The facts that our patient had received treatment with several immunosuppressants and that no other AK lesions were evident around the AK support the notion that in this case, bowenoid AK developed from SK by malignant transformation.
我们报告一例77岁女性脂溢性角化病（SK）经三步组织学改变转变为鲍温样光化性角化病（AK）的病例。患者右脸颊有一褐色病变，病史多年。她报告说几个月前注意到褐色病变内出现了一个粉红色病变。她还因类风湿关节炎接受多种免疫抑制剂治疗多年。体格检查发现右上脸颊外侧有一个大小为13×12 mm的结节。病变包括三个区域：上部为褐色角化过度区域；下部为粉红色区域；另外两个区域之间有一个轻度凹陷的带状区域。组织病理学上，标本由四个区域组成：包含基底样细胞的SK；由鳞状细胞组成的SK；萎缩性AK；以及鲍温样AK。含有基底样细胞和鳞状细胞的SK区域在临床上对应褐色角化过度区域。萎缩性和鲍温样AK区域分别对应凹陷的带状区域和粉红色区域。总体而言，该结节性皮肤病变被诊断为SK病变内伴有萎缩性和鲍温样AK的SK。本病例提示鲍温样AK是由SK经三步组织学改变恶变而来。我们的患者接受过多种免疫抑制剂治疗且AK周围未见其他AK病变，这些事实支持了在本病例中鲍温样AK是由SK恶变而来的观点。
