Case Number : Case 747 - 26 Apr Posted By: Guest

Bowen's disease.

Thanks Mona. The anatomical site is glans penis I think.

If so, then it will be erythroplasia of Queyrat !!!!!

Dysplasia / PeIN but unsure of grading. In real-life, would take more levels and show to colleagues.

Differentiated penile intraepithelial neoplasia (PeIN), probably arising in the setting of a long-term dermatitis.
I prefer the simplified nomenclature for penile preinvasive lesions proposed by Antonio Cubilla et al (Morphological characterization and distribution of penile precancerous lesions using a simplified nomenclature. A study of 198 lesions in 115 patients. Lab Invest 2008;88:696A).

[color=#1C2837][font=arial, verdana, tahoma, sans-serif][size=4]Differentiated PeIN[/size][/font][/color]

Agree with SCC in situ / Bowen's disease / Erythoplasia of Queyrat (The tree of nomenclature needs pruning!)
[color=#000080] - [i]Low power image (top left)[/i]: shows increased pleomorphism and nuclear/cytoplasm volumes, compared to the 'normal' epidermis on the left, and what look like sparse bizarre giant keratinocytes and deeply eosinophilic necrotic keratinocytes in the upper reaches. [very useful image].[/color]
[color=#000080] - [i]Medium and high power images (top right, lower right)[/i]: show mitotic figures at all levels, coarse parakeratosis, dyskeratosis, and prominent nucleoli. There is aberrant multinucleation.[/color]

[size=3][font=Arial]Thank you all for the contributions. I must say that the contributors today all made light work of a difficult case which is very impressive. I am saying this so that any visitors new to dermatopathology (the neophytes) will not be disheartened!! Immunostaining can be exceedingly useful in this setting. [/font][/size]

[size=3][font=Arial]In view of the comments above I e-mailed to Dr Cubilla as follows:[/font][/size]

[size=3][font=Arial]Dear Dr Cubilla,[/font]
I would be most interested on your opinion on the case I posted today for Phillip Mckee's website - the spot diagnosis of the day. I reported it as [b]conventional [high grade] PeIN [/b]because of strong p16 and what I interpreted as focal koilocytosis. I thought the lichenoid reaction was limited to the neoplastic epithelium and was therefore secondary but I would be most grateful for your thoughts.
Richard Carr

Dr Cubilla responds: I would favor this lesion to be a Penile Intraepithelial Neoplasia,basaloid over Diff. PeIN. Cells are rather uniform, surface is parakeratotic with isolated superficial koylocytotic cells. I expect this lesion to be p16 Ki 67 positive. Thanks for calling my attention to this intersting case. Antonio Cubilla.

Additional notes (Dr Carr): Abrupt full thickness p16 with Ki67 at all levels coincides with the inflammatory infiltrate (on the right half of image 1). [/size]

[size=3]I will ask the DermpathPro team to post the additional immunos for your interest. Regards to all and enjoy your weekends[/size]

Thanks Richard, very useful.

Thanks for the Immunos , very nice