2012 Volume 122 Issue 14 Pages 3747-3753
A 54-year-old Japanese male presented with multiple skin tumors on the trunk and extremities in September of 2010. These tumors had started to appear 8 months earlier and were increasing in size and number. He was diagnosed with acute adult T-cell leukemia (ATL) in 2008; OPEC and LSG 15 chemotherapy resulted in complete remission and he had been well controlled with oral 25 mg etoposide 3 days per week. Physical examination revealed multiple, red or brown cauliflower-like tumors, nodules, and plaques up to 4 cm in diameter on the trunk and the extremities; some of which were ulcerated. There were multiple small, flat, darkbrown, verrucous nodules on his penile shaft. Histological examination of the red tumors on his thigh showed the typical findings of Bowenʼs disease, and the other nodules were diagnosed as Bowen carcinomas (squamous cell carcinomas). All of these tumors were excised. Three of them were further analyzed for the presence of humanpapillomavirus (HPV). PCR analyses with DNA sequencing revealed abundant HPV DNA from all of these tumors. The types were identified as HPV 26 and 67. He had no family history of epidermodysplasia verruciformis and no EVER1, EVER2 gene expression in peripheral lymphocytes. Because HPV 26 and 67 are both known as high-risk HPV types, an infection of these viruses are supposed to be involved in the development of multiple Bowenʼs disease in this immunosuppressed patient.