Bowen's Disease with Invasive Adnexal Carcinomaの1例

抄録

A 75-year-old Japanese woman associated with adenocarcinoma is reported. An erythematous patch started on the right side of the abdomen 5 years ago, which had enlarged to a dark pigmented crusting, partly eroding lesion, the size of 12×5cm at first examination. There was a 2×3cm satellite lesion. Histopathology revealed an apparent picture of Bowen's disease in the epidermal tumorous lesion, while there was adenocarcinoma in the dermis and the subcutaneous tissue. Immunohistochemical staining was undertaken with 13 monoclonal antibodies. The Bowen's disease and the adenocarcinoma showed respective different antigenecities.
Extramammary Paget's disease and Bowen's disease have been suspected clinically. However, histopathologically this case was compatible with Bowen's disease, with negative PAS stain and alcian blue stain. It was not compatible with extramammary Paget's disease. Immunohistochemically, it was all positive except for anti-Lewis X antibody; these data were compatible with extramammary Paget's disease. The antigenecity of adenoma resembled that of the eccrine glands, and therefore, the adenocarcinoma was assumed to be of eccrine gland origin. Hirai stated that invasive extramammary Paget's disease acquires antigenecities similar to those of eccrine glands such as blood-type associated antigen antigenecity, according as they take the form of adenomatous structure. Our case was in agreement with the latter, namely it has acquired the antigenecity of eccrine glands. Human milk fat globule membranes (HMFGM) have at least six antigenecities. Hilkens and his co-workers produced many monoclonal antibodies, and they classified them according the molecules such as MAM-1 and MAM-6. In our case, the epidermal tumor did not react with these antigens, but the adenomatous lesions reacted with both MAM-3 antigen and MAM-6 antigen. The cell membrane and the cytoplasma of the inner cells of adenoma were positive for MAM-3 antigen and MAM-6 antigen, similar to the eccrine duct portion in the same specimen, Based on these findings, it is hardly a case of extramammary Paget's disease changing into invasive adenocarcinoma.
Our case apparently showed two portions, an epidermal portion showing Bowen's disease and adenocarcinoma having features of adnexal, especially, eccrine gland origin. These two lesions showed respective antigenecities. A diagnosis was made of Bowen's carcinoma with adenomatous structure.