Bowen disease with invasive mucin‐secreting sweat gland differentiation: Report of a case and review of the literature

Abstract

Bowen disease (BD) with divergent adnexal differentiation is a rare composite cutaneous tumor featuring different phenotypic elements. Sebaceous, poroid and trichilemmal invasive components have been described in this setting and very infrequent reports of mucinous glandular differentiation are extant. Clinically, these tumors are not sufficiently distinctive to enable recognition without histopathological evaluation. From a microscopic perspective, care must be taken to exclude a collision tumor as well as other combined cutaneous neoplasms featuring squamous and glandular differentiation. Direct continuity between the two epithelial phenotypes helps to establish the correct diagnosis and generates interesting speculation about the pathogenesis of these and other epithelial skin tumors. We describe a case of BD in continuity with an invasive adenocarcinoma exhibiting mucinous sweat gland differentiation on the face of an elderly man. Details of the case are outlined with the objective of adding to a scant literature on this topic.

Porocarcinoma with areas of mucinous differentiation suggesting multilineage differentiation

“…9 Finally, regarding the reason for the mucinous lakes in our case, we have only found mucinous sweat gland differentiation described in three previously reported cases of Bowen disease. 10 Contrary to our case, most of the mucin was intracellular in those cases, and they considered the adnexal differentiation to likely be a metaplastic change. 10 Porocarcinomas tested for MUC1 or EMA can be positive, as in other cutaneous malignancies.…”

“…10 Contrary to our case, most of the mucin was intracellular in those cases, and they considered the adnexal differentiation to likely be a metaplastic change. 10 Porocarcinomas tested for MUC1 or EMA can be positive, as in other cutaneous malignancies. 11 Mucin expression may be stimulated either by environmental insults, or intrinsic changes and, as MUC1 is related to an appropriate immune response and with the ability to modulate the adhesion of polymorphonuclear leucocytes, 11 it may imply a difference in prognosis.…”

Bowen's disease

“…BD have been reported to arise from seborrheic keratosis, porokeratosis, Becker's nevus, erythema ab igne, smallpox vaccine scar, and outer sheet of epidermoid and follicular cyst. [ 59 60 61 62 63 64 ] There have been reports of a few cases of invasive adenxal carcinomas arising from BD. This includes phenotypes such as sebaceous, trichilemmal, poroid and in apocrine/mucinous glandular differentiation.…”