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+A 67-year-old Japanese female presented with a left buttock tumor, which had been first detected approximately 1 year earlier, and had recently gradually enlarged.
+Physical examination revealed a relatively well-circumscribed skin-colored tumor with hyperkeratosis, measuring 43 x 38 mm in diameter, in her left buttock.
+The biopsy specimen revealed Bowen’s disease (squamous cell carcinoma in situ), and subsequently, total resection of the tumor was performed.
+Histopathological study of the resected specimen revealed proliferation of atypical squamous cells in the entire layer of the acanthotic epidermis accompanied by hyperparakeratosis (Figure 1A).
+These atypical squamous cells had enlarged and hyperchromatic nuclei (Figure 1B), and multinucleated atypical squamous cells were also present.
+Mitotic figures were scattered and present in the upper portion of the epidermis.
+Atypical mitotic figures were also observed (Figure 1B).
+No invasive neoplastic growth was noted (Figure 1A).
+Approximately 95% of the lesion was composed of the above-mentioned Bowen’s disease (squamous cell carcinoma in situ), and superficial sebaceous carcinoma was present in the central area of the lesion.
+This latter component was composed of proliferation of nests of atypical cells with vacuolated clear cytoplasm and large nuclei containing conspicuous nucleoli (Figure 1C, ​,1D).1D).
+Sebaceous carcinoma had invaded into the superficial reticular dermis (Figure 1C).
+Moreover, atypical cells containing vacuolated cytoplasm were present within the lesion of Bowen’s disease adjacent to the sebaceous carcinoma (Figure 1E).
+Immunohistochemical studies were performed using an autostainer (Ventana) by the same method as previously reported [9-12].
+Epithelial membrane antigen (EMA), cytokeratin 7, and adipophilin were expressed in the sebaceous carcinoma component, but not in Bowen’s disease (Figure 2A).
+Androgen receptor was also expressed in some of the tumor cells of the sebaceous carcinoma, but not in Bowen’s disease.
+Moreover, atypical vacuolated cells within the lesion of Bowen’s disease were also positive for adipophilin (Figure 2B).
+Overexpression of p53 protein was observed in both the sebaceous carcinoma and Bowen’s disease.
+Accordingly, an ultimate diagnosis of sebaceous carcinoma associated with Bowen’s disease was made.