PMC4300359_01
A) The epidermis show irregular acanthosis with loss of normal maturation pattern (H&E x4). B) Focally the epidermal abnormality also extending into the follicular infandibulam (H&E x10). C) Marked cellular disarray in the epidermis with no evidence of invasion (H&E x20). D) The neoplastic cells showing moderate degree of pleomorphism and high nucleo-cytoplasmic ratio. Frequent mitotic figures are seen (arrow) (H&E x40)
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Skin biopsy (Fig. 1A-D) showed features consistent with diagnosis of Bowen's disease.
A) Clinical picture of the patient before radiotherapy treatment. B) On the day of completion of treatment. C) Two weeks after completion of treatment. D) Eight weeks after completion of treatment
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On examination, she had a 15 cm x 10 cm erythematous, hyperpigmented, crusted plaque in the superior and antero-lateral aspect of the left side of scalp with well defined irregular border and extension to forehead (Fig. 2A). Figure 2B shows the clinical picture at completion of the treatment. At 2 weeks after completion of the treatment (Fig. 2C), healthy granulation tissue with partial resolution of the lesion was appreciable along with alopecia in the adjacent area. Figure 2D shows complete resolution of the lesion at 8 weeks of treatment.
A) Shows customized mold with plastic brachytherapy catheters in situ. B) Planning CT scan acquired with customized mold. Orange arrow shows the brachytherapy catheters with lead wire and green arrows show the lead wire around the lesion placed to delineate the treatment area. C) Isodose lines (green color shows 80% and red color shows 100% isodose lines) for the treatment. D) Shows patient being treated on remote after loading HDR brachytherapy unit
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Flexible plastic brachytherapy catheters (12 catheters at a distance of 1 cm from each other) inserted between layers of wax was pasted in close contact with the thermoplastic cast (Fig. 3A). Clinical target volume (CTV) was delineated based on the markers and clinical findings. Organs at risk including brain parenchyma, bones of skull, eyes, lens, optic nerves, optic chiasm, and brainstem was also delineated on serial CT slices (Fig. 3B). Catheters were reconstructed with axial and multi-planar views. Graphical optimization was done to ensure 95% coverage of the CTV (Fig. 3C). Treatment was administered using an Iridium-192 source (Microselectron HDR, Nucletron, an Elekta company, Elekta AB, Stockholm, Sweden) (Fig. 3D). Treatment time was 10 minutes per fraction including treatment set up time.