PMC3884180_01
A partially pigmented 2-year-old lesion on the upper left side of our patient's back. The lesion measured 3 cm in diameter, was round and had an irregular contour and surface. It had a verrucous pigmented rim on its medial side that measured 6-8 mm, while the prominent exophytic erythematous part measured 2.1 x 2.2 cm.
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F1
It had a verrucous pigmented rim on its medial side that measured 6-8 mm, while the prominent exophytic erythematous part measured 2.1 x 2.2 cm (fig. 1).
The pathological examination confirmed an epidermal nevus at the periphery of the lesion. H&E staining, x50 magnification.
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F2
The pathological examination confirmed an epidermal nevus at the periphery of the lesion (fig. 2).
a, b The epidermis showed bowenoid features with irregularly sized nuclei, a loss of polarity, dyskeratosis and mitotic figures. c Some sections from the periphery of the specimen showed multiple intraepidermal eddies of atypical cells or the Borst-Jadassohn phenomenon (arrow).
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F3
Some sections from the periphery of the specimen showed multiple intraepidermal eddies of atypical cells or the Borst-Jadassohn phenomenon (fig. 3c).
Sheets of poorly differentiated, atypical, pleomorphic keratinocytes migrated from the epidermis into hair follicles.
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F4
Sheets of poorly differentiated, atypical, pleomorphic keratinocytes migrated from the epidermis into the whole dermis, hair follicles (fig. 4) and eccrine glands, including a perivascular and perineural invasion (fig. 5a-c).
The tumour exhibited a maximal depth of 7 mm.
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F6
The tumour exhibited a maximal depth of 7 mm (fig. 6).
After 6 weeks, the regional lymph nodes were palpable. The swelling was so extensive that it also infiltrated the surrounding subcutaneous tissue measuring 12 x 17 cm.
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F7
The swelling was so extensive that it also infiltrated the surrounding subcutaneous tissue, measuring 12 x 17 cm (fig. 7).
Metastasis is visible in both lungs (a) and in the spinal cord (b) on a CT image and bone scan, respectively.
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F8
After another 4 weeks, a bone scan, CT and MRI images showed metastasis in both lungs (fig. 8a) and then 3 weeks later in the spinal cord (fig. 8b) and brain (fig. 9), while the liver was spared.
Metastasis is visible in the brain on MRI images.
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F9
After another 4 weeks, a bone scan, CT and MRI images showed metastasis in both lungs (fig. 8a) and then 3 weeks later in the spinal cord (fig. 8b) and brain (fig. 9), while the liver was spared.