ABSTRACT
La papulosis bowenoide es un carcinoma espinocelular in situ de bajo grado que se observa mayormente en genitales. El agente etiológico es el virus del papiloma humano. Existen múltiples opciones terapéuticas médicas y quirúrgicas pero debería ser tratado de forma conservadora. Presentamos dos casos de papulosis bowenoide tratados exitosamente con crioterapia (AU)
Bowenoid papulosis is a low grade squamous cell in situ carcinoma. It is usually seen in genitals. Etiologic agent is the human papilloma virus. There are many treatments available but it should be treated conservatively. Two cases of bowenoid papulosis with good response to cryotherapy are reported (AU)
Subject(s)
Humans , Male , Adult , Papillomaviridae/pathogenicity , Penile Neoplasms/etiology , Carcinoma in Situ/diagnosis , Therapeutics , CryotherapyABSTRACT
La presencia de verrugas anogenitales en niños es una situación controvertida, ya que las vías de acceso del virus del papiloma humano (HPV) al área anogenital infantil pueden ser la perinatal, a partir de lesiones en el canal del parto,la transmisión por auto o heteroinoculacióndes de verrugas vulgares en las manos de los propios niños, familiares o cuidadores, y por abuso sexual. Por ello, para llegar a un correcto diagnóstico y tratamiento es importante contar con una buena historia clínica. Presentamos el caso de una paciente en edad escolar, de sexo femenino, que tras un abuso sexual, presentó una infección por elvirus de la inmunodeficiencia humana (VIH) y desarrolló una papulosis bowenoide.
The presence of anogenital warts in childrenis a controversial situationsincethepaths of human papillomavirus (HPV) in a child´sanogenitalareamay be acquiredperinatally, fromlesions in thebirth canal oracquiredviaauto orheteroinoculationfromcommonwartsonthehands of childrenthemselves, familymembersorcaregivers and fromthegenitals of adultsduring sexual abuse. Hencetheimportance of a goodhistorytoreach a correct diagnosis and treatment.Wereportthe case of a femalepatient,whoafterbeingsexuallyabused, developed HIV and a bowenoidpapulosis.
Subject(s)
Humans , Female , Child , Child Abuse, Sexual , Condylomata Acuminata , Papillomavirus Infections , Lymphomatoid Papulosis , Acquired Immunodeficiency Syndrome , Uterine Cervical NeoplasmsABSTRACT
Objective To analyze the correlation between polymorphisms at position 4 and 14 in exon 2 of the p73 gene and susceptibility to human papillomavirus (HPV) infection.Methods Tissue specimens were obtained from the lesions of 83 patients with condyloma acuminatum and 11 patients with bowenoid papulosis,and blood samples from all the patients as well as 150 health checkup examinees with high risk for sexually transmitted diseases (STDs) at STD clinics (negative control group).PCR was performed to detect HPV DNA in lesional tissue specimens,followed by direct sequencing and nucleotide alignment using the BLAST program for the determination of HPV genotypes.To assess polymorphisms at position 4 and 14 in exon 2 of the p73 gene,DNA was extracted from all the blood samples,and the p73 gene was amplified by PCR with the primer shP73 followed by gene sequencing.The association between the polymorphisms and susceptibility to HPV infection was analyzed.Results Of the 83 tissue specimens from patients with condyloma acuminatum,42.2％ (35/83) were positive for HPV 6,and 41.0％ (34/83) for HPV 11.Among the 11 tisssue specimens from bowenoid papulosis lesions,5 were positive for HPV 16,and 3 for HPV 6.The p73 gene was successfully amplified and sequenced from all the patients with condyloma acuminatum or bowenoid papulosis as well as from 132 out of 150 health checkup examinees.There were three genotypes at position 4 and 14 in exon 2 of the p73 gene,including A4T14/G4C14,A4T14/A4T14,G4C14/G4C14,of which,A4T14/A4T14 was associated with a higher risk for condyloma acuminatum (OR 4.89,95％ CI 1.50-15.91) as well as bowenoid papulosis (OR 7.11,95％ CI 1.144-44.20),and G4C14/G4C14 with a lower risk for bowenoid papulosis (OR 0.16,95％ CI0.04-0.65),in patients with HPV infection.Conclusions The A4T14 allele in exon 2 of the p73 gene increases the risk for bowenoid papulosis and condyloma acuminatum,but no significant correlation is found between the susceptibility to high-or low-risk HPV infection and polymorphisms at the two positions in the p73 gene.
ABSTRACT
Bowenoid papulosis (BP) is a disease that mainly occurs in sexually active young adults. The patients present with multiple pigmented papular lesions with a verrucous surface on the anogenital area. Although extragenital BP is usually associated with concomitant genital involvement, a few cases of isolated extragenital BP have been reported. However, to our knowledge, BP of the nipple has not yet been reported in the medical literature. We report the case of a 32-year-old woman who presented with isolated extragenital BP of the nipple caused by human papillomavirus-16.
Subject(s)
Adult , Female , Humans , Young Adult , NipplesABSTRACT
No abstract available.
ABSTRACT
ObjectiveTo evaluate the relationship of human papillomavirus(HPV) intection with expressions of cell cycle regulatory proteins cyclin D1,E and their dependent kinase inhibitor p27 in bowenoid papulosis(BP).MethodsTissue specimens were obtained from the lesions of 44 patients with BP,and circumcised foreskin tissue from 10 males served as the control.Gene chip was used to determine the genotypes of HPV,and immunohistochemistry to quantify the expressions of cyclin D1,E,p27,in these specimens.Results Of the 44 BP specimens,all were positive for HPV DNA,38(86.36％) for high risk types of HPV,and 6 for low risk types of HPV.Of the high risk HPV-positive specimens,30(68.18％) harbored HPV16,16 harbored single HPV 16,14 harbored other types of HPV besides HPV 16,8 harbored other high risk types of HPV.HPV 6 predominated in low risk HPV-positive specimens.The expression of cyclin D1 was significantly higher in patients with high-risk HPV(u =53.00,P＜ 0.05),with both high and low risk HPV(u =5.00,P＜ 0.01) and with low risk HPV (u =22.50,P＜ 0.05) than in normal human controls,and higher in patients with both high and low risk HPV (u =44.00,P＜ 0.01) and with low risk HPV (u =22.50,P＜ 0.05) than those with high risk HPV.In the case of cyclin E expression,patients with high risk HPV (u =0.00,P ＜ 0.01 ),with both high and low risk HPV (u =4.00,P ＜ 0.01 ),and with low risk HPV(u =1.50,P ＜ 0.01 ) were higher than normal human controls,and patients with high risk HPV were higher than those with low risk HPV(u =11.00,P ＜ 0.01).No significant difference was observed in the expression of p27 between patients with high and low risk types of HPV.A significant increase was observed in the expression of p27 in patients aged ＞ 50 years compared with patients aged 20-30 years(u =47.00,P＜ 0.05) and aged 31-50 years (u =55.50,P＜ 0.05),as well as in the expression of cyclin E in patients aged ＞ 50 years compared with those aged 20-30 years(u =45.50,P ＜ 0.05),and in female patients compared with male patients (u =137.50,P＜ 0.05).ConlusionThere is a significant difference in the expression of cyclin D1,E and p27 among patients with BP infected with different types of HPV.
ABSTRACT
As infecções causadas pelo papillomavírus humano ( HPV ) estão entre as infecções virais transmitidas sexualmente mais frequentes no mundo, sendo o condiloma sua apresentação mais comum. A prevalência de lesões pelo HPV é significativamente maior entre pacientes infectados pelo HIV. Embora haja muitos estudos a respeito da epidemiologia e patogênese da infecção pelo HPV em mulheres, pouco se conhece acerca dessa infecção em homens. Esse estudo tem por objetivo descrever as características da infecção pelo HPV encontradas em genitália externa de homens soropositivos para o HIV, e contribuir para o conhecimento da interação HIV/HPV. Trinta pacientes soropositivos para o HIV que apresentavam lesões em genitália externa relacionadas a infecção pelo HPV foram avaliados e os parâmetros clínicos, histopatológicos e imunológicos foram analisados de acordo com os tipos de HPV encontrados...
Os diagnósticos histopatológicos encontrados foram: papulose bowenóide (n=4) condiloma acuminado (n=23), sendo que 3 apresentavam displasia associada, carcinoma de células escamosas moderadamente diferenciado (n=1) e eritroplasia de Queyrat (n=1). Um paciente apresentou condiloma acuminado e papulose bowenóide ao mesmo tempo. Seis pacientes apresentaram somente HPVs de alto risco, 10 apresentaram somente HPVs de baixo risco, 13 apresentaram ambos os grupos e 1 paciente apresentou resultado negativo. A carga viral para o HPV de alto risco foi maior nos pacientes que apresentavam carcinoma e a carga viral para o HPV de baixo risco foi maior nos pacientes que apresentavam condiloma. Nosso trabalho corrobora a realização de biopsia em todas as lesões compatíveis com infecção pelo HPV presentes em região anogenital de homens soropositivos para o HIV para que um tratamento e acompanhamento adequados possam ser efetuados...
Subject(s)
Male , Condylomata Acuminata , HIV , Papillomavirus InfectionsABSTRACT
BACKGROUND: Bowenoid papulosis occurs primarily on the genitalia of young adults and this is characterized by multiple, apparently benign maculopapular lesions. Bowenoid papulosis shows the histopathological findings of a squamous cell carcinoma in situ, but it follows a largely benign clinical course. If it is misdiagnosed as malignant tumor, unnecessary excessive therapy may be performed. Therefore, exact recognition of this entity is important. OBJECTIVE: The purpose of this study is to examine the clinical and histopathologic features and outcomes of Bowenoid papulosis. METHODS: Twelve patients who had been diagnosed with Bowenoid papulosis between June 1996 and September 2007 were reviewed clinicopathologically. RESULTS: The mean age of the patients was 34.8 years (range: 23~57 years), and the mean duration of Bowenoid papulosis until presentation was 6.3 months (range: 5~48 months). Nine patients were males and 3 patients were females. Eleven patients (92%) had multiple lesions. The average size of the individual lesions was 1.4x0.6 cm in diameter. The colors of the papules were red to black. Seven of 9 male patients had lesions on the penile shaft, with 6 of those occurring at the proximal shaft. The other 2 male patients had lesions on the scrotum and perianal area, respectively. Three female patients had lesions on the labium major, labium major and clitoris, and perianal area respectively. Nine patients (75%) presented without symptom and 3 (25%) presented with mild pruritus. The histopathologic features were as follows: a rete ridge of approximately equal length and breadth throughout the entire lesion (100%), skipped areas of normal keratinocytes between zones of atypical keratinocytes (100%). necrotic keratinocytes (92%), parakeratosis (83%), mitotic figures (83%), vacuolated cells resembling owl's eyes (83%), multinucleated cells (67%), residual changes of typical condyloma acuminatum (17%), involvement of acrotrichia (100%) and involvement of acrosyringia (100%). Eleven patients were effectively treated with surgical excision (8 patients), CO2 laser (2 patients), diphenylcyclopropenone (DPCP) and immunotherapy (1 patient) and 1 patient underwent biopsy only. We followed 12 patients for an average 78.1 months (from 24 to 137 months). During this period, no recurrence or malignant transformation was observed. CONCLUSION: Bowenoid papulosis shows a form of squmaous cell carcinoma in situ for its histopathology, but it hardly ever progresses to squmaous cell carcinoma. On our long term follow-up, there was no malignant transformation. Thus, excessive treatment of Bowenoid papulosis by amputation of the external genitalia is not necessary. Therefore, a through understanding of the clinical and histopathologic features of this entity is necessary for making the diagnosis, the treatment planning and determining the prognosis.
Subject(s)
Female , Humans , Male , Young Adult , Amputation, Surgical , Biopsy , Carcinoma in Situ , Carcinoma, Squamous Cell , Clitoris , Cyclopropanes , Eye , Follow-Up Studies , Genitalia , Immunotherapy , Keratinocytes , Lasers, Gas , Parakeratosis , Prognosis , Pruritus , Recurrence , ScrotumABSTRACT
Bowenoid papulosis of the genitalia follows usually benign clinical course. There are only a few reports in literature stating the occurrence of invasive carcinoma related with bowenoid papulosis. The current report demonstrates invasive carcinoma of vulva arising from bowenoid papulosis. The patient underwent clitoris sparing radical vulvectomy, perianal wide excision and cutaneous free flap, however, she experienced recurrence. She underwent concurrent chemoradiation for secondary treatment.
Subject(s)
Female , Humans , Clitoris , Free Tissue Flaps , Genitalia , Recurrence , Vulva , Vulvar NeoplasmsABSTRACT
Bowenoid papulosis (BP) is largely a disease of young, sexually active adults, which presents with pink or flesh colored macular or papular lesions in the anogenital area. It has been established that various human papilloma virus (HPV) types are the causative agents of BP and of these, HPV-16, the oncogenic one, is the most common. The course of BP is variable, ranging from spontaneous regression to persistent of lesions to a transformation into squamous cell carcinoma. We report a case of Bowenoid papulosis in a 29-year-old, sexually active female whose anogenital area was covered with innumerable papular lesions extended to the lower extremities.
Subject(s)
Adult , Female , Humans , Carcinoma, Squamous Cell , Human papillomavirus 16 , Lower Extremity , PapillomaABSTRACT
La infección por virus de papiloma humano constituye una de las más frecuentes enfermedades de transmisión sexual. Dentro de los más de 100 tipos de virus descriptos hasta el momento, varios de los mismos son capaces de inducir transformación maligna de las células huésped. El presente trabajo consiste en una revisión de las diferentes modalidades terapéuticas utilizando una estrategia de medicina basada en evidencia.
The infection by human papillomavirus is one of the most frequent sexually transmitted diseases. Among more than 100 types of HPV described, several are capable of inducing malignant transformation in host cells. This work intend to review the different therapeutic modalities using an evidence based medicine strategy.
Subject(s)
Humans , Male , Female , Papillomavirus Infections/therapy , Communicable Disease Control/methods , Condylomata Acuminata/diagnosis , Condylomata Acuminata/drug therapy , Diagnosis, Differential , Papillomaviridae/growth & development , Papillomaviridae/pathogenicityABSTRACT
Objective To study the histopathological changes and biological behavior of bowenoid papulosis and its relationship with apopotosis.Methods 20 bowenoid papuloses and 5 normal skin tissues were examined by DNA nick end labeling(TUNEL) technique and the pathological changes of bowenoid papulosis were observed by Hematoxylin-eosin-stained.Results Bowenoid papulosis exhibited disordered maturation and scattered,large,highly atypical cells mitoses throughout all layers of epithelium;and there were few apoptotic cells in 5 normal skin tissuese and many apoptotic cells in bowenoid papuloses.The apoptotic index(27.1?15.1) in bowenoid papulosis patients was significantly higher than that in control group(6.8?3.5)(P
ABSTRACT
Bowenoid papulosis(BP) is characterized by multiple papules with a benign clinical course but having a histopathology of squamous cell carcinoma in situ on the external genitalia of sexually active men and women. It is well known that the Human papilloma virus(HPV) is connected with the development of BP. Out of these, HPV 16 which has been frequently found in the BP lesions is an oncogenic virus and the theory that BP might progress to intraepithelial neoplasia and advanced carcinoma has been postulated. Local destructive therapy including electrodessication, laser surgery, cryosurgery, and surgical excision is effective and produces a low recurrence rate. However, pain, bleeding, restriction in activity, and postoperative scars are inevitable with complete destruction of the multiple lesions. It has been suggested that diphenylcyclopropenone(DCP) might be a promising therapeutic agent for various viral diseases including HPV-related warts, It is a potent sensitizer which is not mutagenic and works by the induction of type IV hypersensitivity response in HPV infected tissue, leading to wart destruction. We herein, report 2 cases of HPV 16-positive BP treated with DCP immunotherapy.
Subject(s)
Female , Humans , Male , Carcinoma, Squamous Cell , Cicatrix , Cryosurgery , Genitalia , Hemorrhage , Human papillomavirus 16 , Hypersensitivity, Delayed , Immunotherapy , Laser Therapy , Oncogenic Viruses , Papilloma , Recurrence , Virus Diseases , WartsABSTRACT
Objective To study the expression of telomerase and its possible clinical significance in patients with condyloma acuminatum,bowenoid papulosis,Bowen's disease and vulvar squamous cell car- cinoma.Methods The human telomerase reverse transcriptase (hTERT) was detected by immunohisto- chemistry technique in all patients.Histopathological analysis was done in patients with bowenoid papulosis or Bowen's disease.Results There was a significant difference in the expression of hTERT among normal tissue,condyloma acuminatum and squamous carcinoma,and the expression rate increased successively from normal control to squamous carcinoma.In bowenoid papulosis,the expression of bTERT was significantly higher as compared to that in condyloma acuminatum,significantly lower as compared to that in squamous carcinoma,and was as the same as that in Bowen's disease.Histopathologically,the degree of cell atypia was significantly higher in Bowen's disease than that in bowenoid papulosis.Conclusions The expression of telomerase increases successively from normal skin,benign tumors to malignant carcinomas,which sug- gests that the expression of telomerase may play an important role in both cell proliferation and immortaliza- tion.
ABSTRACT
Bowenoid papulosis is manifested by clinically the benign-appearing papules of anogenital region and histopathologically similar features of squamous cellurar inoma in situ in human. A cause is thought to be Human Papillomavirus infection, type 16. The treatment is mainly through conservative management but others are topical application of podophyllin, shave excision, local excision, cryotherapy, electrodessication, topical applcation of 5-FU ointment and subcutaneous injection of recombinant interferon gamma. We present a case of Howenoid papulosis treated with DNCB imriunotherapy. The patient, had multiple papules on the penis with mild pruitus. Histopatnologic findings showed crowding and irregular arrangement of the nucleic many of which are large, hyperchromatic, and pleomorphic. Dyskeratotic and multinucleated keratinocytes wire also present, as were atypical mitoses, scattered in epidermal layer. We treated him with DNCB immunotherapy. Initially he was sensitized with 2,000 ug/0.1ml and two weeks later he received 50 ug/0.1ml per every week. After 3 weeks, he had showed no improvement and we elevated the dose to 100 ug/0.1ml. He was improved after 6th trial and his skir. lesions were almostly disappeared at present.
Subject(s)
Humans , Male , Crowding , Cryotherapy , Dinitrochlorobenzene , Fluorouracil , Immunotherapy , Injections, Subcutaneous , Interferons , Keratinocytes , Mitosis , Papillomavirus Infections , Penis , PodophyllinABSTRACT
Fourteen cases of bowenoid papulosis were studied both clinically and histologically and were compared with 22 cases of Bowen's disease to find histologic differences between the two diseases. Bowenoid papulosis was prevalent in young, sexually active adults, consisted of multiple erythematous or hyperpigmented papules, and located mostly on the penis and vulva. The main histologic characteristics of bowenoid papulosis were an orderly background of keratinocyte maturation of the epidermis with monotonous pattern, the frequent presence of 'skip area', and the lesser degree of cytologic atypia than seen in lesions of Bowen's disease. In addition, mitotic figures more than 5 per x400 filed, formation of keratin pearl, and spindling of keratinocytes, which have not been described in other articles yet, are considered very important findings for the diagnosis of bowenoid papulosis. It is our opinion that bowenoid papulosis can be reliably distinguished from Bowen's disease by light microscopic features. Paraffin-embedded samples of bowenoid papulosis, Bowen's disease, and normal skin were investigated with antibodies against S 100-protein to relate the number of intraepidermal Langerhans cells and the disease. Langerhans cells were found to be reduced when compared with normal skin. No significant differences between Bowen's disease and bowenoid papulosis were found in density of Langerhans cells.
Subject(s)
Adult , Male , Female , HumansABSTRACT
Bowenoid papulosis is a popular dermatitis occurring primarily on the genitalia of young adults, almost all under the age of 40. Multiple small reddish brown papules are seen varing from 2mm to 10mm in size. that clinically appear to be benign, but histologically show features in common with squamous cell carcinoma in situ. The clinical diagnosis commonly, but erroneously, given to this entity include lichen planus, verruca vulgaris. condyloma accuminatum, granuloma annulare and nevocellular nevus. Herein we report a case of bowenoid papulosis in a 31-year-old male who underwent rebiopsy and review of clinical finding after diagnosis of penile squamous cell carcinoma.
Subject(s)
Adult , Humans , Male , Young Adult , Carcinoma, Squamous Cell , Dermatitis , Diagnosis , Genitalia , Granuloma Annulare , Lichen Planus , Nevus , WartsABSTRACT
Bowenoid papulosis is a popular dermatitis occurring primarily on the genitalia of young adults, almost all under the age of 40. Multiple small reddish brown papules are seen varing from 2mm to 10mm in size. that clinically appear to be benign, but histologically show features in common with squamous cell carcinoma in situ. The clinical diagnosis commonly, but erroneously, given to this entity include lichen planus, verruca vulgaris. condyloma accuminatum, granuloma annulare and nevocellular nevus. Herein we report a case of bowenoid papulosis in a 31-year-old male who underwent rebiopsy and review of clinical finding after diagnosis of penile squamous cell carcinoma.