Isolated extragenital bowenoid papulosis of the neck

Extragenital Bowenoid Papulosis Associated with Atypical Human Papillomavirus Genotypes

Background:

Bowenoid papulosis typically appears as grouped violaceous or red-brown papules in the genital or perianal regions and clinically resembles condylomata acuminata. Isolated extragenital bowenoid papulosis is rare and has been reported in only a few case reports.

Objectives:

A 51-year-old immunocompetent, healthy woman had two solitary papules on the elbow; a 41-year-old HIV-positive man had a solitary cutaneous plaque on the abdomen. No genital, periungual, or other extragenital sites of involvement were noted in either patient. The diagnosis was confirmed histologically in both cases. Lesional skin from the female patient was tested with the Digenehybrid HPV DNA assay and was positive for a mixture of low-risk HPV subtypes (6, 11, 42, 43, 44). Lesional skin from the male patient was tested with polymerase chain reaction (PCR). Consensus primers targeted for the HPV L1 region, which is a highly conserved sequence common to more than 20 HPV subtypes encoding a viral capsid protein, were used. PCR using the consensus primers was positive, but type-specific probes for HPV types 6, 11, 16, 18, 45, 31, 33, 35, and 39 were negative.

Conclusions:

To our knowledge, our male patient represents the first case of isolated bowenoid papulosis of the abdominal skin. Isolated upper-extremity bowenoid papulosis in our female patient is also a unique case in both location and involvement of low-risk HPV types (6, 11, 42, 43, 44), which have not been previously associated with extragenital bowenoid papulosis.

A case of isolated bowenoid papulosis of the nipple

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.

Oral bowenoid papulosis in an HIV-positive male

Bowenoid papulosis (BP) is a condition triggered by human papillomavirus infection and characterized by the development of 1 or more warty lesions, usually in the anogenital region. Although the oral cavity has been known to host several types of warts, thus far only 4 cases of BP have been reported in this anatomic site. We describe a 42-year-old male with AIDS who presented with numerous papillary lesions of the labial mucosa and vermilion. Biopsy yielded a diagnosis of BP. Treatment of the condition consisted of intralesional and subcutaneous injections of interferon-alpha followed by topical application of imiquimod 5% cream. Neither regimen resulted in resolution of the lesions. To our knowledge, this represents the first case of BP arising in the oral mucosa of an HIV-infected individual.

Molecular diagnosis of infectious diseases in dermatology

The molecular diagnosis of infectious disease has been growing considerably over the past decade. Nucleic acid amplification techniques, such as polymerase chain reaction, ligase chain reaction, transcription-mediated amplification, and nucleic acid sequence-based amplification, provide highly accurate diagnosis of numerous bacterial, viral, fungal, and parasitic infections involved in a variety of dermatologic diseases. In addition, signal amplification with hybrid capture, branched-DNA assays, and in situ hybridization have been used to detect numerous viral pathogens with high degrees of sensitivity and specificity. New technology that involves the use of DNA and protein microarrays has also enabled the detection of a variety of genes and gene mutations. With time, these diagnostic assays are decreasing in cost, gaining approval of the U.S. Food and Drug Administration, and becoming easier and more efficient to use. In the future, these assays will be able to deliver rapid and accurate diagnosis of infectious diseases within a single clinic visit.

LEARNING OBJECTIVE

At the completion of this learning activity, participants should be familiar with molecular diagnosis of infectious diseases in dermatology.

Human papillomavirus-32-positive extragenital Bowenoid papulosis (BP) in a HIV patient with typical genital BP localization

OBJECTIVES

Bowenoid papulosis (BP) is characterized by multiple maculopapular lesions of the genitalia; extragenital localization is rarely found. Human papillomavirus (HPV) type 16 has been found in most cases of BP, but the other HPV genotypes associated with BP had been poorly characterized.

GOAL

We describe an extragenital BP with concomitant genital involvement in an HIV-positive woman.

STUDY

Several HPV gene-specific amplifications and sequencing were performed on DNA extracted from biopsy samples.

RESULTS

The presence of HPV-16 DNA in anogenital and HPV-32 DNA in lip lesions was demonstrated in the absence of any other HPV type and with no coinfection. Semiquantitative polymerase chain reaction analysis revealed that HPV-16 and -32 DNA sequences are in the episomal state.

CONCLUSIONS

This is the first report of BP associated with HPV-32 (the causative agent of a benign hyperplasia) and a rare case of BP associated with 2 HPV types in the same patient. The immune depression could have modified the normal benign progression of the extragenital lesions.

Bilateral Bowen's disease

Multiple Bowen's disease may be difficult to differentiate from bowenoid papulosis because of its clinicopathological resemblance to bowenoid papulosis. We experienced a case of bilaterally and symmetrically developed multiple bowenoid lesions in a 71-year-old man previously diagnosed as having chronic lymphocytic lymphoma (CLL). Based on histological findings and the results of human papillomavirus examinations, we finally diagnosed this case as bilateral Bowen's disease. We speculate that the underlying immunosuppressive state due to CLL may have been associated with onset of the disease. We report the unique clinical picture, the differential diagnosis and the aetiology.

Morphometric assessment of nuclei in Bowen's disease and bowenoid papulosis

BACKGROUND

Occasionally, Bowen's disease and bowenoid papulosis cannot be distinguished in microscopic finding. Their clinical presentations are quite different from one another. The purpose of this study was to evaluate the histological differences in Bowen's disease and bowenoid papulosis, by comparing the size and shape of nuclei, using image analysis system.

METHODS

We performed morphometric assessment on 13 specimens of Bowen's disease and eight specimens of bowenoid papulosis using an image analysis system, and the following parameters were calculated, such as nuclear contour index (NCI), irregularities of nucleus (IN), form factor (form AR) and circulatory factor (form PE).

RESULTS

For NCI, there were significant differences between the Bowen's disease and bowenoid papulosis, and IN also shows significant differences between these two dis-eases, showing that Bowen's disease has more corrugated or indented nucleus contour than bowenoid papulosis. In the parameter of form PE, there were significant differences between the two diseases, indicating that Bowen's disease has more oval-shaped nuclei than bowenoid papulosis. There were no significant differences in form factor between Bowen's disease and bowenoid pupulosis.

CONCLUSIONS

Significant differences were found in the morphometric evaluation between Bowen's disease and bowenoid papulosis. The nuclei were larger, more oval and more irregular margins in Bowen's disease than bowenoid papulosis.

Extragenital bowenoid papulosis associated with atypical human papillomavirus genotypes

BACKGROUND

Bowenoid papulosis typically appears as grouped violaceous or red-brown papules in the genital or perianal regions and clinically resembles condylomata acuminata. Isolated extragenital bowenoid papulosis is rare and has been reported in only a few case reports.

OBJECTIVES

A 51-year-old immunocompetent, healthy woman had two solitary papules on the elbow; a 41-year-old HIV-positive man had a solitary cutaneous plaque on the abdomen. No genital, periungual, or other extragenital sites of involvement were noted in either patient. The diagnosis was confirmed histologically in both cases. Lesional skin from the female patient was tested with the Digenehybrid HPV DNA assay and was positive for a mixture of low-risk HPV subtypes (6, 11, 42, 43, 44). Lesional skin from the male patient was tested with polymerase chain reaction (PCR). Consensus primers targeted for the HPV L1 region, which is a highly conserved sequence common to more than 20 HPV subtypes encoding a viral capsid protein, were used. PCR using the consensus primers was positive, but type-specific probes for HPV types 6, 11, 16, 18, 45, 31, 33, 35, and 39 were negative.

CONCLUSIONS

To our knowledge, our male patient represents the first case of isolated bowenoid papulosis of the abdominal skin. Isolated upper-extremity bowenoid papulosis in our female patient is also a unique case in both location and involvement of low-risk HPV types (6, 11, 42, 43, 44), which have not been previously associated with extragenital bowenoid papulosis.

Isolated human papillomavirus 18-positive extragenital bowenoid papulosis and idiopathic CD4+ lymphocytopenia

We report a case of isolated extragenital bowenoid papulosis (BP) in a young man with an idiopathic low CD4 count. The lesions occurred on the dorsal aspect of his left middle finger and were not associated with genital involvement. Polymerase chain reaction studies of a biopsy demonstrated human papillomavirus 18. As far as we are aware, this is the first documented case of BP (genital or extragenital) associated with idiopathic CD4 lymphocytopenia.