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Lieblong BJ, Montgomery BEE, Su LJ, Nakagawa M. Natural history of human papillomavirus and vaccinations in men: A literature review. Health Sci Rep 2019; 2:e118. [PMID: 31139757 PMCID: PMC6529831 DOI: 10.1002/hsr2.118] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/07/2018] [Accepted: 02/09/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND AIMS Infection with high-risk (HR) genotypes of the human papillomavirus (HPV) is necessary for and causative of almost all cervical cancers and their precursor condition, cervical intraepithelial neoplasia. These conditions have been sharply reduced by cervical cytology screening, and a further decrease is expected because of the recent introduction of prophylactic HPV vaccinations. While significant attention has been given to gynecologic HPV disease, men can be affected by HPV-related cancers of the anus, penis, and oropharynx. This literature review aims to address disparities in HPV-related disease in men, and certain HR male subpopulations, compared with women. DISCUSSION Overall, immunocompetent men are far less likely than women to develop anogenital HPV-related cancers, despite harboring HR HPV infections at anogenital sites. On the other hand, men who have sex with men and men living with human immunodeficiency virus infection are at considerably higher risk of HPV-related disease. Historic rates of prophylactic HPV vaccination in males have trailed those of females due to numerous multilevel factors, although, in recent years, this sex gap in vaccination coverage has been closing. In the absence of routine HPV screening in males, therapeutic vaccinations have emerged as a potential treatment modality for preinvasive neoplasia and are in various phases of clinical testing. CONCLUSION Successful reductions in HPV disease morbidity at the population level must acknowledge and target HPV infections in men.
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Affiliation(s)
- Benjamin J. Lieblong
- College of Medicine, Department of PathologyUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - Brooke E. E. Montgomery
- Faye W. Boozman College of Public Health, Department of Health Behavior and Health EducationUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - L. Joseph Su
- Faye W. Boozman College of Public Health, Department of EpidemiologyUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - Mayumi Nakagawa
- College of Medicine, Department of PathologyUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
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2
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Chan MP. Verruciform and Condyloma-like Squamous Proliferations in the Anogenital Region. Arch Pathol Lab Med 2018; 143:821-831. [PMID: 30203987 DOI: 10.5858/arpa.2018-0039-ra] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
CONTEXT.— Histologic distinction between condyloma acuminatum and various benign and malignant condyloma-like lesions in the anogenital area poses a common diagnostic challenge to pathologists across subspecialties. OBJECTIVE.— To review the overlapping and distinguishing features of condyloma acuminatum and its mimics, and to clarify confusing terminology and diagnostic criteria for problematic entities. DATA SOURCES.— A review of the literature on condyloma acuminatum (ordinary and giant types), verrucous carcinoma, warty/warty-basaloid high-grade squamous intraepithelial lesion and squamous cell carcinoma, papillary squamous cell carcinoma, bowenoid papulosis, verruca vulgaris, epidermolytic acanthoma, and verruciform xanthoma was performed. CONCLUSIONS.— Correct diagnosis of condyloma acuminatum and condyloma-like lesions has important clinical implication and entails familiarization with their clinical presentations and histopathologic features. Contrary to historical belief, giant condyloma acuminatum and verrucous carcinoma should be considered distinct entities based on different pathogenetic pathways. Ancillary tools available for identifying and genotyping human papillomavirus can aid in diagnosis when histopathologic findings are inconclusive. Recognition of relatively rare entities such as bowenoid papulosis, epidermolytic acanthoma, and verruciform xanthoma would avoid overdiagnosis and unnecessary, overaggressive treatment.
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Affiliation(s)
- May P Chan
- From the Department of Pathology, University of Michigan Health System, Ann Arbor
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3
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Papadopoulos AJ, Schwartz RA, Lefkowitz A, Tinkle LL, Jänniger CK, Lambert WC. Extragenital Bowenoid Papulosis Associated with Atypical Human Papillomavirus Genotypes. J Cutan Med Surg 2016. [DOI: 10.1177/120347540200600204] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
| | - Robert A. Schwartz
- Dermatology, Pediatrics and Pathology, New Jersey Medical School, Newark, New Jersey, USA
| | - Aza Lefkowitz
- Dermatology, Pediatrics and Pathology, New Jersey Medical School, Newark, New Jersey, USA
| | - Lily L. Tinkle
- Dermatology, Pediatrics and Pathology, New Jersey Medical School, Newark, New Jersey, USA
| | - Camila K. Jänniger
- Dermatology, Pediatrics and Pathology, New Jersey Medical School, Newark, New Jersey, USA
| | - W. Clark Lambert
- Dermatology, Pediatrics and Pathology, New Jersey Medical School, Newark, New Jersey, USA
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4
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Shimizu A, Kato M, Takeuchi Y, Sano T, Kaira K, Uezato H, Ishikawa O. Detection of human papillomavirus (
HPV
) in patients with squamous cell carcinoma and the clinical characteristics of
HPV
‐positive cases. Br J Dermatol 2014; 171:779-85. [DOI: 10.1111/bjd.13234] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2014] [Indexed: 12/12/2022]
Affiliation(s)
- A. Shimizu
- Department of Dermatology Gunma University Graduate School of Medicine 3‐39‐22 Showa‐machi Maebashi Gunma371‐8511 Japan
| | - M. Kato
- Department of Dermatology Gunma University Graduate School of Medicine 3‐39‐22 Showa‐machi Maebashi Gunma371‐8511 Japan
| | - Y. Takeuchi
- Department of Dermatology Gunma University Graduate School of Medicine 3‐39‐22 Showa‐machi Maebashi Gunma371‐8511 Japan
| | - T. Sano
- Department of Diagnostic Pathology Gunma University Graduate School of Medicine 3‐39‐22 Showa‐machi Maebashi Gunma371‐8511 Japan
| | - K. Kaira
- Department of Oncology Clinical Development Gunma University Graduate School of Medicine 3‐39‐22 Showa‐machi Maebashi Gunma371‐8511 Japan
| | - H. Uezato
- Department of Dermatology Graduate School of Medicine University of the Ryukyus 207 Uehara Nishihara Okinawa 903‐0215 Japan
| | - O. Ishikawa
- Department of Dermatology Gunma University Graduate School of Medicine 3‐39‐22 Showa‐machi Maebashi Gunma371‐8511 Japan
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5
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A combined assay of hTERT and E6 oncoprotein to identify virus-infected keratinocytes with higher telomerase activity in human papillomaviruses 16 and 18-related bowenoid papulosis. Am J Dermatopathol 2013; 34:813-7. [PMID: 22688392 DOI: 10.1097/dad.0b013e318252f956] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In the present study, we aim to evaluate the application potential of a combined assay of human telomerase reverse transcriptase (hTERT) and E6 oncoprotein in screening the virus-infected keratinocytes with higher telomerase activity in human papillomaviruses (HPV) 16- and 18-related bowenoid papulosis (BP). HPV16/18 DNA in BP (n = 123) was identified by in situ hybridization, the expression of hTERT and E6 in HPV16/18-related BP (n = 68) was determined by immunohistochemistry. We demonstrated that the expression of hTERT correlated well with that of E6 oncoprotein in HPV16/18-related BP lesions (Spearman rho = 0.868, P < 0.01). Furthermore, the majority of keratinocytes with positive nuclear staining for hTERT or E6 in the consecutive sections of each HPV16/18-related BP lesion showed nuclear paleomorphism or nuclear mitosis. In conclusion, we suggested that a combined assay of hTERT and E6 oncoprotein can be used to screen the HPV-infected keratinocytes with higher telomerase activity in HPV16-related and HPV18-related BP lesions.
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6
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Gormley RH, Kovarik CL. Human papillomavirus–related genital disease in the immunocompromised host. J Am Acad Dermatol 2012; 66:867.e1-14; quiz 881-2. [DOI: 10.1016/j.jaad.2010.12.050] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 12/17/2010] [Accepted: 12/19/2010] [Indexed: 11/30/2022]
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7
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Wikström A, Hedblad MA, Syrjänen S. Penile intraepithelial neoplasia: histopathological evaluation, HPV typing, clinical presentation and treatment. J Eur Acad Dermatol Venereol 2011; 26:325-30. [DOI: 10.1111/j.1468-3083.2011.04069.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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8
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Bigot P, Longvert C. [Penile dermatological lesions: how to identify premalignant lesions?]. Prog Urol 2011; 21 Suppl 2:S50-2. [PMID: 21397829 DOI: 10.1016/s1166-7087(11)70011-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Penile squamous cell carcinoma is a highly evolving tumor. Thus an early diagnosis is a major matter in order to avoid tumoral spread and mutilating surgery. Intra-epithelial neoplasia is a carcinoma in situ involving a disorganized cytological structure and intraepithelial architecture without any change on the derma. It has a bimodal pathogenesis: it can be induced by papilloma virus HPV infection and thus Bowen's disease or Bowenoïd papulosis, or by a lichen sclerosus. Bowen's disease concerns mainly men after 50 years old. There are not any spontaneous remission and it transforms slowly in 20-30% of the cases into a squamous cell carcinoma. Its treatment is surgical removal of the lesion. The Bowenoïd papulosis concerns mainly young men. These lesions are rarely invasive and are likely to regress spontaneously. It can be treated conservatively. The lichen sclerosis is an inflammatory chronic disease which etiology is still unknown. It is localized on the glans and the prepuce. Its treatment is essentially circumcision. After treatment, patients must be followed-up and biopsies must be performed for any sign of degeneration.
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Affiliation(s)
- P Bigot
- Service d'Urologie, CHU d'Angers, 4 rue Larrey, 49933 Angers Cedex, France.
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10
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Minhas S, Manseck A, Watya S, Hegarty PK. Penile cancer--prevention and premalignant conditions. Urology 2010; 76:S24-35. [PMID: 20691883 DOI: 10.1016/j.urology.2010.04.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 04/09/2010] [Accepted: 04/09/2010] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Relatively little evidence is available in the published studies on the prevention of penile cancer and premalignant conditions of the penis. The present review examined the current evidence available in preventing penile cancer and pathologic subtypes of premalignant conditions and their treatment. The recommendations made in the present review formulate the basis of the recent 2009 International Consultation on Urologic Disease Consensus Publishing Group. METHODS The association of human papillomavirus subtypes and penile cancer is well-established, although the etiology, natural history, and treatment of premalignant lesions have mainly been reported in retrospective case series with short-term follow-up. The exact pathologic role of chronic inflammatory conditions, such as balanitis xerotica obliterans in the etiology of penile cancer remains largely unknown. RESULTS Some of the potential strategies for the prevention of penile cancer could include circumcision, reducing the risk of transmission of penile human papillomavirus infection with male vaccination, early treatment of phimosis, smoking cessation, and hygienic measures. Implementing some of these measures would require extensive cost/benefit analysis, with significant changes in the global health policy. CONCLUSIONS Owing to the current levels of evidence from published studies, firm guidelines cannot be formulated for the treatment of premalignant conditions, although preventative measures, such as reducing human papillomavirus transmission, could become strategic health targets.
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Affiliation(s)
- Suks Minhas
- Institute of Urology, Division of Surgical and Interventional Sciences, University College London, 25 Grafton Way, London, United Kingdom.
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11
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Les lésions précancéreuses du pénis. Ann Dermatol Venereol 2010; 137:486-92; quiz 485, 493-4. [DOI: 10.1016/j.annder.2010.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Accepted: 03/12/2010] [Indexed: 11/20/2022]
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12
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De Gusmão Nunes M, Azevedo-E-Silva M, Gonçalves CP, Trope BM, Oliveira LDHDS, Ramos-E-Silva M. Human papillomavirus detection and typification in cutaneous and mucosal lesions of HIV-seropositive patients. Int J STD AIDS 2008; 19:611-6. [DOI: 10.1258/ijsa.2007.007224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Summary: High-risk human papillomavirus (HPV) in a lesion is related to an increased chance of neoplasic transformation, especially when with immunosuppression, as in HIV infection. We investigated HPV frequency in cutaneous and mucosal lesions of HIV-seropositive male patients. The frequency of malignancy, its association with the HPV type detected and some clinical variables were also assessed. A total of 38 lesions from 27 patients were studied in a period of 18 months. The biopsied fragment was submitted to HPV detection and typification, through polymerase chain reaction with generic (MY09/11) and specific (types 6, 11, 16 and 18) primers. HPV frequency was 63.2%, with detection of HPV types 6, 11 or 16 in 18 lesions and with multi-infection in three. There was low detection of high-risk HPV (type 16, 18.4%) and no HPV type 18. Of the lesions, 36.8% were already premalignant or malignant, and the frequency of moderate or severe dysplasia was higher in the study patients than that described in the HIV-seronegative population. High-risk HPV (type 16) was detected in four benign lesions and low-risk HPV (type 6) in three premalignant genital lesions. There was no significant association between the clinical variables and an increase in the prevalence of premalignant or malignant lesions.
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Affiliation(s)
- Mariana De Gusmão Nunes
- Sector of Dermatology and Post Graduation course in Dermatology, Universidade Federal do Rio de Janeiro, Rio de Janeiro
| | - Melissa Azevedo-E-Silva
- Sector of Dermatology and Post Graduation course in Dermatology, Universidade Federal do Rio de Janeiro, Rio de Janeiro
| | - Carolina Pereira Gonçalves
- Sector of Dermatology and Post Graduation course in Dermatology, Universidade Federal do Rio de Janeiro, Rio de Janeiro
| | - Beatriz Moritz Trope
- Sector of Dermatology and Post Graduation course in Dermatology, Universidade Federal do Rio de Janeiro, Rio de Janeiro
| | | | - Marcia Ramos-E-Silva
- Sector of Dermatology and Post Graduation course in Dermatology, Universidade Federal do Rio de Janeiro, Rio de Janeiro
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13
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14
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GULDBAKKE KJETILK, BRODSKY JOSHUA, LIANG MICHELLE, SCHANBACHER CARLF. Human Papillomavirus Type 73 in Primary and Recurrent Periungual Squamous Cell Carcinoma. Dermatol Surg 2008; 34:407-13. [DOI: 10.1111/j.1524-4725.2007.34081.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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15
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Herat A, Whitfeld M, Hillman R. Anal intraepithelial neoplasia and anal cancer in dermatological practice. Australas J Dermatol 2007; 48:143-53; quiz 154-5. [PMID: 17680964 DOI: 10.1111/j.1440-0960.2007.00369.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Anal intraepithelial neoplasia is considered to be a precursor lesion of invasive anal cancer. It is now increasingly recognized in high-risk groups, such as men who have sex with men and HIV-infected patients. Human papillomaviruses are considered to be an important aetiological agent in both anal intraepithelial neoplasia and anal cancer. Dermatologists are likely to encounter these conditions among the differential diagnoses to be considered in high-risk patients presenting with perianal and anal lesions. Anal cancer rates are also increasing among the HIV-infected and HIV-non-infected population. The successful treatment of anal intraepithelial neoplasia may reduce the risk of subsequent development of anal cancer. However, current therapies for anal intraepithelial neoplasia may be associated with treatment-related morbidity and are not well validated. It is currently not proven that they reduce the likelihood of the development of anal cancer. Nevertheless, screening for anal intraepithelial neoplasia is being advocated for high-risk groups and may become standard dermatological care for these patients. In view of recent developments in the understanding of this condition, this article reviews the current understanding of anal intraepithelial neoplasia and its treatment from a dermatological perspective.
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Affiliation(s)
- Asoka Herat
- Skin and Cancer Foundation, Darlinghurst, New South Wales, Australia.
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16
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Schmitz MW, Goldberg LJ, Adler AJ. An extensive case of Bowen's disease in an HIV-positive male. AIDS Patient Care STDS 2007; 21:78-80. [PMID: 17328656 DOI: 10.1089/apc.2006.0059] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Bowen's disease is a form of squamous cell carcinoma in situ often associated with human papillomavirus (HPV). HPV has been hypothesized to cause in situ carcinoma via multiple mechanisms including cell immortalization and cell cycle disruption. Coinfection with HIV is associated with greater risk of malignancy. We describe a case of HPV-associated Bowen's disease in a 44-year-old African American male with sexually acquired HIV (CD4 < 20) who presented with an extensive skin lesion encompassing his penis, scrotum, and left inguinal canal.
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Affiliation(s)
- Michael W Schmitz
- Department of Internal Medicine, St. Barnabas Hospital, Bronx, New York 10458, USA.
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17
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Palamaras I, Hamill M, Sethi G, Wilkinson D, Lamba H. The usefulness of a diagnostic biopsy clinic in a genitourinary medicine setting: recent experience and a review of the literature. J Eur Acad Dermatol Venereol 2006; 20:905-10. [PMID: 16922935 DOI: 10.1111/j.1468-3083.2006.01563.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Genital diseases include a wide range of lesions e.g. infectious and inflammatory. In most cases a clinical diagnosis is reached without the need for a biopsy. Nonetheless, a genital biopsy is safe and may help to confirm the diagnosis. We established a dedicated diagnostic biopsy clinic in 2003. Our objective was to evaluate the effectiveness of our diagnostic biopsy clinic and compare it with other Genitourinary medicine (GUM) clinics in the UK. A retrospective case-note study was performed on 71 patients referred to the biopsy clinic with persistent genital lesions over a 12-month period. Forty-seven biopsies were performed (71% biopsy rate). 43 specimens (92%) were appropriate for histopathological diagnosis. Of these 15% were lichen planus, 15% lichen sclerosis, 10% psoriasis, 7.5% each: eczema, Zoon's and non-specific balanitis. The remainder represented a variety of other conditions. In 27 cases (68%) the clinical diagnosis was consistent with the histological result. The possibility of self-referral and walk-in nature of our GUM service substantially decrease the waiting times for assessment of anogenital disorders. We had a lower biopsy rate for the diagnosis of non-specific balanitis (7.5%) compared with the average rate (21.5%) in 14 UK GUM clinics and good agreement between clinical and histological diagnosis. An empirical first treatment, with simple emollients before biopsy, appears to be a safe clinical approach for the treatment of non-specific balanitis. A multidisciplinary approach (GUM physicians, dermatologists and urologists/gynaecologists) could help prevent unnecessary biopsies and improve correlation between clinical and histological diagnosis.
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Affiliation(s)
- I Palamaras
- Department of Genitourinary Medicine, Jefferiss Wing, St Mary's Hospital, London W2 1NY, UK.
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18
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Abstract
Human papillomavirus (HPV) infection is causally related to several benign and malignant diseases of the anogenital tract. In this article the authors detail the epidemiology, methods of transmission and risk factors, pathogenesis, and oncogenesis of HPV, and describe clinical manifestations and current treatments. Special attention is given to condyloma acuminatum and non-cervical anogenital intraepithelial neoplasia. The authors conclude with the latest information on prophylactic vaccine development and prospects for future control of HPV-related disease.
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Affiliation(s)
- Ammar M Ahmed
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
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Micali G, Nasca MR, Innocenzi D, Schwartz RA. Penile cancer. J Am Acad Dermatol 2006; 54:369-91; quiz 391-4. [PMID: 16488287 DOI: 10.1016/j.jaad.2005.05.007] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2004] [Revised: 03/30/2005] [Accepted: 05/03/2005] [Indexed: 11/24/2022]
Abstract
UNLABELLED Penile cancer, while relatively rare in the western world, remains a disease with severe morbidity and mortality, not to mention significant psychological ramifications. Furthermore, the disease is observed with dramatically increased incidence in other parts of the world. A review of the literature has shown that the overwhelming majority of penile cancers are in situ or invasive squamous cell carcinomas, including a well-differentiated variant, verrucous carcinoma. Important predisposing factors are lack of circumcision, human papillomavirus infections, and penile lichen sclerosus, although other factors have occasionally been reported as well. Prevention, careful monitoring of patients at risk, and early diagnosis are essential to reduce the incidence of penile carcinoma and to provide a definitive cure. Public health measures, such as prophylactic use of circumcision, have proved successful but are controversial. Also, no standard therapeutic guidelines as to the best treatment strategy according to different stages, including efficacy of conservative nonsurgical modalities and indications for lymph nodal dissection, are available so far. It is common opinion that penile cancer is an emerging problem that deserves further investigations, and physicians, especially dermatologists, should be aware of this issue. LEARNING OBJECTIVE At the completion of this learning activity, participants should be familiar with penile carcinoma, its risk factors, its clinical and histologic presentation, and the treatments currently available for its management.
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Affiliation(s)
- Giuseppe Micali
- Department of Dermatology, University of Catania School of Medicine, Catania, Italy.
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20
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Rinaggio J, Glick M, Lambert WC. Oral bowenoid papulosis in an HIV-positive male. ACTA ACUST UNITED AC 2006; 101:328-32. [PMID: 16504866 DOI: 10.1016/j.tripleo.2005.02.066] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2004] [Revised: 01/11/2005] [Accepted: 02/23/2005] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Joseph Rinaggio
- Department of Diagnostic Sciences, University of Medicine and Dentistry of New Jersey-New Jersey Dental School, Newark, NJ 07103-2400, USA.
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21
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Degener AM, Laino L, Pierangeli A, Accappaticcio G, Innocenzi D, Pala S. Human papillomavirus-32-positive extragenital Bowenoid papulosis (BP) in a HIV patient with typical genital BP localization. Sex Transm Dis 2005; 31:619-22. [PMID: 15389001 DOI: 10.1097/01.olq.0000140017.86696.71] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
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.
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Affiliation(s)
- Anna Marta Degener
- Dipartimento di Medicina Sperimentale e Patologia, Sezione di Virologia, Viale di Porta Tiburtina, n. 28, 00185- Rome, Italy.
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Hama N, Ohtsuka T, Yamazaki S. Elevated Amount of Human Papillomavirus 31 DNA in a Squamous Cell Carcinoma Developed from Bowenoid Papulosis. Dermatology 2004; 209:329-32. [PMID: 15539898 DOI: 10.1159/000080858] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2003] [Accepted: 05/14/2004] [Indexed: 11/19/2022] Open
Abstract
A 50-year-old woman presented with asymptomatic, multiple black macules on the genitalia for 6 months. She presented multiple, round to irregularly shaped, black macules on her labia major and perineum. A keratotic reddish nodule was found on one of the macules. The results of laboratory investigations showed pancytopenia and a decreased CD4/CD8 ratio. A lymphocyte stimulation test showed a decreased response. The histological examination of a biopsy specimen led us to the diagnosis of bowenoid papulosis (BP) for the macules and squamous cell carcinoma (SCC) for the nodule. The macules and nodule were removed successfully. An elevated amount of HPV DNA was demonstrated in SCC compared with that of BP. The HPV DNA in SCC and BP was shown to be HPV-31. These observations indicated that the elevated amount of HPV-31 DNA could have led to the emergence of SCC from BP under the condition of decreased cellular immunity.
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Affiliation(s)
- N Hama
- Department of Dermatology, Dokkyo University School of Medicine, Tochigi, Japan
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Gross G, Pfister H. Role of human papillomavirus in penile cancer, penile intraepithelial squamous cell neoplasias and in genital warts. Med Microbiol Immunol 2004; 193:35-44. [PMID: 12838415 DOI: 10.1007/s00430-003-0181-2] [Citation(s) in RCA: 153] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2003] [Indexed: 02/04/2023]
Abstract
Using PCR, the overall prevalence of human papillomavirus (HPV) DNA in penile carcinoma is about 40-45%, which is similar to the detection rate of HPV-DNA in vulvar carcinoma (50%). In analogy to vulvar cancer two different pathways of penile carcinogenesis seem to exist. In contrast to basaloid and warty penile cancers which are regularly HPV-associated (about 80-100%), only a part of keratinizing and verrucous penile carcinomas appear to be related with HPV (33-35%). Penile intraepithelial neoplasias comprising Bowen's disease, erythroplasia of Queyrat and bowenoid papulosis are precursor lesions of basaloid and warty carcinomas of the penis. Precursors of keratinizing carcinomas and verrucous carcinomas are not established. Whether lichen sclerosus and squamous-cell hyperplasia precede penile keratinizing carcinoma is a matter of discussion. Giant condylomata acuminata may precede the development of verrucous carcinomas in some cases. Since high risk HPVs are more frequently found in verrucous carcinomas than in giant condylomas, HPV typing may be a helpful diagnostic step to differentiate giant condyloma from verrucous carcinoma.
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Affiliation(s)
- G Gross
- Department of Dermatology and Venereology, Faculty of Medicine, University of Rostock, Augustenstrasse 80-84, 18055 Rostock, Germany.
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24
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Ibe M, Kawase M, Ishiji T, Kamide R, Niimura M. A cardiac allograft recipient with Bowen's disease on a finger and concurrent perianal bowenoid papulosis. J Dermatol 2003; 30:389-94. [PMID: 12773804 DOI: 10.1111/j.1346-8138.2003.tb00404.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2002] [Accepted: 02/18/2003] [Indexed: 12/01/2022]
Abstract
We report a patient who developed Bowen's disease of the finger and bowenoid papulosis of the perianal area after cardiac transplantation. Human papillomavirus (HPV) type 16 only, not any skin-related or epidermodysplasia verruciformis-related types, was detected in both lesions by in situ hybridization and polymerase chain reaction. The same virus type was identified in both the tumor of the finger and the perianal area, which suggests contact transmission. HPV 16 has often been associated with malignant changes and may be at least one source of the malignancies that are more common in immunosuppressed patients. The presence of a potentially oncogenic type of the HPV in an immunosuppressed patient highlights the importance of regular follow-up of such patients.
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Affiliation(s)
- Miha Ibe
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
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25
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Porter WM, Francis N, Hawkins D, Dinneen M, Bunker CB. Penile intraepithelial neoplasia: clinical spectrum and treatment of 35 cases. Br J Dermatol 2002; 147:1159-65. [PMID: 12452865 DOI: 10.1046/j.1365-2133.2002.05019.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Penile intraepithelial neoplasia (PIN) is the term used to describe erythroplasia of Queyrat (EQ), Bowen's disease (BD) and bowenoid papulosis (BP). These conditions are distinct clinical entities and have different epidemiological and aetiological associations and prognostic implications. OBJECTIVES To describe the presentation and treatment of patients with PIN. METHODS Thirty-five patients presenting with PIN over a 7-year period are described. RESULTS Our observations include: (i) patients with BP are younger than those with EQ or BD and sometimes have a history of immunosuppression; (ii) patients with BP usually have a history or clinical evidence of previous genital human papillomavirus infection; (iii) patients with EQ often have a concurrent penile dermatosis (lichen sclerosus or lichen planus); (iv) patients with PIN are usually uncircumcised; and (v) response to treatment of BP depends on the integrity of the immune system. CONCLUSIONS We recommend vigorous treatment of all patients with PIN, including circumcision. Smoking should be actively discouraged. Patients should have life-long follow-up and partners of patients with BP should be screened for other forms of intraepithelial neoplasia (cervical and anal).
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Affiliation(s)
- W M Porter
- Department of Dermatology, Chelsea and Westminster Hospital, Imperial College School of Medicine, London SW10 9NH, UK.
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26
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Papadopoulos AJ, Schwartz RA, Lefkowitz A, Tinkle LL, Jänniger CK, Lambert WC. Extragenital bowenoid papulosis associated with atypical human papillomavirus genotypes. J Cutan Med Surg 2002; 6:117-21. [PMID: 11992183 DOI: 10.1007/s10227-001-0034-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Anthony J Papadopoulos
- Dermatology, Pediatrics and Pathology, New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07101-2714, USA
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Longstaff E, von Krogh G. Condyloma Eradication: Self-Therapy with 0.15–0.5% Podophyllotoxin versus 20–25% Podophyllin Preparations—An Integrated Safety Assessment. Regul Toxicol Pharmacol 2001; 33:117-37. [PMID: 11350195 DOI: 10.1006/rtph.2000.1446] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Topical application of podophyllin solution, long considered the therapy of first choice against condylomata acuminata, can no longer be recommended due to its low efficacy and gross toxicity. Self-treatment with 0.15-0.5% purified podophyllotoxin preparations, applied twice daily for 3 days, is now advocated as the alternative first-line therapy of choice, when significant improvement is conveniently, and cost-effectively, accomplished within a few weeks. This review provides a summary of the comparative efficacy and utility of podophyllin versus podophyllotoxin as well as a compilation of in vivo and in vitro safety evaluations. In light of overwhelming safety and efficacy data in favor of podophyllotoxin-derived products, it is concluded that podophyllin preparations have no place in the modern treatment portfolio for anogenital warts.
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Affiliation(s)
- E Longstaff
- Stiefel Laboratories R&D, Holtspur Lane, Wooburn Green, High Wycombe, Buckinghamshire, HP10 0AU, United Kingdom
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28
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Purnell D, Ilchyshyn A, Jenkins D, Salim A, Seth R, Snead D. Isolated human papillomavirus 18-positive extragenital bowenoid papulosis and idiopathic CD4+ lymphocytopenia. Br J Dermatol 2001; 144:619-21. [PMID: 11260028 DOI: 10.1046/j.1365-2133.2001.04097.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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.
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Affiliation(s)
- D Purnell
- Department of Pathology, Walsgrave Hospitals NHS Trust, Coventry CV2 2DX, U.K
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29
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Biliris KA, Koumantakis E, Dokianakis DN, Sourvinos G, Spandidos DA. Human papillomavirus infection of non-melanoma skin cancers in immunocompetent hosts. Cancer Lett 2000; 161:83-8. [PMID: 11078916 DOI: 10.1016/s0304-3835(00)00596-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Human papilloma viruses (HPVs) consist of more than 70 different types and are known to be associated with numerous malignant tumors, including carcinomas of the mucosal and cutaneous epithelium. Non-melanoma skin carcinoma (NMSC) is the most frequently occurring malignancy worldwide in the Caucasian population. Most studies examining the involvement of papillomaviruses in the development of cutaneous carcinomas have been performed on lesions from patients with epidermodysplasia verruciformis or from immunosuppressed patients. Our specimens were obtained from 108 immunocompetent patients with benign and malignant skin lesions, and HPVs were detected in 27%. HPV 8 and HPV 18 were the most frequent types (62 and 48%, respectively). Our results suggest that HPVs, particularly the oncogenic potential of certain types such as HPV 8, 18, and 5 could contribute to the development of NMSCs.
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Affiliation(s)
- K A Biliris
- Laboratory of Virology, Medical School, University of Crete, Heraklion 71409, Crete, Greece
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30
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Park KC, Choi WW, Han WS, Choi HO, Kim KH, Chung JH, Eun HC. Epidermodysplasia verruciformis associated with human papillomavirus 20 in a Korean child. Pediatr Infect Dis J 2000; 19:1108-9. [PMID: 11099100 DOI: 10.1097/00006454-200011000-00021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- K C Park
- Department of Dermatology, Seoul National University College of Medicine, Seoul National University Hospital, Korea
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31
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Yoneta A, Yamashita T, Jin HY, Iwasawa A, Kondo S, Jimbow K. Development of squamous cell carcinoma by two high-risk human papillomaviruses (HPVs), a novel HPV-67 and HPV-31 from bowenoid papulosis. Br J Dermatol 2000; 143:604-8. [PMID: 10971337 DOI: 10.1111/j.1365-2133.2000.03718.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We report a patient with bowenoid papulosis (BP) involving two high-risk human papillomaviruses (HPVs) and the development of invasive squamous cell carcinoma (SCC). Our patient showed verrucous lesions on the penis, perianal area and groin that had been noted over the previous 8 years and had recurred after all therapeutic approaches. The perianal and left inguinal lesions revealed invasive SCC on histology. HPV-31 and HPV-67 sequences were detected by polymerase chain reaction from BP lesions of the perianal area and the shaft of the penis. HPV-31 has already been reported in BP as a high-risk HPV for the development of SCC, but HPV-67 is a novel one that has never been reported in BP. As HPV-67 has sequence homology to HPV-52 and HPV-58, it belongs to the family of HPV-16, a high-risk HPV group. Thus our patient showed two high-risk HPVs, i.e. HPV-31 and the novel HPV-67, which may be directly involved in the development of SCC.
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Affiliation(s)
- A Yoneta
- Departments of Dermatology and Urology, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo 060-8543, Japan
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Griffiths TR, Mellon JK. Human papillomavirus and urological tumours: I. Basic science and role in penile cancer. BJU Int 1999; 84:579-86. [PMID: 10510097 DOI: 10.1046/j.1464-410x.1999.00271.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- T R Griffiths
- University Urology Unit, Freeman Hospital, Newcastle upon Tyne, UK
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