Bowenoid
papulosis is a lesion which usually occurs on the genitalia, and
presents as a solitary or
multiple verruca-like papules or plaques.
Sometimes there is a history of a
previous condyloma.
Bowenoid
papulosis has a close histological resemblance to
Bowen's disease.
Age & sex : Bowenoid
papulosis
has a predilection for
young sexually active adults. The male to female ratio is equal.
Site:
In males involves
the glans penis and also the foreskin. In females the vulval
lesions are often multiple, bilaterial and pigmented. They resemble
verrucae, small condylomas or nevi.
Extragenital
sites include neck, face and
fingers.
Anal lesion:
Anal
intraepithelial neoplasia (AIN) presenting as bowenoid papulosis and
perianal Bowen's disease is a precursor lesion for invasive squamous
cell carcinoma.
Causative
organisms :
Most cases of bowenoid papulosis are
due to HIV-16.
In few cases HPV-18, 35 and 39, or mixed
infections, have been present.
HPV-16 strain has also been implicated
in the pathogenesis of vulval carcinomas and cervical intraepithelial
neoplasia.
Anogenital
cancers have been associated with the above mentioned HPV types
together with more recently identified types
such as HPV-30, 31, 33, 45, 51, 52, 56, 58, 66 and 69.
Microscopic
features:
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- The histological
differentiation of bowenoid papulosis and Bowen’s disease is
difficult.
- Bowenoid papulosis is characterized
by full-thickness epidermal atypia and loss of architecture. The
epidermal atypia is sometimes known as bowenoid dysplasia.
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- The
basement membrane is intact.
- Mitoses are frequent, sometimes with
abnormal forms.
-
Dyskeratotic cells are
also present.
- True koilocytes are
rare. Partly
vacuolated cells are sometimes present.
- The
stratum corneum and granular cell layer often contain small
inclusion-like bodies.
- Inclusion bodies
are deeply basophilic, rounded and
sometimes surrounded by a halo.
-
These inclusion bodies, together with the
numerous metaphase mitoses, are the features that suggest a diagnosis
of bowenoid papulosis rather than Bowen’s disease.
- The type VIN (vulvar
intraepithelial neoplasia) designated as Bowenoid Papulosis show a
degree of cytological atypia approaching that of Bowen's disease. In
Bowenoid keratosis the dysplastic cells are present in a backround of
relatively orderly epithelial maturation and that the acrotrichium is
usually spared.
Fate:
-
Lesions are often resistant to
treatment and may have a protracted course, usually in older patients
and in those with depressed immunity.
- Some of these lesions
persist for more than 5 years and may never regress completely
- In a number of young
patients spontaneous regression occurs within few months.
- In a small
number of cases invasive carcinoma develops. The risk of carcinomais
greatest in women over age of 40. It may also occur in men. It has been suggested
that a cocarcinogenic factor, may lead to malignant transformation.
- In the vulva, spontaneous regression
has been observed and response to conservative therapy is the rule
even if recurrences are common.
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