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Pathology of Bowenoid Papulosis

Dr Sampurna Roy MD         





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 and 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:


- 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.         

- 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.


- 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.


Further reading:

Case Link by Dr Yutaka Tsutsumi MD 

Genitoanal Human Papillomavirus Infection and Associated Neoplasias

HPV-associated diseases

Cutaneous Human Papillomavirus Infection: Manifestations and Diagnosis

Human papillomavirus type 16 related DNA in genital Bowen's disease and in bowenoid papulosis

Bowenoid papulosis of the genitalia

Bowenoid papulosis of the male and female genitalia: risk of cervical neoplasia

Extensive bowenoid papulosis of the vulva treated by carbon dioxide laser in a patient with AIDS.

Periungual bowenoid papulosis due to human  papillomavirus type 42.

Spontaneous regression of bowenoid papulosis.

Skin Pathology- Weedon D, 2nd Ed.Churchill Livingstone.Pg 705.

Differential diagnosis of chronic perianal dermatitis. Premalignant and malignant disorders.





Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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