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Penis and scrotum
Dysplasia / carcinoma in situ
Bowenoid papulosis
Editors: Antonio Cubilla, M.D. and Alcides Chaux, M.D. (see Author/Reviewers page)
Revised: 13 May 2010, last major update April 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Benign HPV-related condition characterized by multiple soft papules, most commonly in the skin of the shaft, that usually regress spontaneously
● Originally described in 1977 by Kopf and Bart (J Dermatol Surg Oncol 1977;3:265)
Terminology
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● Type of penile intraepithelial neoplasia (males) or vulvar intraepithelial neoplasia (females)
Epidemiology
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● Preferentially affects sexually active young males (mean age 30 years)
Sites
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● Primarily penile shaft; may also be present in foreskin, glans or scrotum
Etiology
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● Sexually transmitted disease associated with HPV 16 or 18
Clinical features
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● Occurs in young, sexually active population
● Clinically resembles condyloma but histologically resembles Bowen’s disease
● Usually regresses spontaneously (mean duration of disease is 2 months), leaving no sequelae
● Either macular or papular
● Less than 1% progress to penile cancer
Prognostic factors
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● None identified
Treatment
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● Often regresses spontaneously
● Local agents include 5 fluorouracil, imiquimod, podophyllin and cidofovir (Indian J Dermatol 2009;54:283)
● Also retinoids (topical or systemic), excision, electrocautery, CO2 laser, cryosurgery, photodynamic therapy and Interferon
Clinical images
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Scrotal lesions before Penile lesions before Lesion of shaft Various images
and after treatment and after treatment
Various images Two small papules with irregular margins
Gross description (Macroscopy)
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● Multiple, small, pigmented papular lesions, may resemble condyloma acuminatum
Micro description (Histopathology)
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● Histologically resembles basaloid PeIN, but may have mild/heavy melanin pigmentation within the lesion, and atypical cells are more spotty
● Often spiky or flat appearance
● May have less cytologic atypia
Micro images
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Epidermal dysmaturation and dyskeratosis
Acanthosis and spotty distribution of atypical cells
Differential Diagnosis
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● Penile intraepithelial neoplasia: different clinical history; atypical cells are more diffuse, less maturation of keratinocytes
Additional references
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End of Penis and scrotum > Dysplasia / carcinoma in situ > Bowenoid papulosis
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