Bowenoid Papulosis

Histopathology The histopathological features of bowenoid papulosis (BP) are hyperkeratosis, focal keratosis, acanthosis, and cellular atypia of the epidermis characterized by hyperchromatic nuclei, prominent nucleoli, mitotic figures, epidermal multinucleated giant cells, and dyskeratotic cells.1 Slight or moderate perinuclear vacuole formation is occasionally observed. Histopathologically, BP shows similar but generally milder changes compared with Bowen's disease. Dilated capillaries and perivascular diffuse infiltration of lymphocytes can be observed in the upper dermis. The most characteristic finding of BP is an occasional transformation of bowenoid atypia to benign proliferation as time progresses, especially during the course of spontaneous regression.1 Parakeratosis, acanthosis, scattered cellular atypia of the epidermis, dyskeratotic cells, dilated capillaries, and perivascular diffuse infiltration of lymphocytes, all of which are typical histopathological features of BP, were observed in our patient (Fig. 1).Figure 1: Histopathological result of a specimen from the patient with bowenoid papulosis. Parakeratosis, acanthosis, scattered cellular atypia of the epidermis, dyskeratotic cells, dilated capillaries, and perivascular diffuse infiltration of lymphocytes were observed. Hematoxylin–eosin, ×100.Clinical features BP was originally described by Wade et al.2 in 1979. This condition is now known to affect the genitalia, such as the penis and labia minora, of sexually active people. The lesions in our patient were limited to the glans (Fig. 2), which is rare. BP is associated with human papilloma virus (HPV) infection, particularly HPV-16 and HPV-18; however, other types have also been reported, such as HPV-6, HPV-11, HPV-31, HPV-33, HPV-34, and HPV-51.3-4 Abnormal expression of p53 and pl6 oncoproteins as well as an increased telomerase concentration are closely associated with the occurrence and development of BP.Figure 2: Clinical photograph of the lesion from the patient with bowenoid papulosis. The lesions were limited to the glans and presented as 3- to 5-mm purple-red papules.BP is commonly characterized by papules or plaques that are usually <1 cm in diameter, and the surfaces of these lesions can be flat, dome-shaped, papillomatous, or verrucous. BP lesions exhibit variable colors, such as shiny flesh, pink, reddish-brown, violaceous, or black; they may also show coloration similar to that of the surrounding skin or mucosa.5-6 The most frequently affected sites are the penis, vulva, and perianal region, but other areas such as the oral cavity, neck, periungual region, elbows, and abdomen may be involved. The lesions in our patient were limited to the glans and presented as 3- to 5-mm purple-red papules (Fig. 2). Most patients have no symptoms, but a small number of patients may experience itching or mild pain. BP must be differentiated from Bowen disease, lichen planus, granuloma annulare, condyloma acuminata, and erythroplasia of Queyrat. The prognosis of BP is unclear. Some lesions may regress, while others may develop into malignant tumors.7 Although the histopathology of BP is a cancerous change in situ, most of its biological behaviors are benign. Treatment of BP usually involves carbon dioxide laser therapy, cryotherapy, electrocoagulation, and excisional surgery. Several other treatments have also been reported, such as the application of topical 5-fluorouracil cream and photodynamic therapy.8-9