Bowenoid papulosis of the genitals
Introduction
Introduction to the genital Bowen-like papulosis The genital Bowen-like papulosis is a multiple flat papule that occurs in the external genital area of young people. Histopathology is a lesion of low-grade malignant squamous cell carcinoma in situ. Since Bowen-like papulosis often coincides with HPV (human papillomavirus) infection, the disease has now been classified as a sexually transmitted disease. basic knowledge The proportion of illness: 0.004% Susceptible people: seen in women Mode of transmission: sexual transmission Complications: Condyloma acuminata
Cause
The cause of genital Bowen-like papulosis
(1) Causes of the disease
Pussy-like papulosis may be associated with the following viral infections:
1. Related to HPV infection: Gross (1985) reported that the Bowen-like papulosis lesion has a specific DNA sequence closely related to HPV, which proves that this virus infection plays a role in the pathogenesis of Bowen-like papulosis, the external genital abalone 63% of the pattern papules detected HPV16, Crook (1991) reported that the carcinogenicity of HPV16 is that the viral-encoded E6 and E7 proteins bind to the p53 tumor suppressor protein of the host cell and inactivate the tumor suppressor protein. A key step in the carcinoma, Yamashita (2000) and other multi-polymer chain reaction showed that HPV31,67 is a high risk factor for Bowen-like papulosis and squamous cell carcinoma.
2. Associated with HlV (human immunodeficiency virus) infection: Brodland noted that a group of skin mucosal tumors including basal cell carcinoma, squamous cell carcinoma and Bowen-like papulosis are associated with the onset of AIDS.
3. May be associated with HSV (herpes simplex virus): Herpes simplex virus type II-induced antigen is often found in cells of Bowman's papulosis in the labia area.
(two) pathogenesis
The genital Bowen-like papulosis is histologically similar to Bowen's disease, but it is not exactly the same. Under the microscope, the keratinization of the epidermis is seen, the acanthosis is proliferated, some cells are atypical hyperplasia, the cell size is different, and the proportion of nuclear matter is increased. The nucleus accumulates irregularly, changes like "wind blows", mitosis is active, clusters of mitotic phases appear, strange nucleus or multinuclei, there are a few cavitation cells in the surface, nails are stretched and widened, dermal telangiectasia and lymphocytes infiltration.
Prevention
Pussy-like papulosis prevention
Enhance physical fitness, cleanse yourself, prevent genital tract infections, regular physical examination, early detection, early treatment, and follow-up work.
Complication
Pussy-like papulosis complications Complications Condyloma acuminata
Vulva, vagina combined with other bacterial infections.
Symptom
Pussy-like Bowen-like papulosis symptoms Common symptoms Papular wet phlegm ulcer ulcer scales
The genital Bowen-like papulosis is more common in female vulva and labia, male glans and penis. The lesion is often a small papule with multiple micro-protrusions on the skin. It is brown-red to purple, with a few scales, and severely merged into patchy, some The surface of the skin lesion is velvety or scorpion-like, without ulceration. The female vulva and perianal area have pink or brown-red small papules or sputum-like shape, with a diameter of 0.2-1.0 cm, an average of 4 mm, often coexisting with condyloma acuminata, and the lesion range is small. There is no ulcer, crusting, and no infiltration of subcutaneous tissue. Some cases can naturally improve or subside in 3 months to 1 year. It has also been reported to be malignant.
Examine
Examination of genital Bowen-like papulosis
Immunological detection; polymerase chain reaction of human papillomavirus, polymerase chain reaction of herpes simplex virus, etc.
Colposcopy, histopathological examination.
Diagnosis
Diagnosis and diagnosis of genital Bowen-like papulosis
According to clinical manifestations, signs, laboratory tests and pathological findings can be clearly diagnosed.
Differential diagnosis
1. Bowen disease: more common in middle-aged, the average age of onset is 55.6 years old, any body can occur, the lesion is larger than Bowen-like papulosis, often more than 1cm, dark red plaque, clear and irregular The surface often covers keratinized scales, and there are erosion and crusting and granulation tissue formation. The abnormality of the tumor cells is obvious under the microscope, and the mitotic figures are more common. The lesions affect the terminal hair follicles, the outer root sheath, the sebaceous gland duct, and easily develop into invasive cancer. The Bowen-like papulosis skin is structurally intact, and the keratinocytes have cell maturation markers of keratin transparent particles and keratin bodies.
2. Condyloma acuminata: more common in young people, the site of the vulva size of the labia, cervix, vaginal anal, etc., the tumor is gray-red, dense papillary or mulberry-like changes, brittle and easy to break, the surface of the lesion and surrounding secretions increased There is obvious itching. The microscopic epithelium is papillary-like hyperplasia, mainly composed of acanthosis cells. There are flaky or focal koilocytes in the spinous layer. The cells are large and round, and the cytoplasm is translucent. Bubble-like, the nuclear is deeply stained and irregular, and there is a mitotic image.
3. Malignant melanoma: more common in the back and lower legs, the lesion is often larger, larger than 1.5 ~ 2.5cm, brown or dark brown, the surface of the tumor is often erosive, ulcer, microscopically see the round or polygonal melanin-containing sputum cells The tumor-like cells have obvious morphological features, mitotic figures are common, nucleoli are large and clear, and they are eosinophilic. The tumor cells are often nested and cord-like. The tumors are invasively growing and infiltrating the epidermis and subdermal tissues. The case fatality rate is high.
4. Pigment : Cell star polygon, small round, uniform cell size, no mitotic division, nested, cord-like arrangement, mature cells in the surface often contain a large number of yellow-brown black granules.
5. Vulvar canal tumor: It is a kind of tumor-like tumor. A considerable number of patients have a family history. It is more common in adolescent and middle-aged women. It is related to endocrine. It can be located in the vulva alone, and can also be in the upper and lower eyelids of the face. The waxy luster of the flat papules is almost skin-colored. The tumor cells are often located in a small area of the dermis. There are many small ducts in the fibrous interstitial, which are shaped like commas or scorpions. a catheter lumen.
