Modern aspects of the clinic, diagnosis and treatment of HPV-associated penile intraepithelial neoplasia

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Abstract

A clinical case that demonstrates the development of human papilloma virus (HPV)-associated penile intraepithelial neoplasia (PIN), namely the erythematous form of bowenoid papulosis in a young patient, as well as a delay in making a correct diagnosis due to incorrect diagnostic tactics and low alertness of doctors regarding oncologic diseases, is presented in the article. Penile intraepithelial neoplasia is the histological term for precancerous lesions of the penis. Timeliness is important in the diagnosis of PIN, since currently there is a high morbidity and mortality associated with the progression to squamous cell penile carcinoma. From the morphologic and pathogenetic standpoints, HPV-negative (differentiated) and HPV-positive subtypes of PIN are divided. The latter includes Bowenoid papulosis, erythroplasia of Queyrat and Bowen's disease. It is important to carry out a differential diagnosis between these lesions, since the rate of development of penile cancer for erythroplasia of Queyrat is 30%, for Bowen's disease is 5% and for bowenoid papulosis is 1%.

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About the authors

N. I. Chernova

Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology

Author for correspondence.
Email: d.chernova@mail.ru
ORCID iD: 0000-0002-4111-6670

Ph.D., MD, Head of the Department of Anogenital Dermatosis and Sexually Transmitted Infections

Russian Federation, Moscow

N. V. Frigo

Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology

Email: frigo.n@mosderm.ru
ORCID iD: 0000-0001-6231-971X

Ph.D., MD, Head of the Department of Scientific and Applied Research Methods

Russian Federation, Moscow

T. G. Markosyan

State Research Center – Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency

Email: tigranich2006@yandex.ru
ORCID iD: 0000-0003-1464-5654

д.м.н., профессор кафедры восстановительной медицины, физиотерапии Медико-биологического университета инноваций и непрерывного образования 

Russian Federation, Moscow

I. S. Zadorozhnaya

Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology

Email: d.zadorozhnayais@mail.ru
ORCID iD: 0000-0001-7291-3149

Ph.D., junior researcher of the Department of Anogenital Dermatosis and Sexually Transmitted Infections

Russian Federation, Moscow

References

  1. Giannico G.A., Cubilla A.L. Updates in the pathology of penile intraepithelial neoplasia. Diagnostic Histopathology. 2023;29(6):276–282. doi: 10.1016/j.mpdhp.2023.03.002.
  2. Siegel R.L., Miller K.D., Fuchs H.E., et al. Cancer statistics, 2022. CA: a cancer journal for clinicians. 2022;72(1):7–33. doi: 10.3322/caac.21708.
  3. Olesen T.B., Sand F.L., Rasmussen C.L., et al. Prevalence of human papillomavirus DNA and p16INK4a in penile cancer and penile intraepithelial neoplasia: a systematic review and meta-analysis. Lancet Oncol. 2019;20(1):145–158. doi: 10.1016/S1470-2045(18)30682-X.
  4. Douglawi A., Masterson T.A. Penile cancer epidemiology and risk factors: a contemporary review. Curr Opin Urol. 2019;29(2):145–149. doi: 10.1097/MOU.0000000000000581. PMID: 30562185.
  5. Skeppner E., Andersson S.O., Johansson J.E., Windahl T. Initial symptoms and delay in patients with penile carcinoma. Scand J Urol Nephrol. 2012;46(5):319–325. doi: 10.3109/00365599.2012.677473.
  6. Adhikari P., Kunwar K.J., Huang C. Erythroplasia of Queyrat: Case Report & Review of the Literature. Clinical Medicine. 2017;6:308–310.
  7. Ikenberg H., Gissmann L., Gross G., et al. Human papillomavirus type-16-related DNA in genital Bowen’s disease and in bowenoid papulosis. Int J Cancer. 1983;32:563–565.
  8. Wieland U., Jurk S., Weissenborn T., et al. Erythroplasia of queyrat: coinfection with cutaneous carcinogenic human papillomavirus type 8 and genital papillomaviruses in a carcinoma in situ. J Invest Dermatol. 2000;115:396–401.
  9. Von Krogh G., Horenblas S. Diagnosis and clinical presentation of premalignant lesions of the penis. Scand J Urol Nephrol Suppl. 2000;34:201–214.
  10. Zreik A., Ismail M., Nigam, R. Penile intraepithelial neoplasia: management and outcomes. Human Andrology. 2013;3(1):6–9.
  11. Issa A., Sebro K., Kwok A., et al. Treatment Options and Outcomes for Men with Penile Intraepithelial Neoplasia: A Systematic Review. Eur Urol Focus. 2022;8(3):829–832. doi: 10.1016/j.euf.2021.04.026.
  12. Clinical recommendations Anogenital (venereal) warts. 2021 https://cr.minzdrav.gov.ru/schema/204_1%20. Russian (Клинические рекомендации Аногенитальные (венерические) бородавки. 2021 г. https://cr.minzdrav.gov.ru/schema/204_1%20).
  13. Gilson R., Nugent D., Werner R.N., Ballesteros J., Ross J. 2019 IUSTI-Europe guideline for the management of anogenital warts. J Eur Acad Dermatol Venereol. 2020;34(8):1644–1653. doi: 10.1111/jdv.16522.
  14. Brouwer O.R., Albersen M., Parnham A., et al. European Association of Urology-American Society of Clinical Oncology Collaborative Guideline on Penile Cancer: 2023 Update. European urology. 2023;83(6):548–560.
  15. Clinical recommendations for penile cancer. 2020 https://cr.minzdrav.gov.ru/recomend/51_1 Russian (Клинические рекомендации Рак полового члена. 2020 г. https://cr.minzdrav.gov.ru/recomend/51_1).
  16. Sauder D.N. Imiquimod: modes of action. Brit. J. Dermatol. 2003;149(Suppl. 66):5–8.
  17. Wolff F., Loipetzberger A., Gruber W. Imiquimod directly inhibits Hedgehog signalling by stimulating adenosine receptor/protein kinase A-mediated GLI phosphorylation. Oncogene. 2013;32(50):5574–5581.

Supplementary files

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2. Fig. 1. Clinical picture of intraepithelial neoplasia of the penis head in a 38-year-old patient before treatment (primary examination): a - erythematous plaque with clear boundaries and papillomatous growths on the surface; b - round plaque with clear boundaries of bright red varnished color with an area of hyperkeratotic papillomatous growths.

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3. Fig. 2. Clinical picture of intraepithelial neoplasia of the penis head as a result of topical therapy for 8 weeks with 5% imiquimod cream combined with interferon-alpha solution of 500 thousand units; preservation of the hyperkeratosis focus (marked with an oval).

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4. Fig. 3. The same observation, 2 months after discontinuation of topical treatment. New lesions on the glans penis in the form of pink flat plaques

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5. Fig. 4. Morphologic picture of HPV-associated penile intraepithelial neoplasia: a - micro specimen with multilayer squamous epithelium with koilocytic atypia; b - diffuse expression of p16 protein throughout the entire thickness of multilayered squamous epithelium at IGC examination.

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6. Fig. 5. The same observation, 1.5 months after 1 session of photodynamic therapy (PDT). The lesions on the head of the penis have resolved

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