Oncogenic balanitis
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Дата
2013-09
Автори
Tchernev, G.
Ananiev, J.
Cardoso, J. C.
Philipov, S.
Wollina, U.
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Издател
Централна медицинска библиотека - МУ София / Central Medical Library - MU Sofia
Резюме
Summary. The so-called „oncogenic balanitis“ is a not so rare nosological entity, whose pathogenesis is related in most cases to infection with oncogenic strains of the human papilloma viruses (HPVs). In the early stages of the disease the clinical presentation of the infection with some oncogenic or high risk human
HPVs is often non-specific, contributing to its persistance for a long time, often misdiagnosed
as a candidous or bacterial balanitis. Clinically the lesions may also be
confused with lichen planus or lichen sclerosus, as well as penile eczema or psoriasis.
Local and/or systemic therapy with corticosteroids can lead to unmasking of
the symptoms and rapid progression of the disease, with potential risk of malignant
transformation. Additionally, some patients decline a biopsy, further hampering the
confirmation of the diagnosis. In all these problematic cases a diagnostic PCR
examination of material taken from lesional skin could be of help for the diagnosis
of Bowen’s disease, erythroplasia Queyrat, consequently preventing its progression
to invasive squamous cell carcinoma. We present a rare case of erosive and partially verrucous balanitis, in which HPV 56 strains were identifed by PCR in
repeated samples from lesional skin. Additionaly, HPV 16 was also identified in the
second sample. The clinical findings were entirely consistent with erythroplasia of
Queyrat but histopathological examination was not possible. A local therapy with
imiquimod was started. After complete clinical recovery a vaccination with Gardasil
was additionaly planned with the hope that the patient would be protected from
possible recurrence due to the generation of cross-immunity against HPV 56. Due to the risk of malignant transformation into squamous cell carcinoma of the penis, HPV-associated “oncogenic balanitis” is a disease portending a potentially unfavorable prognosis. In patients with longstanding genital lesions unresponsive to topical
treatments usually used for balanitis, the possibility of HPV-induced “oncogenic
balanitis” should be a strong consideration. PCR testing from lesional skin is probably
one of the most sensitive, accurate, and reliable methods that help the clinician
identify oncogenic and nononcogenic HPV-strains in problematic patients who
refuse invasive and semi-invasive diagnostic options such as biopsy and cytological
examination. Subsequent therapy should be complemented by regular clinical
follow-up due to the possibility of relapse.
Описание
Address for correspondence:
Assoc. Professor Dr. Georgi Tchernev;
Saint Kliment Ohridski University;
Medical Faculty;
University Hospital Lozenetz
Polyclinic for Dermatology and Venerology
1 Koziak St.;
1407 Sofia, Bulgaria;
Tel. 00359 885 588 424 ;
e-mail: georgi_tchernev@yahoo.de
Ключови думи
oncogenic balanitis, HPV infection, erythroplasia of Queyrat, penile intraepithelial neoplasia
Цитирания
G. Tchernev, J. Ananiev, J. C. Cardoso, S. Philipov and U. Wollina. Oncogenic balanitis - Acta medica bulgarica , 40, 2013, No 2, 18-22.