Case 144. HPV-16 infection (bowenoid papulosis) (38 y-o M)
Biopsy from multiple penile lesions with verrucous projections
Key words : 
bowenoid papulosis, human papillomavirus, squamous cell carcinoma    
sexually transmitted infection
The acanthotic squamous mucosa histologically resembles Bowen's disease (HE). Dyskeratotic cells are scattered.   Multiplicity of the lesions, spontaneous regression and HPV genome identification in the lesion distinguish this condition from Bowen's disease or erythrodysplasia of Queyrat (HE, high power).
Carcinogenic HPV 16 genome is demonstrated in the superficial part of the lesion (in situ hybridization).   Reference case 144A
Multiple vulvar pigmented lesions with verrucous projections in a 40 y-o female (gross findings). Multipliciity of the lesions are characteristic of this rare condition, namely bowenoid papulosis.
Reference case 144A
Verrucous squamous epithelial growth is evident at a low power magnification (HE). Nuclear atypia is mild, so that the histology resembles condyloma acuminatum in this view. Usually, Bowen's disease-like atypia is accentuated focally in this carcinogenic HPV-related wart.
  Reference case 144A
Bowen's disease-like features are focally seen in the surrounding squamous mucosa (HE). In cutaneous Bowen's disease, HPV antigen and/or genome are never identified by conventional histochemical approach.
Reference case 144A
Immunostaining for HPV antigen focally demonstrates positive signals in the superficial layer. In addition to HPV antigen, HPV, type 31/33/35 genome, demonstrated by cocktail probes, was also focally demonstrated in this lesion.
  Reference case 144A
Invasive squamous cell carcinoma developed 4 years later (HE). Groin nodal metastasis was positive. Invasion of atypical squamous cells into the inflamed stroma is shown in this biopsy specimen.