Detection of mucosal human papilloma virus DNA in bowenoid papulosis, Bowen's disease and squamous cell carcinoma of the skin

Human papilloma virus (HPV) is known to be an etiologic agent for benign warts of the skin. Recently, HPV have been detected in malignant skin and mucosal diseases suggesting that HPV infection can induce malignant skin tumors. In the present study, we examined the presence of mucosal HPV DNA in normal tissue, Bowen's disease (BD), Bowenoid papulosis (BP) and squamous cell carcinoma (SCC) of the skin. We detected the HPV DNA with polymerase chain reactions, and identified the type by DNA sequencing. In the results, we detected HPV DNA in none of the 17 normal controls, two of the three BP (66.7%), one of the 21 BD (4.8%), and six of the 26 SCC of the skin samples (23.0%). The occurrence rates of HPV in BP and SCC were significantly elevated compared to that of normal controls (P < 0.01 and P < 0.01, respectively). In addition, the occurrence rate of HPV in BP was significantly elevated compared to that of BD (P < 0.05). The reproducibility was confirmed with a polymerase chain reaction (PCR) with another primer pair. Of the two cases of BP with positive HPV DNA, one case showed HPV 31 and the other case HPV 16. The case of BD with positive HPV DNA showed HPV 31. Of the six cases of SCC with positive HPV DNA, one case showed HPV 16, another case HPV 34, and the other four cases HPV 31. These results showed that mucosal HPV, including HPV 31 and 16, could be detected in SSC of the skin. Mucosal HPV, not only the epidermodysplasia verruciformis type, appear to induce malignant skin tumors.     

Development of squamous cell carcinoma by two high-risk human papillomaviruses (HPVs), a novel HPV-67 and HPV-31 from bowenoid papulosis

We report a patient with bowenoid papulosis (BP) involving two high-risk human papillomaviruses (HPVs) and the development of invasive squamous cell carcinoma (SCC). Our patient showed verrucous lesions on the penis, perianal area and groin that had been noted over the previous 8 years and had recurred after all therapeutic approaches. The perianal and left inguinal lesions revealed invasive SCC on histology. HPV-31 and HPV-67 sequences were detected by polymerase chain reaction from BP lesions of the perianal area and the shaft of the penis. HPV-31 has already been reported in BP as a high-risk HPV for the development of SCC, but HPV-67 is a novel one that has never been reported in BP. As HPV-67 has sequence homology to HPV-52 and HPV-58, it belongs to the family of HPV-16, a high-risk HPV group. Thus our patient showed two high-risk HPVs, i.e. HPV-31 and the novel HPV-67, which may be directly involved in the development of SCC.     

Squamous cell carcinoma in untreated lichen sclerosus of the penis: a rare complication

Lichen sclerosus et atrophicus (LSA) is an uncommon disease of the skin and mucosae of either sex. Apart from a number of complications, SCC developing from a lesion of LSA in males is rare, although it is well known in females. We report two cases recently seen by us to alert clinicians of this potentially fatal complication in males.     

Squamous cell carcinoma in a renal transplant recipient with linear porokeratosis.

A 40-year-old man developed squamous cell carcinoma on a perianal lesion of linear porokeratosis after renal transplantation. The tumor metastasized to the left inguinal lymph node 25 months after the primary tumor was excised. p53 overexpression was observed in the tumor cells, but not in the porokeratotic lesion. Interestingly, continuous subcutaneous infusion of peplomycin for the lymph node metastasis significantly improved the warty lesions of porokeratosis. In this patient, immunosuppressive agents might have accelerated the development of carcinoma on a skin area with malignant potential.     

Mucosal human papillomavirus types in squamous cell carcinomas of the uterine cervix and subsequently on fingers

Human papillomavirus (HPV), especially type 16, is causally involved in the pathogenesis of anogenital cancer. There is an increasing number of reports of HPV infections in squamous cell carcinoma (SCC) of the fingers. A search of the Swedish cancer register covering the period 1958-94 inclusive for women with a history of genital and upper extremity SCC revealed 63 cases. Archival material from both cervical and cutaneous lesions was traced and analysed for the presence of HPV DNA in 32 of these patients. A newly developed 'neighbour primer' polymerase chain reaction (PCR) for HPV 16 DNA, aimed at overcoming the obstacle of cross-linked target DNA, was shown to be superior to conventional general and type-specific HPV PCR tests. HPV DNA was significantly more frequently found in digital tumours than in tumours at other cutaneous sites of the upper extremities [67% (10 of 15) vs. 7% (three of 43); P < 0.001]. Among 13 patients with a history of both cervical and finger SCC, HPV 16 was found in cervical samples from seven patients. From five of these seven patients, HPV 16 was also present in the corresponding finger lesions. The results support the hypothesis of a possible transmission of patients' genital HPV infections to fingers.     

面部鳞癌伴巨大皮角一例

患者，女，85岁。左侧面部角状褐色肿物2年余。组织病理示：基底部分区域细胞增生明显活跃。免疫组化示P63（+）、Ki-67（局灶指数30%）。临床症状结合病理及免疫组化结果，诊断为面部鳞癌伴巨大皮角。全麻手术下行皮肤恶性肿物切除术，随访3个月，未复发。     

Squamous cell carcinoma arising in long-standing necrobiosis lipoidica

Necrobiosis lipoidica (NL) is a disease of collagen. Squamous cell carcinomas developing in areas of chronic ulceration and scarring have been well documented in a variety of skin diseases but rarely in areas of necrobiosis lipoidica. The case history of a 76-year-old female is presented, whose squamous cell carcinoma appeared 30 years after the diagnosis of necrobiosis lipoidica. The clinical and histopathological picture is described, stressing the importance of the unusual association of the two pathologies in the prognostic.     

Merkel cell carcinoma in a black human immunodeficiency virus-infected patient

Merkel cell carcinoma (MCC) is a rare malignant tumour that develops in sun-exposed areas in immunocompromised patients (chronic lymphocytic leukaemia, transplant recipients) older than 50 years. We report MCC in a young black woman with human immunodeficiency virus (HIV) infection. A 2-cm binodular violaceous lesion developed on her left ear lobe. Extensive work-up, including computed tomographic scans of the neck, chest, abdomen and pelvis, octreotide scan and sentinel node biopsy, did not demonstrate any metastasis. A wide excision was performed and the patient remained free of disease after 9 months. This case is the fourth observation of MCC in an HIV-infected patient.     

Squamous cell carcinoma with osteoclast‐like giant cells: a morphologically heterologous group including carcinosarcoma and squamous cell carcinoma with stromal changes

Cutaneous squamous cell carcinoma (SCC) with osteoclast‐like giant cells (hereafter, osteoclastic cells) is very rare; eight cases have been reported since 2006. Whether the osteoclastic cells represents a reactive or neoplastic change remains a matter of debate. Osteoclastic cells are often observed in the sarcomatous component of cutaneous carcinosarcoma. SCC with osteoclastic cells is a heterogeneous condition that includes SCC with stromal changes containing osteoclastic cells (also known as osteoclast‐like giant cell reaction) and carcinosarcoma. In some cases, SCC with an associated osteoclast‐like giant cell reaction has been differentiated from carcinosarcoma based on the degree of cytologic atypia in non‐epithelial components. We summarized the clinical and histopathologic characteristics of 11 patients of SCC with osteoclastic cells, including our two cases of SCC with an osteoclast‐like giant cell reaction and one case of carcinosarcoma. The affected patients were old and more likely to be male (64%). Seven cases (64%) were in the head and neck. Moreover, multiple features of high risk SCC were observed, such as a tumor size greater than 2 cm (56%), moderate or poor differentiation (100%), recurrence (33%) and nodal metastasis (17%) after excision and immunosuppression (27%). Interestingly, half of the previously reported cases of SCC with osteoclastic giant cell reaction had histopathologic findings that were overlapping with those of carcinosarcoma.     

鲍温病继发鳞状细胞癌一例

患者，女，71岁。左背部皮肤增生物5年，表面丘疹半年。疣状物和红斑处的皮肤镜分别提示鲍温病和鳞癌表现，结合组织病理诊断鲍温病继发高分化鳞状细胞癌。手术切除，随访1年无复发。     

Squamous cell carcinoma developing in thermal keratosis

Two cases of squamous cell carcinoma (SCC), both of them developed from thermal keratosis arising in areas of erythema ab igne (EAI) are reported. The lesions were located on the legs of two elderly Japanese women who had histories of chronic exposure to heat from a “kotatsu”, a type of leg-warmer widely used in Japan. In one case, metastasis to regional lymph nodes occurred. It is emphasized that keratotic lesions arising in an area of EAI should be excised or biopsied because of the possibility of metastasizing SCC developing from them.     

Detection and typing of human papillomavirus in cutaneous warts of patients infected with human immunodeficiency virus type 1

BACKGROUND: Cutaneous warts are caused by human papillomavirus (HPV). To date, more than 120 different types of HPV are known, of which 80 have been completely characterized. Prevalence studies on types of HPV present in cutaneous warts have been carried out in immunocompetent individuals and immunosuppressed organ allograft recipients, but not in human immunodeficiency virus (HIV)-positive patients. OBJECTIVES: To determine the HPV types present in cutaneous warts of HIV-infected patients. METHODS: Twenty-five biopsies of cutaneous warts from HIV-infected patients and 14 samples from control non-HIV-infected patients were studied. HPV detection was performed by polymerase chain reaction using two sets of primers: MY09/MY11 and RK91. The type of HPV was determined by restriction fragment length polymorphism analysis and direct sequencing of the amplified products. RESULTS: HPV DNA was detected in 64% of cutaneous warts from HIV-infected patients and in 79% of samples from the control group. The HPV types identified in HIV-infected patients were: HPV 2 (38%), 57 (31%), 27 (12%), 6 (12%) and 7 (6%). HPV 2/27/57 predominated in both groups, being present in 81% of lesions from HIV-infected patients and 82% of samples from non-HIV-infected patients. HPV 6, a genital HPV type rarely found in cutaneous lesions, was detected in two warts from HIV-infected patients and in one lesion of the immunocompetent group. HPV 7, characteristically associated with butcher's warts, and recently detected in oral and perioral lesions of HIV-infected patients, was found for the first time in a non-facial lesion of an HIV-infected patient. CONCLUSIONS: This is the first study evaluating the prevalence of HPV types in cutaneous warts of HIV-infected patients and immunocompetent individuals in Brazil.     

High incidence of lichen sclerosus in patients with squamous cell carcinoma of the penis

BACKGROUND: There is a well-documented association between lichen sclerosus (LS) and vulval carcinoma in women; however, until recently, there have only been anecdotal reports of penile squamous cell carcinoma (SCC) occurring in men with LS. OBJECTIVE: The incidence of penile carcinoma occurring on a background of LS remains uncertain, and we wished to examine this possible association further. METHOD: To address this, all the cases (n = 20) of penile SCC held on our pathology database (4 years) were examined. Histology was reviewed, blind to the clinical picture, for evidence of LS, applying strict histological criteria. Subsequently, clinical notes were reviewed for history of LS before the SCC presented, and history of previous circumcision, treatments, node involvement, metastases and death. RESULTS: In eight cases, evidence of LS was found in the excision specimen. Seven of these had well-differentiated SCC. In the 12 cases with no evidence of LS, only three were well differentiated. With case note review, seven had a history of LS (four with histological LS), sometimes preceding the SCC by 10 years. These all had well-differentiated SCC. Ten of the 20 patients are dead, seven from metastatic disease. Four deaths occurred in the 'well-differentiated LS' group, but only one from penile SCC metastatic disease. CONCLUSIONS: There appears to be a definite association between SCC of the penis and the presence of LS, similar to that reported between LS and vulval SCC in women. Of the 20 patients with penile SCC studied, 11 had a clinical history and/or histological evidence of LS. However, clinical presentation of the LS or need for circumcision may precede the SCC by many years. As follow-up is impractical, counselling at the time of diagnosis is very important, and it is essential that medical practitioners are aware of this association so that the subsequent risk from SCC is reduced.     

Squamous cell carcinoma in vitiligo lesion after long-term PUVA therapy

Photochemotherapy using psoralen and ultraviolet (UV)A irradiation (PUVA) is a useful treatment method for vitiligo. However, long-term PUVA therapy may cause several adverse effects including skin cancer, especially squamous cell carcinoma (SCC). We describe a case of SCC in vitiligo lesion after long-term PUVA therapy.     

鳞状细胞癌和麻风慢性下肢溃疡

目的：进一步了解麻风下肢溃疡癌变的流行病学情况、临床特征及其治疗预后，为溃疡恶变的预防，早期发现和合理治疗提供参考。方法：对1980年6月－2001年9月期间由全省各地转到我院作住院治疗且有完整病历的麻风下肢溃疡癌变病例作回顾性分析，并对治疗结果作进一步追踪观察。结果：共收治21例，男15例，女6例；年龄48－71岁（平均59．1岁）溃疡病程8－30年（平均16．2年）；16例溃疡位于足底，4例位于小腿下部，1例位于踝部。病理分级：1级16例，2级5例；1993年10月以前的病例全部作了大腿截肢，此后的病例全部作了小腿截肢。3例失访；得到随访的18例中，截止2001年9月术后已平均存活37．7个月；已有9例死亡，大部分死亡术后1年左右。有10例确定有肿瘤转移，2例在局部，4例腹股沟淋巴结转移，4例发生远处转移。结论：溃疡病期在10年以上者是溃疡癌变的高发人群。早期诊断和治疗是提高存活期的关键     

女性高危型人乳头瘤病毒感染者配偶病毒感染状况及危险因素

目的:分析高危型人乳头瘤病毒(HPV)感染者配偶的病毒感染状况并调查其危险因素。方法:对146例妻子确定为高危型HPV阳性的已婚男性进行阴茎头和尿道口上皮细胞高危型HPV型别检测,并通过问卷调查收集感染者配偶的人口学信息,分析发生病毒感染的可能危险因素。结果:146例男性共检出高危型HPV感染64例,感染率为43.84%,优势型别为HPV16、18、58、52型。多个性伴侣(≥2)、性生活前后不经常清洗外阴、包皮过长或包茎、患包皮阴茎头炎是感染者配偶高危型HPV感染的危险因素(P<0.05或P<0.01)。结论:女性高危型HPV感染者的配偶也是高危型HPV感染的高危人群,男性在性活动中洁身自好、保持良好的性行为方式和尽早治疗包皮过长、包茎、包皮阴茎头炎可能有利于减少病毒在配偶之间的相互传播。     

外阴鳞状细胞癌中人乳头瘤病毒感染与端粒酶和生存素的关系

目的:探讨人乳头瘤病毒(HPV)6/11、16/18在外阴鳞状细胞癌(vulvarsquamouscellcarcinoma,VSCC)组织中的感染情况及其与人端粒酶逆转录酶(hTERT)和凋亡抑制基因生存素(survivin)表达的关系。方法:采用PCR检测HPV6/11、16/18在31例VSCC及13名正常人皮肤组织中的感染情况,同时用原位杂交法检测hTERTmRNA的表达,免疫组化法检测生存素蛋白的表达。结果:①HPV6/11、16/18在VSCC患者的阳性率分别为25.81%和38.17%,正常对照者为阴性。VSCC患者与正常对照者HPV16/18阳性率的差异有统计学意义(P<0.05)。②VSCC患者hTERTmRNA、生存素蛋白表达的阳性率与正常对照者比较,差异均有统计学意义(P<0.05),且VSCC患者hTERTmRNA表达与生存素蛋白表达的阳性率呈明显的正相关(P<0.05)。③hTERTmRNA在HPV16/18阳性组中的表达明显强于HPV16/18阴性组,生存素蛋白在HPV16/18阳性组中的表达低于其在HPV16/18阴性组中的表达。结论:HPV感染及hTERT、生存素表达在VSCC发生发展中起一定作用;VSCC中hTERT与生存素的表达具有一定的相关性。     

尖锐湿疣高危人群分泌物人乳头瘤病毒基因分型检测结果及临床分析

目的分析尖锐湿疣高危人群分泌物人乳头瘤病毒（HPV）基因分型检测结果及临床特点。方法应用荧光定量聚合酶链反应（FQ—PCR）对尖锐湿疣高危人群分泌物标本进行HPV—DNA分型检测。结果436例分泌物中，总阳性率35．1％。其中6／11型101例次，16型52例次，18型43例次。尖锐湿疣治疗后3～6个月复查，男、女阳性率分别44．7％和46．8％。性伴或配偶患尖锐湿疣，受检男、女阳性率为30．8％和46．3％。非尖锐湿疣性病患者男、女阳性率分别为27．9％和29．1％。自检男、女阳性率分别为19．0％和38．0％。可疑CA男、女阳性率分别为13．3％和39．5％。结论分泌物检测中HPV6／11型最多。非尖锐湿疣性病患者、性伴或配偶患尖锐湿疣、可疑尖锐湿疣和要求自检患者均可发生HPV感染，尖锐湿疣治疗后3～6个月仍有HPV残留，因这些患者均属于尖锐湿疣高危人群，应进行HPV检测。     

CO2激光碳化尖锐湿疣残存HPVDNA活性的实验研究

对20例尖锐湿疣（CA）患者，局部皮损经CO2激光治疗后，碳末DNA进行PCR扩增，并与正常角质形成细胞（KC）培养，观察KC增殖情况，观察其是否具有活性。结果发现：碳末DNAPCR扩增，40％阳性，碳末DNA对KC有明显抑制作用。从而推断碳末DNA仍有活性，可能是引起该病复发的原因之一。