Anogenital malignancies and pre‐malignancies

Abstract

Anogenital pre-malignancies and malignancies are frequently encountered. Aetiopathogenetically, human papillomavirus (HPV) infection plays a critical role. However, there is a variable degree of association of HPV infection with the development of anogenital malignancies. In this context, the high level of clinically unapparent HPV infection should be considered. Therefore, the question arises if the association with HPV is always causative. Besides HPV, pre-existent lichen sclerosus is also an important aetiopathologic factor in the development of anogenital malignancies. Common anogenital pre-malignancies comprise Bowen's disease (BD), Bowenoid papulosis (BP) and erythroplasia of Queyrat (EQ). From a clinical point of view, these are clearly different entities, but from a histopathological point of view, BD, BP and EQ are indistinguishable. They all represent forms of squamous intraepithelial neoplasia (IN). Intraepithelial neoplasia (IN) is not only restricted to squamous variants, but also includes non-squamous IN, Paget's disease (PD) and melanoma in situ. The risk of developing anogenital (pre)malignancies or other tumours is higher in immunocompromised and immunodeficient patients, in particular those suffering from human immunodeficiency virus (HIV) infection. Such risk factors will affect treatment and follow-up modalities. Regarding prophylactic measures, a relatively recent but very important development is the availability of HPV vaccination on a large scale. Momentarily, the effects of such vaccination, on a population-based scale, are not yet clear but will become apparent in the near future. Management of anogenital pre-malignancies and malignancies should be tailor-made and may be organized in a multidisciplinary fashion.

Human Papillomaviruses in Anogenital Epithelial Lesions

“…Koilocytes were also seen in the upper epidermis (Fig. 1b) 1 ), while Case 9 showed a pigmented plaque on the dorsum of the penile shaft ( Fig. S1 Case 9 (a) 1 ).…”

“…However, the 3 types of lesions have different biological behaviours. in a previous study, Henquet (1) stated that the probability of malignant evolution is highest for EQ, intermediate for BD and low or non-existent for BP. This study clearly demonstrates that HPV infection occurs in various small epithelial lesions around the anogenital area.…”

A Combined Assay of hTERT and E6 Oncoprotein to Identify Virus-Infected Keratinocytes With Higher Telomerase Activity in Human Papillomaviruses 16 and 18–Related Bowenoid Papulosis

“…7,[9][10][11][12] From laboratory studies and epidemiological investigations, it is clear that high-risk human papillomaviruses (hrHPVs) play a major role in the etiology of various squamous anogenital cancers. 9,13 Furthermore, it is documented that HPV16 and HPV18 are frequently detected in BP and female sexual partners of men having BP run an increased risk of cervical carcinoma as a result. 14,15 Therefore, it is meaningful to learn more about its malignant potential for BP sufferers and their sexual partners.…”

Erythroplasia of Queyrat Treated with 5% Imiquimod Cream — Case Report Emphasizing the Role of Human Papilloma Virus Testing in a Clinical Setting

“…Although from a histopathological point of view these 3 entities are indistinguishable, from a clinical point of view they have very dissimilar features. 1,2 High-risk HPV types have been linked with genital carcinomas and premalignant conditions. Very few studies have been carried out on the link between EQ and HPV infection.…”