Detection of human papillomavirus types 33 and 56 in extragenital Bowen's disease involving the sole

ARTICLE

Auteur(s) : Hiroshi Hara, Teruhiko Makino, Osamu Norisugi, Yukie Asano, Megumi Furuichi, Tadamichi Shimizu

Department of Dermatology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Sugitani 2630, Toyama 930-0194, Japan

Bowen's disease (BD) is an in situ type of squamous cell carcinoma occurring in the skin and mucocutaneous regions. Several types of human papillomavirus (HPV) have recently been identified in BD lesions. Most HPV-positive lesions in BD are localized in either the genital region or distal extremities, and HPV type 16 is frequently detected [1, 2]. This report describes the detection of HPV types 33 and 56 in BD which occurred on the sole.

A 60-year-old Japanese male presented with a skin ulcer on his left sole, which had been present for about 1 year. Physical examination revealed a 12×12 mm skin ulcer with an irregular edge on his left sole (figure 1A). The peripheral skin was thoroughly wet. A few erythematous and hyperkeratotic lesions were observed around the ulcer. This patient had no genital lesions associated with HPV infection. The blood test findings, including SCC antigen, were all within normal ranges. The histological findings from the lesions showed an irregular thickening of the epidermis with hyperkeratosis and dyskeratotic cells (figure 1B). The epidermis contained a lot of atypical cells, including clumping cells (figure 1C). The papillary dermis was not involved in the malignant process. These findings were diagnostic for BD. The tumor was thereafter totally excised. Polymerase chain reaction (PCR) amplification for the DNA of HPV types 6, 11, 16, 18, 30, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 66 was performed, as previously reported [3]. As a result, both HPV types 33 and 56 were detected from the lesion tissue.

BD is one of the most common pre-malignant conditions of the skin. Trauma, exposure to ultraviolet light, and the intake of arsenic have all been cited as causative factors. Recently, HPV infection has been implicated as another causal agent of BD. Based on risk for cancer, HPVs have been divided into two major groups. The high-risk group includes HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56 and 58, which are often detected in either intraepithelial carcinoma or invasive carcinoma. The low-risk group includes HPV types 6, 11, 42, 43 and 44. Oncoprotein E7 binds to and inactivates Retinoblastoma protein (Rb) in high-risk types of HPV infection, and consequently the expression of p16^INK4a is upregulated [4]. Therefore, dysregulation of the Rb/p16^INK4a pathway might be associated with the pathogenesis of BD related to HPV infection. Both HPV types 33 and 56 were first detected in uterine cervical carcinoma and are thought to have an oncogenic potential. These HPVs have also been identified from extragenital BD lesions [5, 6]. Although multiple-type HPV is occasionally detected in single lesions of both cervical carcinoma and BD, the combination of HPV types 33 and 56 has never been reported in BD to date. Therefore, this is the first paper to detect the two types of HPV, namely, HPV types 33 and 56, from extragenital BD.

Acknowledgements

References

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