Answer to last month's Clinical Quiz

Question:

A 40 years old lady complained of vulval lumps and itchiness for one year. She was diagnosed to have genital warts and was given various treatments without improvement.

Answer:
D. Bowenoid papulosis

Bowenoid papulosis (BP) has strong association with high-risk Human Papillomavirus infection, notably HPV 16 and 18. Clinically there are multiple warty papules on the anogenital region in both sexes. It is difficult to differentiate from condylomata acuminata (genital warts). Histology shows severe intraepithelial dysplasia with enlarged keratinocytes, nuclear pleomorphism and increased mitotic activity, hallmark of Bowen's disease. Diagnosis depends on high index of suspicion. Skin biopsy is required for confirmation.

As BP does not progress in the majority of cases, radical surgical procedure is not necessary. Conservative destruction is however recommended, due to the small risk of malignant transformation. These include simple excision of small areas, cryosurgery, laser and diathermy. Topical treatment like retinoid and imiquimod may be tried. All patients should be screened for other sexually transmitted infections. Female patients should be evaluated regularly for cervical cytology.