[Case of erythroplasia of the glans with special reference to the etiology of erythroplasia].
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Erythroplasia↗
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Erythroplasia of queyrat: coinfection with cutaneous carcinogenic human papillomavirus type 8 and genital papillomaviruses in a carcinoma in situ.
Erythroplasia of Queyrat is a carcinoma in situ that mainly occurs on the glans penis, the prepuce, or the urethral meatus of elderly males. Up to 30% progress to squamous cell carcinoma. The cause of erythroplasia of Queyrat is largely unknown. Human papillomavirus type 16 DNA has previously been detected only in very few distinctly characterized patients. We have investigated 12 paraffin-embedded biopsies from eight patients with penile erythroplasia of Queyrat and control biopsies of inflammatory penile lesions, of genital Bowen's disease, and of premalignant/malignant cervical or vulvar lesions by 10 different polymerase chain reaction protocols for the presence of cutaneous and genital/mucosal human papillomaviruses. Human papillomavirus typing was performed by sequencing (cloned) polymerase chain reaction products. Human papillomavirus DNA was detected in all erythroplasia of Queyrat patients and in none of the controls with inflammatory penile lesions. The rare cutaneous carcinogenic epidermodysplasia verruciformis-associated human papillomavirus type 8 was present in all erythroplasia of Queyrat patients and the genital high-risk human papillomavirus type 16 in seven of eight patients (88%). In addition to human papillomavirus type 8 and human papillomavirus type 16, four patients carried the genital carcinogenic human papillomavirus type 39 and/or type 51. All human papillomavirus type 8 sequences found in erythroplasia of Queyrat showed some polymorphism among each other and differed in specific nucleotide exchanges from the human papillomavirus type 8 reference sequence. Viral load determinations (human papillomavirus copies/beta-globin gene copies) by realtime polymerase chain reactions showed that the human papillomavirus type 16 levels in the erythroplasia of Queyrat biopsies were one to five orders of magnitude higher than the human papillomavirus type 8 levels. Human papillomavirus type 8 was not detected in cervical or vulvar precancerous and cancerous lesions and in Bowen's disease lesions that carried genital human papillomavirus types. The data suggest that in erythroplasia of Queyrat, in contrast to other genital neoplasias, a coinfection with human papillomavirus type 8 and carcinogenic genital human papillomavirus types occurs. The presence or absence of human papillomavirus type 8 might help to distinguish between penile erythroplasia of Queyrat and Bowen's diseases.
Aged↗
Erythroplasia: the earliest sign of asymptomatic oral cancer.
This prospective study was conducted to determine the significance of erythroplasia (red) versus leukoplakia (white) in the diagnosis of asymptomatic oral carcinoma and to accurately record the appearance of the erythroplastic lesion. Persistent asymptomatic lesions in any portion of the oral cavity, except the lip, that were considered clinically suspicious with our previous criteria (erythroplasia), or those changes that did not correspond to the visual criteria but were found in high risk sites, were studied and biopsies were performed. Degrees of redness versus whiteness and clinical diagnoses were documented. Of 148 lesions in 113 patients, 66 were malignant (52 invasive and 14 in situ). There was a false negative diagnostic rate of 4.5% (3 of 66) and a false positive rate of 7% (4 of 57). Of the malignant lesions, 86.3% were primarily red compared with 31.9% of the benign lesions. OF the cancers, 10.7% were predominantly white as opposed to 66.7% of benign lesions. This analysis confirms our previous suppositions that persistent erythroplasia rather than leukoplakia, in high-risk sites of the oral cavity, is the earliest and predominant sign of oral carcinoma.
Adult↗
Metastasizing erythroplasia Queyrat. Report of a case.
A typical clinical and histologic case of Queyrat's erythroplasia of the glans penis is presented. For several years the patient had been treated for balanitis and inflammation of the glans. A few months before the patient died, the correct diagnosis was established. Shortly after, metastases to the inguinal lymph nodes were found and treated with X-rays. At autopsy, metastases to other organs were revealed. It is concluded that erythroplasia of Queyrat might be Bowen's disease of a mucosal or mucocutaneous area, and this "carcinoma in situ" may metastasize. Consequently Queyrat's erythroplasia should be treated as a malignant disorder as soon as the diagnosis is established.
Aged↗
Erythroplasia of Queyrat. Treatment with topically applied fluorouracil.
Three patients with biopsy-confirmed erythroplasia of Queyrat were treated with topically applied fluorouracil. The lesions cleared completely, and recurrence-free follow-up periods ranged from 20 to 60 months. There were normal histological findings in posttreatment biopsy specimens in two of the patients. A literature review yielded five additional cases successfully treated with fluorouracil applied topically. Patients with histologically confirmed erythroplasia of Queyrat should be afforded treatment with topically applied fluorouracil, as results appear to be superior to those of surgical or radiological treatment, with less morbidity.
Administration, Topical↗
Imiquimod 5% cream in the treatment of human papillomavirus-16-positive erythroplasia of Queyrat.
Erythroplasia of Queyrat is a human-papillomavirus-associated carcinoma in situ of the penis. Imiquimod, a new topically applied immunomodulatory agent, has been successfully used in the treatment of anogenital warts. We report the complete clearance of HPV-16-positive erythroplasia of Queyrat with 5% imiquimod cream.
Adjuvants, Immunologic↗
Erythroplasia of Queyrat: treatment with topical 5-fluorouracil.
Seven adult men with biopsy-confirmed erythroplasia of Queyrat (EQ) were cured of their disease with topically applied 5-fluorouracil (5-FU) under occlusion. Post-treatment biopsy specimens revealed normal histologic findings and recurrence-free follow-up periods extended up to 70 months. It is suggested that topical 5-FU is the treatment of choice for histologically confirmed EQ because of its superior results compared with thoseof surgery or radiation therapy. Our view is corroborated by several single case reports of EQ similarly treated.
Administration, Topical↗
Review of erythroplasia of Queyrat and its treatment.
EQ (erythroplasia of Queyrat) manifests itself by single or multiple asymptomatic papules or plaques on the glans penis, or periurethrally, predominantly in uncircumcised men, age range from twenty to eighty years of age. The bright red lesions may be ulcerated. The disease progresses slowly, and the interval between onset and diagnosis may be years. The cause is unknown. Diagnosis is confirmed only by histologic examination. A therapeutic regimen of 5 per cent 5-fluorouracil cream applied to lesion(s) twice daily for four to five weeks has produced a high cure rate and maintained penile integrity and function.
Adult↗
Carbon dioxide rapid superpulsed laser treatment of erythroplasia of Queyrat.
A single case of erythroplasia of Queyrat successfully treated by rapid superpulsed carbon dioxide laser emission is presented. The results of this single case and previous studies are compared with thos obtained by different modalities used in the past.
Aged↗
Clinical criteria for identifying early oral and oropharyngeal carcinoma: erythroplasia revisited.
From 1961 to 1981, we evaluated 502 asymptomatic oral and oropharyngeal lesions in a veterans population of tobacco and alcohol users. Three hundred twenty-six cancers (236 invasive and 90 in situ) in 276 patients were recorded and described. For invasive cancers and in situ lesions, 64 percent and 54 percent, respectively, were red or predominantly red. Eleven percent and 16 percent were white only or predominantly white. The invasive cancers were more often granular than the in situ cancers. The traditional clinical characteristics of ulceration, induration (palpability), elevation, bleeding, and associated cervical adenopathy were not usually present in these early lesions. We found leukoplakia to be a variable characteristic as opposed to the almost constant presence of erythroplasia. These findings strongly suggest that it would probably be useful to eliminate the term leukoplakia from the discussion of cancer in a population of tobacco and alcohol users.
Carcinoma in Situ↗
Erythroplasia (Queyrat) of conjunctiva.
Erythroplasia of Queyrat (EQ) is an epidermoid carcinoma in situ which is histologically identical with Bowen's disease of the skin but involves mucosal surfaces. The lesion is known to occur on the glans penis, the vulva, and the oral mucosa. Two cases of EQ of the conjunctiva that developed several years after radiotherapy for basal cell carcinoma of the eyelids are here reported. The signs and symptoms closely mimicked those of chronic conjunctivitis. The lesions were excised by the microscopically controlled excision of Mohs. It is recommended that biopsy material be obtained in patients who develop a nonresolving chronic conjunctivitis, especially when there is history of radiotherapy of the eyelids.
Carcinoma in Situ↗
Erythroplasia of Queyrat treated by topical aminolaevulinic acid photodynamic therapy.
Erythroplasia of Queyrat (EQ) is an intraepithelial carcinoma in situ affecting the mucosal surfaces of the penis, with a significant risk of invasion and metastasis. Treatment is often difficult and is associated with significant recurrence rates. Topical 5-aminolaevulinic acid (ALA) photodynamic therapy (PDT) combines a photosensitizer precursor and visible light to produce a photodynamic effect. It has been used successfully to treat benign, premalignant and malignant skin diseases. We present four patients with EQ who have been treated by topical ALA PDT. Of two patients with limited disease one has achieved a long-term complete response (36 months) and the other developed a recurrence at 18 months after a complete response. Two further patients with more extensive disease achieved a significant improvement, allowing easier treatment by laser vaporization. Although topical ALA PDT offers the advantages of tumour specificity, preservation of function and a good cosmetic result, more extensive EQ appears less responsive to this new therapeutic modality using current treatment parameters.
Administration, Topical↗
Surgical treatment of erythroplasia of Queyrat.
An operative technique is described for the treatment of large lesions of erythroplasia of the penis. The defect on the glans and on the coronary sulcus is covered by a flap prepared from the external part of the prepuce. This therapy has been effective and has given a good functional result.
Aged↗
Carbon dioxide laser treatment of erythroplasia of Queyrat.
We present a case of erythroplasia of Queyrat in a 77-year-old man involving the distal two-thirds of the penis. There was no urethral or periurethral involvement. Due to the location of the lesion, its recognition as carcinoma in situ, and the technical difficulty of cold-steel excision in this area, we used the carbon dioxide (CO2) laser to selectively destroy the tumor. In this case the laser provided controllable tissue destruction, ease of surgery, and excellent cosmesis.
Aged↗
Soft-X-ray therapy in Bowen's disease and erythroplasia of Queyrat.
The therapeutic results obtained with soft-X-ray irradiation on 77 lesions in 52 patients are reported. 35 males (67.3%) and 17 females (32.7%) were treated. Clinical and histological features revealed Bowen's disease in 73 cases (94.8%) and erythroplasia of Queyrat in 4 cases (5.2%). The primary healing was rated as 100% in all cases up to 6 months after a cumulative dosage of 3,200-5,000 R. 2 cases with a genital localization (2.6% of all sites and 11.1% of anogenital localizations) relapsed after 8 and 16 months, respectively. The follow-up period ranged from 1 to 11 years with a mean of 3 years. In order not to miss the late recurrences, the oncologic follow-up is taken care of by the Dermatology Department of the Zurich University Hospital during 10 years, or longer in some cases. Association with a malignant internal tumour (larynx, bronchi, anus) was found in 3 patients (5.8%).
Adult↗
Queyrat's erythroplasia of the prepuce: a case-report.
A case of Queyrat's erythroplasia of the prepuce is reported. The Authors emphasize the precancerous role of the lesion because of its high frequency of malignant transformation. Local excision appears to be the only adequate form of treatment.
Erythroplasia↗
Treatment of erythroplasia of Queyrat with liquid nitrogen cryosurgery.
Erythroplasia Queyrat is now generally considered to be Bowen's disease of the glans penis. The literature is reviewed and the need for a treatment that is destructive to abnormal tissue yet cosmetically acceptable is stressed. Cryosurgery appears to be a very appropriate form of treatment for this condition--its effectiveness was demonstrated in two cases.
Aged↗
Bowen's disease of the glans penis (erythroplasia of Queyrat) in plasma cell balanitis.
We report a case of a persistent penile plaque on the glans penis of allegedly more than 20 years' duration, which was refractory to circumcision and local treatment. Over the years, the patient repeatedly presented with a circumscribed inflammatory lesion of the glans penis, diagnosed as Zoon's balanitis on the basis of clinical aspects and two biopsies. Because of unresponsiveness of the lesion to circumcision and focal steroid infiltration, repeated biopsies were performed in an attempt to rule out malignancy. Two further biopsies were carried out. One again showed the features of a plasmacellular inflammation, while the other finally revealed the histopathologic features of erythroplasia of Queyrat (carcinoma in situ or Bowen's disease of the glans penis). We assume that either the former biopsy specimens were taken from a plasma cell-rich reactive infiltrate around the neoplastic lesion, or that carcinoma in situ may have arisen due to the chronic inflammation of Zoon's balanitis plasmacellularis. Radiotherapy was performed with good clinical response and subsequent histopathologic proof of complete remission of the lesion.
Aged↗