Medicine · 2025
Limitations of photodynamic therapy in HPV-positive Erythroplasia of Queyrat: A case of progression to carcinoma in situ.
СтатьяКлинический случайНазвание и аннотация: Перевод в очереди
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Lou Yangfeng, Duan Qiuyan, Yang Longfei, Zhou Peng
Аннотация
RATIONALE: This case of Erythroplasia of Queyrat (EQ) in a 52-year-old male, driven by high-risk human papillomavirus (HPV)-18, is notable for progressing to carcinoma in situ despite photodynamic therapy (PDT). It highlights PDT's limitations in HPV-positive EQ, emphasizing HPV genotyping and aggressive initial therapies to prevent malignancy.
PATIENT CONCERNS: The patient had a persistent, erythematous, velvety plaque on the glans penis with mild pruritus. Examination showed a well-demarcated lesion.
DIAGNOSES: Biopsy confirmed dysplastic squamous epithelium. Molecular testing identified HPV-18, indicating high malignant potential, leading to a diagnosis of EQ.
INTERVENTIONS: The patient received PDT, followed by conservative treatments including topical therapies upon recurrence.
OUTCOMES: PDT achieved partial lesion regression, but recurrence as carcinoma in situ was confirmed histologically. Conservative treatments failed to stop progression, with HPV-18 driving the aggressive course, necessitating escalated interventions.
LESSONS: HPV genotyping is vital to identify high-risk subtypes like HPV-18; PDT may be inadequate for HPV-positive EQ, requiring aggressive therapies; rigorous long-term surveillance is essential to prevent squamous cell carcinoma progression.
PATIENT CONCERNS: The patient had a persistent, erythematous, velvety plaque on the glans penis with mild pruritus. Examination showed a well-demarcated lesion.
DIAGNOSES: Biopsy confirmed dysplastic squamous epithelium. Molecular testing identified HPV-18, indicating high malignant potential, leading to a diagnosis of EQ.
INTERVENTIONS: The patient received PDT, followed by conservative treatments including topical therapies upon recurrence.
OUTCOMES: PDT achieved partial lesion regression, but recurrence as carcinoma in situ was confirmed histologically. Conservative treatments failed to stop progression, with HPV-18 driving the aggressive course, necessitating escalated interventions.
LESSONS: HPV genotyping is vital to identify high-risk subtypes like HPV-18; PDT may be inadequate for HPV-positive EQ, requiring aggressive therapies; rigorous long-term surveillance is essential to prevent squamous cell carcinoma progression.