Eritroplaziya Keyra

Description:

The term "Keyr's eritroplaziya"  is used for designation of cancer in situ of a balanus. Though clinically and histologically this disease has much in common with Bowen's disease, a number of specific features allows to consider it as an independent nosological form of a tumor. Besides, as specifies R.M. MacKie (1998), the major argument for continuation of use of the term "Keyr's eritroplaziya" consists that it was offered in 1911 to L. Queyrat one year prior to the description of a disease of Bowen. Eritroplaziya Keyra is quite rare disease which suffer not only elderly people, meets at men with an unextracted prepuce of a penis more often. Eritroplaziya Keyra has more expressed tendency to development of a planocellular carcinoma cutaneum, than Bowen's disease. According to G.R. Mikhail (1980), approximately in 30% of cases Keyr's eritroplaziya is transformed to invasive planocellular cancer, and at 20% metastasises are observed.

Pathogeny:

The histologic picture of an eritroplaziya Keyra is in many respects identical that at Bowen's disease and is characterized by growth akantotichesky tyazhy of the acanthceous cells getting deeply into the subject fabrics. Among acanthceous cells there are elements with big hyperchromic ugly kernels, multinucleate cells. Unlike Bowen's disease, at Keyr's eritroplaziya, there is no focal dyskeratosis. The derma can be an infiltrirovana inflammatory cells.

Symptoms of an eritroplaziya of Keyr:

Eritroplaziya Keyra this usually male disease. Most often Keyr's eritroplaziya is located on a balanus or on a prepuce. The site struck with Keyr's eritroplaziya is able to do saturated color from brightly red to вишнево - claret, a clear boundary. The surface of an eritroplaziya of Keyr can be both brilliant, and velvety. Eriroplaziya Keyra develops slowly. At Keyr's eritroplaziya on a penis or a prepuce suppurations or a white plaque which easily is removed often develop. At this precancerous disease often there are bleedings from the site of defeat by Keyr's tumor. Regeneration of an eritroplaziya of Keyr in cancer occurs approximately in 30% of cases. In case of regeneration of a precancer of Keyr in cancer diapyetic bloody crusts and a fleshy node, and also a sore in the site of defeat by cancer, for example on a penis poyavltsya. At transformation of an eritroplaziya of Keyr in planocellular cancer in the center consolidation signs, warty growths, the superficial or deeper ulceration covered with a whitish plaque or bloody crusts appear. Озлокачествившаяся Keyr's eritroplaziya clinically does not differ from planocellular cancer and is followed by innidiation. At the same time Keyr's eritroplaziya is not associated neither with Bowen's disease of skin, nor with increase in frequency of cancer of internals.

Diagnosis:

The diagnosis of an eritroplaziya of Keyr is established on the basis of a characteristic clinical picture and results of a histologic research. Dye application - 1% of solution toluidine blue, painting the site of an eritroplaziya in blue color whereas the simple erythema is not painted by it is applied to recognition of an eritroplaziya of Keyr and definition of its borders. Besides, it is necessary to consider that the majority of usual inflammatory diseases of a balanus and prepuce have less clear boundary and regresses after use of corticosteroid and antimicrobic means. The differential diagnosis of an eritroplaziya of Keyr with a limited plazmotsitarny balanitis of the Zoon. proceeding from data of a clinical picture, it is impossible and it is carried out on the basis of results of a cytologic and histologic research. Its histologic features are: an atrophy of epidermis and plentiful inflammatory infiltrate with a large number of plasmocytes, and also lack of tumor cells. Unlike a hard ulcer, at Keyr's eritroplaziya are absent consolidation in the basis of the center and a regional scleradenitis. However it is necessary to consider that at transformation of a tumor in planocellular cancer there is a fabric consolidation, and at metastasises in inguinal lymph nodes the last increase in a size and get a dense and elastic consistence. The correct diagnosis in such cases is helped by results of a cytologic research (absence with separated from the center of defeat of pale treponemas and existence of tumor cells) and data of the anamnesis. The erosive and ulcer form of a leukoplakia differs from Keyr's eritroplaziya in long existence of whitish limited sites of keratinization against the background of which erosive and ulcer changes develop. At the same time are absent the velvety surface of saturated-red color characteristic of Keyr's disease. Histologically at an erosive and ulcer form of a leukoplakia (unlike Keyr's eritroplaziya) akantotichesky growths on edge of defect of an epithelium without cellular anaplaziya are noted. The barmy balanoposthitis is presented by an inflammatory erythema of a balanus and a prepuce without clear boundary with a grayish-white plaque. At the same time there is no such saturated-red coloring and velvet of a surface, as at Keyr's eritroplaziya. Establishment of the diagnosis is helped by the cytologic researches allowing to reveal a mycelium of drozhzhepodobny mushrooms at a barmy balanoposthitis, and at Keyr's eritroplaziya - tumor cells. Red flat deprive of a balanus it is presented by the papular elements of a polygonal form of lilac and nacreous coloring tending to group in the form of various figures that is not noted at Keyr's eritroplaziya. Besides, along with rashes on a balanus, rashes, typical for this dermatosis, can be found on other sites of skin and a mucous membrane of an oral cavity.

Treatment of an eritroplaziya of Keyr:

Treatment of patients with Keyr's eritroplaziya has to be complex, with use of the general chemotherapeutic means and outside methods of treatment. The choice of methods of treatment depends on terms of existence of the center of defeat, and also data of a histologic research. The general chemotherapeutic means are appointed at an invasive form of an eritroplaziya of Keyr. In similar cases the most effective chemotherapeutic drug is Bleomycinum or its domestic analog блеомицитин. Drugs of Bleomycinum enter intramusculary or intravenously (at hit on skin the necrosis develops). Freshly cooked solution of Bleomycinum is applied to intravenous injections: 0,015 g of Bleomycinum part in 20 ml of isotonic solution of sodium chloride and enter slowly (not less than 5 min.). For intramuscular injections of 0,015 g of Bleomycinum part in 5-7 ml of isotonic solution of sodium chloride. The drug is administered on 15 mg every other day; the course dose should not exceed 5-6 mg/kg. In need of carrying out a repeated course of treatment Bleomycinum the interval has to make not less than 1,5-2 months. From side effects of drug it should be noted nausea, a hair loss, a hyperpegmentation, stomatitis. The specified phenomena arise most often at a high dose of the administered drug. The most terrible complication is pneumonia. At its development treatment is stopped. The choice of outside therapy of an eritroplaziya of Keyr depends on the place of localization of the center of defeat. At localization of the center of defeat in area of a balanus on a coronal furrow use influence by liquid nitrogen (struyno) or applications of liquid nitrogen with exposure 30-40 from 2nd once a week (4-5 procedures). Before carrying out cryoinfluence surely appoint anesthetics. Effectively also use of ftorofurovy, 30% of prospidinovy or 5% of ftoruratsilovy ointment (daily applications within 20-22 days). At an invasive form of an eritroplaziya of Keyr and reaction from regional lymph nodes carrying out a short-distance roentgenotherapy with an extirpation of lymph nodes is reasonable.

Prevention:

Prevention of an eritroplaziya of Keyr consists in the earliest detection of a disease and performing active therapy. The main task is prevention of development of a planocellular carcinoma cutaneum from the eritroplaziya center. At all suspicious processes in the field of a prepuce, a balanus carrying out a cytologic research which allows to reveal cells with atypical keratinization or cells with large hyperchromic kernels is necessary.