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Mehrotra P, Tirumalae R, Ballal S. Epidermodysplasia Verruciformis: A Study of Clinicopathologic Features, Biomarkers, and Associated Malignancies in Indian Patients. Am J Dermatopathol 2023; 45:608-612. [PMID: 37462151 DOI: 10.1097/dad.0000000000002491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
BACKGROUND Epidermodysplasia verruciformis (EDV) is a rare cutaneous manifestation of human papilloma virus infection, which has a potential for malignant transformation. The characteristic histologic features of EDV may not always be present and may often be overlooked. The use of a panel of novel biomarkers may aid in differentiating EDV from their clinical and pathologic mimics. MATERIAL AND METHODS We reviewed 20 cases histologically diagnosed as EDV from 2013 to 2022. Sections were reviewed for histopathologic features, and immunohistochemistry for p16 and Ki67 was performed. RESULTS There were 20 cases, ranging in age from 6 to 52 years with a male predominance. Four patients were immunosuppressed, and 4 patients had a positive family history. The most common presentation was hypopigmented papules and macules. In all the cases, epidermal keratinocytes showed dysmaturation, enlargement, and a blue-gray cytoplasm. These changes were very focal and superficial in 15 cases (75%). Associated malignancies included carcinoma in situ (1), trichilemmoma (2), and trichilemmal carcinoma (1). The trichilemmal tumors were seen in 2 siblings. p16 was expressed in the parabasal and basal layers in 7 of 17 cases (41%), in keratinocytes with and without inclusions. Ki67 was increased and localized to suprabasal and parabasal keratinocytes in 15 of 17 cases (88%). CONCLUSION Although striking and characteristic, the keratinocyte changes are often focal and superficial, requiring multiple step-sections. Association of EDV with familial trichilemmal neoplasms is a novel finding requiring further genetic testing. In cases of clinically suspected EDV with negative histopathologic findings, p16 and Ki67 seem useful as adjunct biomarkers and could serve as cost-effective alternatives to genotyping.
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Affiliation(s)
- Parul Mehrotra
- Department of Pathology, St. John's Medical College, Bangalore, Karnataka, India; and
| | - Rajalakshmi Tirumalae
- Department of Pathology, St. John's Medical College, Bangalore, Karnataka, India; and
| | - Sumedha Ballal
- Department of Dermatology, St. John's Medical College and Hospital, Bangalore, Karnataka, India
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2
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Płachta I, Kleibert M, Czarnecka AM, Spałek M, Szumera-Ciećkiewicz A, Rutkowski P. Current Diagnosis and Treatment Options for Cutaneous Adnexal Neoplasms with Follicular Differentiation. Int J Mol Sci 2021; 22:4759. [PMID: 33946233 PMCID: PMC8125718 DOI: 10.3390/ijms22094759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 12/30/2022] Open
Abstract
Neoplasms derived from follicular tissue are extremely rare. Clinically, they are reported as non-symptomatic, slow-growing nodules. These lesions are mainly benign, but the malignant type can occur. Mainly middle-aged people (50-60 years of age) are affected. These carcinomas are mainly localized on the head and neck or torso. They can be locally aggressive and infiltrate surrounding tissue and metastasize to regional lymph nodes. In the minority of cases, distant metastases are diagnosed. Quick and relevant diagnosis is the basis of a treatment for all types of tumors. The patient's life expectancy depends on multiple prognostic factors, including the primary tumor size and its mitotic count. Patients should be referred to a specialized skin cancer center to receive optimal multidisciplinary treatment. This article tries to summarize all the information that is currently available about pathogenesis, diagnosis, and treatment methods of follicular tumors.
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Affiliation(s)
- Iga Płachta
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (I.P.); (M.K.); (M.S.); (P.R.)
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Marcin Kleibert
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (I.P.); (M.K.); (M.S.); (P.R.)
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Anna M. Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (I.P.); (M.K.); (M.S.); (P.R.)
| | - Mateusz Spałek
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (I.P.); (M.K.); (M.S.); (P.R.)
| | - Anna Szumera-Ciećkiewicz
- Department of Pathology and Laboratory Diagnostics, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland;
- Department of Diagnostic Hematology, Institute of Hematology and Transfusion Medicine, 00-791 Warsaw, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (I.P.); (M.K.); (M.S.); (P.R.)
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3
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Fulton EH, Kaley JR, Gardner JM. Skin Adnexal Tumors in Plain Language: A Practical Approach for the General Surgical Pathologist. Arch Pathol Lab Med 2019; 143:832-851. [PMID: 30638401 DOI: 10.5858/arpa.2018-0189-ra] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Skin adnexal tumors, those neoplasms deriving from hair follicles and sweat glands, are often a source of confusion amongst even experienced pathologists. Many well-described entities have overlapping features, tumors are often only partially sampled, and many cases do not fit neatly into well-established classification schemes. OBJECTIVES.— To simplify categorization of adnexal tumors for the general surgical pathologist and to shed light on many of the diagnostic dilemmas commonly encountered in daily practice. The following review breaks adnexal neoplasms into 3 groups: sebaceous, sweat gland-derived, and follicular. DATA SOURCES.— Pathology reference texts and primary literature regarding adnexal tumors. CONCLUSIONS.— Review of the clinical and histopathologic features of primary cutaneous adnexal tumors, and the diagnostic dilemmas they create, will assist the general surgical pathologist in diagnosing these often challenging lesions.
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Affiliation(s)
- Edward H Fulton
- From the Department of Pathology, University of Arkansas for Medical Sciences, Little Rock
| | - Jennifer R Kaley
- From the Department of Pathology, University of Arkansas for Medical Sciences, Little Rock
| | - Jerad M Gardner
- From the Department of Pathology, University of Arkansas for Medical Sciences, Little Rock
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4
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Gonzalez JL, Plotnikova N, Seymour A, Mannion CM, Danialan R, Rosmarin D. Linear trichilemmomas on the ankle of a 28-year-old female. J Cutan Pathol 2016; 44:93-97. [PMID: 27683091 DOI: 10.1111/cup.12825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 09/04/2016] [Accepted: 09/20/2016] [Indexed: 11/27/2022]
Abstract
Trichilemmomas are benign cutaneous proliferations derived from the outer root sheath of the hair follicle. They most often occur on the head and neck region and show a female predominance. When multiple, they are associated with Cowden syndrome (CS), a rare disorder due to an autosomal dominant germline mutation in PTEN (phosphatase and tensin homolog on chromosome 10), a tumor suppressor gene. Trichilemmomas outside of the head and neck region are rare, and as such, the association with CS is not clear. A 28-year-old healthy female with no significant family history of cancer presented to her dermatologist with multiple erythematous papules on the left anterior ankle, starting at birth. A shave biopsy confirmed the diagnosis of trichilemmoma with focal desmoplastic features (or desmoplastic trichilemmoma). A PTEN immunohistochemical study showed patchy (but not complete) loss of staining of the lesional cells. After shave removal, the trichilemmomas recurred 1-2 months later.
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Affiliation(s)
| | | | - Andrew Seymour
- Department of Dermatopathology, Miraca Life Sciences, Newton, MA, USA
| | - Ciaran M Mannion
- Department of Pathology and Laboratory Medicine, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Richard Danialan
- Department of Dermatopathology, Miraca Life Sciences, Newton, MA, USA
| | - David Rosmarin
- Department of Dermatology, Tufts Medical Center, Boston, MA, USA
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5
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Lesions With an Epidermal Hyperplastic Pattern: Morphologic Clues in the Differential Diagnosis. Am J Dermatopathol 2016; 38:1-16; quiz 17-9. [PMID: 26730692 DOI: 10.1097/dad.0000000000000324] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In this report, we review the most common entities that show a epidermal hyperplastic pattern in the biopsy. These entities include inflammatory, reactive, infectious, hamartomatous, and tumoral conditions, each with a very different prognosis. Therefore, an approach based on the classic "patterns and clues" tools used in dermatopathology can bring a lot of information to the dermatopathologist or the general pathologist evaluating these lesions.
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6
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Tellechea O, Cardoso JC, Reis JP, Ramos L, Gameiro AR, Coutinho I, Baptista AP. Benign follicular tumors. An Bras Dermatol 2016; 90:780-96; quiz 797-8. [PMID: 26734858 PMCID: PMC4689065 DOI: 10.1590/abd1806-4841.20154114] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 03/23/2015] [Indexed: 11/22/2022] Open
Abstract
Benign follicular tumors comprise a large and heterogeneous group of neoplasms that
share a common histogenesis and display morphological features resembling one or
several portions of the normal hair follicle, or recapitulate part of its
embryological development. Most cases present it as clinically nondescript single
lesions and essentially of dermatological relevance. Occasionally, however, these
lesions be multiple and represent a cutaneous marker of complex syndromes associated
with an increased risk of visceral neoplasms. In this article, the authors present
the microscopic structure of the normal hair follicle as a basis to understand the
type and level of differentiation of the various follicular tumors. The main
clinicopathological features and differential diagnosis of benign follicular tumors
are then discussed, including dilated pore of Winer, pilar sheath acanthoma,
trichoadenoma, trichilemmoma, infundibuloma, proliferating trichilemmal cyst/tumor,
trichoblastoma and its variants, pilomatricoma, trichodiscoma/fibrofolliculoma,
neurofollicular hamartoma and trichofolliculoma. In addition, the main syndromes
presenting with multiple follicular tumors are also discussed, namely Cowden,
Birt-Hogg-Dubé, Rombo and Bazex-Dupré-Christol syndromes, as well as multiple tumors
of follicular infundibulum (infundibulomatosis) and multiple trichoepitheliomas.
Although the diagnosis of follicular tumors relies on histological examination, we
highlight the importance of their knowledge for the clinician, especially when in
presence of patients with multiple lesions that may be the cutaneous marker of a
cancer-prone syndrome. The dermatologist is therefore in a privileged position to
recognize these lesions, which is extremely important to provide further propedeutic,
appropriate referral and genetic counseling for these patients.
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Affiliation(s)
- Oscar Tellechea
- Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | | | - José Pedro Reis
- Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Leonor Ramos
- Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | | | - Inês Coutinho
- Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
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7
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Human papilloma virus DNA in Nongenital Seborrheic Keratosis. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2013. [DOI: 10.5812/pedinfect.9414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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8
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Idriss MH, Khalil A, Long W, Elston DM. Epidermal panfolliculoma: an adnexal proliferation with advanced follicular differentiation confined to the epidermis. J Cutan Pathol 2013; 40:409-12. [PMID: 23398529 DOI: 10.1111/cup.12088] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 12/25/2012] [Accepted: 12/31/2012] [Indexed: 11/30/2022]
Abstract
Follicular differentiation can be exhibited by a variety of epidermal lesions. We report an example of panfolliculoma purely confined to the epidermis. The lesion presented as a verrucous plaque on the leg of a 55-year-old man. Histopathologic sections showed an acanthoma with follicular differentiation including areas mimicking the follicular germ, matrix, root sheath and infundibular components.
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Affiliation(s)
- Munir H Idriss
- Ackerman Academy of Dermatopathology, New York, NY, USA.
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9
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Cho CH, Son JH. A Case of Multiple Eyelid Trichilemmoma Associated with Cowden Syndrome. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.5.803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Chan Ho Cho
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Jun Hyuk Son
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
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Abstract
The expression of p16 in cutaneous neoplasms is upregulated in melanocytic neoplasms, ultraviolet radiation-induced neoplasms, such as actinic keratoses and squamous cell carcinomas, and in lesions related to human papillomavirus, such as Bowen's disease and bowenoid papulosis. In cervical dysplasia and tonsillar carcinoma, there is such a close relationship between p16 and human papillomavirus (HPV) to the extent that p16 immunostaining is used as a surrogate marker for the presence of HPV proteins. In this study we were interested in the expression pattern of p16 in trichilemmomas. Twenty-six conventional and 19 desmoplastic trichilemmomas were immunohistochemically stained for p16. p16 immunostaining was noted in the majority of conventional (80.8%) and desmoplastic trichilemmomas (73.7%). The staining pattern was both nuclear and cytoplasmic. The staining intensity was more pronounced in the desmoplastic variant. We describe for the first time p16 expression in trichilemmomas and discuss our findings in conjunction with p16 expression found in other cutaneous neoplasms. Additionally, the relationship of p16 to HPV infection is critically evaluated.
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11
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Stierman S, Chen S, Nuovo G, Thomas J. Detection of human papillomavirus infection in trichilemmomas and verrucae using in situ hybridization. J Cutan Pathol 2009; 37:75-80. [PMID: 19615037 DOI: 10.1111/j.1600-0560.2009.01348.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND It is hypothesized that trichilemmomas are 'burned out' verrucae. By performing in situ hybridization using HPV type-specific probes, we explored this concept. METHODS Verrucae vulgaris and plantaris were positive controls, and inverted follicular keratoses (IFKs) were negative controls. Additionally, all lesions were tested for HPV genital types (low and high risk). RESULTS We analyzed 9 trichilemmomas, 20 verrucae vulgaris, 8 verrucae plana, 3 verrucae plantaris and 6 IFKs. All trichilemmomas were negative for HPV types 1, 2 and genital types. Conversely, 9/20 verrucae vulgaris, 2 verrucae plantaris, and 1 verruca plana were positive for HPV type 2. Among HPV-2 positive lesions, 2/2 verrucae plantaris and 1 verruca vulgaris (chin) were strongly positive for genital-type HPV. One verruca plana (shin) was positive for genital-type HPV only. All 6 IFKs were HPV negative. CONCLUSIONS Using HPV type 1 and 2-specific probes and mixed genital-type probes, we were unable to detect HPV in trichilemmomas. This suggests that HPV-1, HPV-2 and low and high risk genital-type HPVs are not involved in the histogenesis of trichilemmoma. We also showed that genital HPV types could be present in non-genital verrucae.
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Affiliation(s)
- Sarah Stierman
- Department of Dermatology, Wayne State University, Dearborn, MI, USA.
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12
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Ackerman AB. On the nature of adnexal neoplasms. J Am Acad Dermatol 2009. [DOI: 10.1016/j.jaad.2008.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Affiliation(s)
- Catherine A Harwood
- Center for Cutaneous Research, Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Carlson JA, Cribier B, Nuovo G, Rohwedder A. Epidermodysplasia verruciformis-associated and genital-mucosal high-risk human papillomavirus DNA are prevalent in nevus sebaceus of Jadassohn. J Am Acad Dermatol 2008; 59:279-94. [PMID: 18638629 DOI: 10.1016/j.jaad.2008.03.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 02/17/2008] [Accepted: 03/10/2008] [Indexed: 02/03/2023]
Abstract
BACKGROUND The hamartoma nevus sebaceus (NS) presents at birth or early childhood as a yellowish plaque characterized histologically by variable acanthosis, papillomatosis, sebaceus hyperplasia, and proliferations of adnexal structures. Clinically apparent human papillomavirus (HPV) infection is also recognized by acanthosis and papillomatosis. OBJECTIVE We sought to determine the prevalence and physical state of HPV DNA in NS. METHODS DNA was retrieved from 44 formalin-fixed, paraffin-embedded samples of NS (22 with secondary tumors [eg, trichoblastoma, verruca, syringocystadenoma papilliferum] and two epidermal nevi [EN]). Nested polymerase chain reaction with multiple degenerate consensus and type-specific primers and direct sequencing of polymerase chain reaction products was performed. For selected cases, in situ hybridization using probes specific for HPV 5 and 8 and for high-risk genital-mucosal HPV types was performed. RESULTS HPV DNA was detected in 82% of NS and both EN, and consisted of genital-mucosal HPV types in 52% (HPV 6, 16, and 33) and a diverse variety of epidermodysplasia verruciformis-associated HPV types in 61%, including well-known epidermodysplasia verruciformis HPV types (5, 8, 15, 20, 22, 24, 36, 37, 38, and 80) and putatively novel epidermodysplasia verruciformis HPV types (DL285, DL287, DL436, and alb-1, -2, -3, -5, -6, -7, -8, -10, -11, -12, and -13). HPV coinfection was frequent, found in 48% (two HPV genotypes in 35% and 3 in 13%). Of NS and EN, 42% had HPV genotypes associated with cancer (ie, HPV 5, 8, 16, 20, 33, and 38); the two most commonly identified HPV types where HPV 16 (39%) and HPV 38 (18%). No differences were detected comparing frequency of HPV DNA detected with respect to age or presence of a secondary tumor. Histologically, all NS and EN showed HPV-associated cytopathic effects (ie, perinuclear halos, altered keratohyaline granules). By in situ hybridization, 64% (18/28) were positive, showing a low-intensity, punctate nuclear signal in epidermal and adnexal keratinocytes, indicating viral integration and low viral genome copy number. LIMITATIONS Absence of adjacent, uninvolved normal-appearing skin control samples. CONCLUSION HPV DNA is prevalent in NS, and HPV 16, the most frequently detected genotype, appears to be integrated into the host genome. Whether HPV represents a commensal infection caused by localized cutaneous predisposition, or is an essential factor in the pathogenesis of NS is unknown. The high frequency of oncogenic HPV types implicates maternal transmission of HPV and infection of an ectodermal stem cell leading to an epigenetic mosaic and altered skin development manifested along Blaschko's lines.
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Affiliation(s)
- J Andrew Carlson
- Department of Pathology, Division of Dermatopathology, Albany Medical College, Albany, New York 12208, USA.
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15
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Lin MT, Rohwedder A, Mysliborski J, Leopold K, Wilson VL, Carlson JA. ‘HPV vulvitis’ revisited: frequent and persistent detection of novel epidermodysplasia verruciformis-associated HPV genotypes. J Cutan Pathol 2008; 35:259-72. [DOI: 10.1111/j.1600-0560.2007.00805.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Abstract
Cancer-associated genodermatoses are a group of genetic disorders inherited in an autosomal-dominant fashion in which unique cutaneous findings are a reliable marker for the risk of developing internal malignancies. The historical, clinical and dermatopathological aspects of basal cell nevus syndrome, Muir-Torre syndrome, Cowden syndrome, Carney complex and Birt-Hogg-Dubé syndrome are reviewed in a personal and informal fashion. The latest advances in the molecular genetics of the disorders are also summarized.
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Ruhoy SM, Thomas D, Nuovo GJ. Multiple inverted follicular keratoses as a presenting sign of Cowden's syndrome: case report with human papillomavirus studies. J Am Acad Dermatol 2005; 51:411-5. [PMID: 15337985 DOI: 10.1016/j.jaad.2003.12.049] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Inverted follicular keratosis is characterized by a squamous epithelial expansion of the infundibular portion of the hair follicle in an exophytic and endophytic pattern. The lesion is often associated with squamous eddies similar to an irritated keratosis and may have a superficial papillomatous architecture. The lesion most often arises as a solitary nodule on the face of middle age to elderly individuals. Inverted follicular keratosis has been described as a distinct entity by some while others believe that it is related to trichilemmomas and/or verruca vulgares. The cutaneous pathology of Cowden's syndrome is characterized by multiple trichilemmomas. We present a woman who fulfills the clinical criteria for Cowden's syndrome and who initially presented with multiple inverted follicular keratoses. Also, in situ hybridization studies performed on the patient's keratoses do not reveal evidence of human papillomavirus infection.
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Affiliation(s)
- Steven M Ruhoy
- Department of Pathology, Sunrise Hospital and Medical Center, USA.
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18
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Forslund O, Lindelöf B, Hradil E, Nordin P, Stenquist B, Kirnbauer R, Slupetzky K, Dillner J. High prevalence of cutaneous human papillomavirus DNA on the top of skin tumors but not in "Stripped" biopsies from the same tumors. J Invest Dermatol 2004; 123:388-94. [PMID: 15245440 PMCID: PMC3822504 DOI: 10.1111/j.0022-202x.2004.23205.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Genomes of human papillomaviruses (HPV) are common in biopsies from non-melanoma skin cancers but are also found on healthy skin and it is possible that HPV positivity in tumor biopsies by PCR may merely reflect contamination of the lesion surface. To investigate this issue, 229 immunocompetent patients were tested for HPV DNA in swab samples collected on top of skin tumors and in biopsies of the same tumors, obtained after stripping with tape to remove superficial layers. HPV DNA was detected on top of 69% (159 of 229) of the lesions, and in 12% (28 of 229) of the stripped biopsies (p<0.001). The difference was seen for all four types of tumors studied. Seborrheic keratosis had 79% (34 of 43) HPV positivity on top of lesions versus 19% (eight of 43) in biopsies; actinic keratosis had 83% (38 of 46) HPV positivity on top versus 11% (five of 46) in biopsies; basal cell carcinoma had 63% (69 of 109) on top versus 8% (nine of 109) in biopsies and squamous cell carcinoma had 58% (18 of 31) on top versus 19% (six of 31) in biopsies. HPV DNA is common in superficial layers of lesions, but is not necessarily present throughout tumors.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biopsy
- Carcinoma, Basal Cell/epidemiology
- Carcinoma, Basal Cell/pathology
- Carcinoma, Basal Cell/virology
- Carcinoma, Squamous Cell/epidemiology
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/virology
- DNA, Viral/analysis
- Female
- Humans
- Keratosis, Seborrheic/epidemiology
- Keratosis, Seborrheic/pathology
- Keratosis, Seborrheic/virology
- Male
- Middle Aged
- Papillomaviridae/genetics
- Papillomaviridae/isolation & purification
- Papillomavirus Infections/epidemiology
- Papillomavirus Infections/pathology
- Prevalence
- Skin Neoplasms/epidemiology
- Skin Neoplasms/pathology
- Skin Neoplasms/virology
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Affiliation(s)
- Ola Forslund
- Department of Medical Microbiology, Malmö University Hospital, Lund University, Malmö, Sweden.
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19
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Schaller J, Rohwedder A, Burgdorf WHC, Itin PH, Lautenschlager S. Identification of human papillomavirus DNA in cutaneous lesions of Cowden syndrome. Dermatology 2004; 207:134-40. [PMID: 12920361 DOI: 10.1159/000071782] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2002] [Accepted: 11/22/2002] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cowden syndrome (CS) or multiple hamartoma syndrome is a cancer-associated genodermatosis inherited in an autosomal dominant pattern. One of the diagnostic criteria is facial papules which are felt to be trichilemmomas, benign hair follicle tumors, which some consider to be induced by human papillomavirus (HPV). OBJECTIVE To search for HPV in skin tumors, especially trichilemmomas, from patients with CS. METHODS Skin lesions from patients with CS were classified histologically. Each tumor was then analyzed for HPV DNA by polymerase chain reaction with different primer sets; positive amplicons were typed by direct sequencing. RESULTS Twenty-nine biopsies from 7 patients with CS were investigated. Only 2 of 29 tumors clinically suspected of being trichilemmomas were confirmed histologically. In addition, 3 sclerotic fibromas, also typical of CS, were found, as well as 1 sebaceous hyperplasia. The other 23 lesions showed histological features of HPV- induced tumors in various stages of development. HPV DNA was found in 19 of 29 cutaneous lesions. Tumors without any histological signs of HPV induction were negative for HPV DNA. Two tumors which were histologically classified as common warts contained HPV types 27 and 28. All the 17 other HPV types belong to the group of epidermodysplasia-verruciformis-associated types. CONCLUSIONS The majority of cutaneous lesions in CS contain HPV DNA. They may have a variety of histological patterns. Trichilemmomas are not clinically distinctive and can be difficult to identify in CS patients.
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Affiliation(s)
- Jörg Schaller
- Department of Dermatology, Dermatohistological Unit, St. Barbara Hospital, Duisburg, Germany.
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20
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Norgauer J, Rohwedder A, Schaller J. Human papillomavirus and Grzybowski's generalized eruptive keratoacanthoma. J Am Acad Dermatol 2003; 49:771-2. [PMID: 14512942 DOI: 10.1067/s0190-9622(03)01676-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Rohwedder A, Murphy M, Carlson JA. HPV in verruciform xanthoma--sensitivity and specificity of detection methods and multiplicity of HPV types affect results. J Cutan Pathol 2003; 30:219-20; author reply 220-1. [PMID: 12641784 DOI: 10.1034/j.1600-0560.2003.00011.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Neoplasms With Follicular Differentiation, 2nd edition. Am J Dermatopathol 2002. [DOI: 10.1097/00000372-200204000-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jaqueti G, Requena L, Sánchez Yus E. Trichoblastoma is the most common neoplasm developed in nevus sebaceus of Jadassohn: a clinicopathologic study of a series of 155 cases. Am J Dermatopathol 2000; 22:108-18. [PMID: 10770429 DOI: 10.1097/00000372-200004000-00004] [Citation(s) in RCA: 117] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nevus sebaceus of Jadassohn is a hamartoma that combines epidermal, follicular, sebaceous, and apocrine gland abnormalities. Classically, several types of cutaneous neoplasms have been associated with this hamartoma, with basal cell carcinoma being the most frequently described malignancy. We studied a series of 155 examples of nevus sebaceus of Jadassohn with clinicopathologic correlation. Several histopathologic changes related to the age of the patients were found. In our series, we could not identify any cases of authentic basal cell carcinoma. In contrast, several examples of primitive follicular induction and of trichoblastomas were seen. Other cutaneous hamartomas, hyperplasias, and neoplasms found in our series of nevus sebaceus of Jadassohn included syringocystadenoma papilliferum, sebomatricoma, apocrine gland cyst, poroma, different histopathologic variants of warts (classic warts, tricholemmoma, and desmoplastic tricholemmoma), primitive follicular induction, and ductal induction. In our series, no examples of malignant neoplasms were identified. On the basis of these findings, the classically recommended treatment for this hamartoma, which consists of early excision to prevent the development of malignancy, seems to be inappropriate.
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Affiliation(s)
- G Jaqueti
- Department of Dermatology of Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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Carlson JA, Rohwedder A, Daulat S, Schwartz J, Schaller J. Detection of human papillomavirus type 10 DNA in eccrine syringofibroadenomatosis occurring in Clouston's syndrome. J Am Acad Dermatol 1999; 40:259-62. [PMID: 10025758 DOI: 10.1016/s0190-9622(99)70201-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Syringofibroadenomatosis is often associated with an underlying condition such as diabetes mellitus or hidrotic ectodermal dysplasia. By reason of these associations, a reactive or hamartomatous cause is suspected. We report a case of a 71-year-old woman with Clouston's syndrome in whom progressive multiple palmoplantar syringofibroadenomas developed over a 10-year period. The syringofibroadenomas formed flat-topped papules simulating verruca plana; the widespread distribution and chronic progressive course resembled epidermodysplasia verruciformis. Contiguous with the syringofibroadenoma's characteristic epithelial-stromal proliferation were epidermal changes of verruca plana. Evidence of human papillomavirus (HPV) infection was verified by immunolabeling with antibodies to bovine papillomavirus type 1 and detection of HPV 10 viral DNA by means of polymerase chain reaction. Rather than a hamartomatous process, these findings suggest that syringofibroadenomas occurring in the setting of Clouston's syndrome could represent an HPV-induced epithelial proliferation.
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Affiliation(s)
- J A Carlson
- Department of Pathology, Albany Medical College, New York 12208, USA
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Abstract
Non-melanoma skin cancer (NMSC) is the most frequent cancer among Caucasians worldwide. The lesions occur preferentially on sun-exposed sites of the body. The role of human papillomavirus (HPV) in the etiology of carcinoma of the genital tract is well established. Epidermodysplasia verruciformis (EV) has been regarded as a model for NMSC developing on sun-exposed sites. Infection with a specific group of HPV types has been associated with the benign and malignant lesions occurring in these patients. Recent studies using improved detection methods, as well as re-examining material used in previously published studies, reported the presence of HPV DNA in NMSC from immunocompetent patients, as well as more than 90% of NMSC occurring in organ transplant recipients. Five HPV types were identified as the most prevalent in these tumors, i.e., HPV 20, HPV 23, HPV 38 and two newly identified HPV types, DL40 and DL267. These and other HPV types were also demonstrated in normal skin biopsies (35%) and a small number of melanomas. The frequent presence of more than one HPV type within a lesion was noticeable, with at least one type belonging to the EV-associated HPV types. Present data indicate that the primary infection with the majority of, if not all, HPV types, apparently occurs early in life, after which it remains latent. Prolonged ultraviolet (UV) radiation is needed either to activate viral gene functions, and/or to inactivate cellular genes responsible for controlled cell growth. Further studies are clearly needed to determine the molecular mechanisms by which these HPV infections in combination with UV-radiation may contribute to this carcinogenic process.
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Affiliation(s)
- E M de Villiers
- Abteilung Tumorvirus-Charakterisierung, Deutsches Krebsforschungszentrum, Heidelberg, Germany
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