Eosinophilic inclusion bodies and cytoplasmic masses in verrucae; their incidence in 156 lesions consecutively removed

Granulomatous arteritis in cutaneous lesions of Churg?Strauss syndrome

BACKGROUND

Although granulomatous arteritis is usually found in extracutaneous Churg-Strauss syndrome (CSS) lesions, the vasculitis in CSS cutaneous lesions typically shows small vessel vasculitis (leukocytoclastic vasculitis) without demonstrating the feature of granulomatous arteritis confirming the proper classification of CSS in the category of granulomatous vasculitis.

METHODS

Four deep excisional biopsies were obtained from three untreated CSS patients who presented with livedo reticularis and subcutaneous nodules. Tissue blocks were recut and submitted for hematoxylin and eosin and elastic tissue staining to evaluate the histological features of the affected vessels. Immunostaining for histiocytes, lymphocytes, and neutrophils were performed on serial sections to confirm the cellular infiltration.

RESULTS

In all specimens, subcutaneous granulomatous arteritis was observed. The unique histological feature distinct from other vasculitic disorders is characterized by marked infiltration of histiocytes and multinucleated giant cells in and around the disrupted subcutaneous arterial walls mixed with an eosinophilic infiltrate. In two specimens, granulomatous arteritis was found in the subsequent serial sections, not in the initial sections. The initial section may show extravascular granulomatous inflammation without evidence of vasculitis.

CONCLUSIONS

Granulomatous arteritis as identified in the extracutaneous lesions can also be found in subcutaneous CSS lesions presenting with livedo reticularis and/or subcutaneous nodules.

Papillomaviruses: their possible role in oral disease

Papillomaviruses are ubiquitous DNA viruses that are epitheliotropic and produce a range of epithelial neoplasms, both benign and malignant, in animals and man. Human papillomaviruses are associated with a variety of rare and uncommon oral lesions, and there has been increasing suspicion that they may be implicated also in some premalignant and malignant oral lesions.

[Light-microscopic study of classified virus warts (HPV-1 and HPV-4) (author's transl)]

Histological investigations of verrucae vulgares of the hand and of plantar warts show striking differences between HPV-1-induced warts and those caused by the virus type HPV-4. In warts caused by HPV-1 massive vacuolization and disturbance of epidermal cell differentiation through the entire thickness of the epidermis is predominant whereas in HPV-4 stimulated warts cell differentiation is impaired to a much lesser degree. Despite the presence of inclusions and of vacuolized cells a thick stratum granulosum and a compact horny layer are formed in the latter type.

[Comparison of the epidermodysplasia verruciformis Lewandowsky-Lutz with the other Papova virus acanthomas by light and electron microscopy (author's transl)]

Based on histology and electron microscopy, a series of Papova virus acanthomas consisting of 300 common warts and Condylomata acuminata as well as primary efflorescences of 7 typical and 7 questionable cases of Epidermodysplasia verruciformis have been classified. Four cytological types expressing different cytopathogenic viral actions were established. Typ 4 ("basophilic foamy giant keratinocytes") seems to be specific for Epidermodysplasia verruciformis which thus can be differentiated histologically against ordinary warts (type 1-3).

Human papova (wart) virus

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