Inverted follicular keratosis and verruca vulgaris. An investigation for the papillomavirus common antigen

Multiple inverted follicular keratoses as a presenting sign of Cowden's syndrome: case report with human papillomavirus studies

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.

Human papillomavirus type 2 DNA in oral and labial verruca vulgaris

Twenty instances of verruca vulgaris, equally divided between oral mucosa and lip vermillion, were assayed for the presence of human papillomavirus (HPV) capsid antigen and type-specific DNA employing in situ hybridization methods. All 10 cases arising on lip vermillon expressed capsid antigen and harbored HPV Type 2 genomes as assessed under conditions of high stringency DNA hybridization. Oral verrucae rarely expressed capsid antigen; HPV Type 2 genomes were encountered in 20% of the cases.

A comparative immunoperoxidase and histopathologic study of condylomata acuminata

Thirty-seven lesions from 29 patients with condylomata acuminata were comparatively studied by peroxidase-antiperoxidase (PAP) technique and routine histopathology. PAP staining demonstrated papillomavirus common antigen (PCA) mostly in the granular layer of the epidermis in 22 of 37 lesions (59%) of condylomata acuminata. Presence of PCA is closely correlated with the following histopathologic findings: 1) coarse keratohyalin granules; 2) perinuclear vacuolization or koilocytotic cells in the granular layer; 3) hyperkeratosis with focal parakeratosis. From these findings it is concluded that these histopathologic findings suggest the presence of PCA, and that the presence of papillomavirus may play a role in the formation of these histopathologic features of condylomata acuminata.

Correlative studies of Verruca vulgaris by H & E, PAP immunostaining, and electronmicroscopy

Twenty-one specimens of Verruca vulgaris were used for an investigation to define what portion of the papillomatous structures seen in H & E stain will correspond to the areas of positive staining for papilloma virus antigen utilizing the peroxidase-antiperoxidase immunostaining technique. Vacuolar spaces filled with thready material and large ovoid parakeratotic cells seen in H & E stain stained positively for papilloma virus antigen. In the granular layer, viral antigens stained heavily, the nuclei of cells showing koilocytosis. Both round and irregularly shaped kerathohyaline granules did not stain positively for viral antigen stain. Eight of the 21 specimens showed marked positivity for papilloma virus antigen. Three other cases were positive in only focal sites. Of the 8 immunostained-positive selected cases used for ultrastructural studies, only 2 showed the viral particles. The study suggests that the PAP immunostaining is a more sensitive and yet less cumbersome method than electronmicroscopy for demonstration of papilloma virus.