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Cuomo R, Rozen WM, Pentangelo P, Ceccaroni A, Alfano C, Seth I. Human Papillomavirus-Associated Giant Clear Cell Acanthoma and Squamous Cell Carcinoma: A Rare Case Report and Literature Review. J Clin Med 2024; 13:2482. [PMID: 38731009 PMCID: PMC11084788 DOI: 10.3390/jcm13092482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/13/2024] [Accepted: 04/21/2024] [Indexed: 05/13/2024] Open
Abstract
Clear cell acanthoma (CCA) and squamous cell carcinoma (SCC) represent distinct entities within dermatological oncology, each posing unique diagnostic and therapeutic challenges. CCA is a rare, benign epidermal growth, often not associated with human papillomavirus (HPV) infection, whereas SCC, a more aggressive form of skin cancer, has been linked to both ultraviolet (UV) exposure and HPV. Understanding the co-occurrence of these conditions in a single patient can enhance diagnostic accuracy and therapeutic outcomes. We report a 64-year-old male who underwent an operation for a verruciform lesion in the right groin, which was diagnosed as HPV-positive CCA alongside keratinised SCC. A literature search across January 2024 revealed limited evidence directly linking HPV to CCA, suggesting a need for further investigation. The speculative association between HPV and CCA warrants deeper exploration, especially considering the potential for HPV to contribute to lesion development through indirect mechanisms. The coexistence of CCA and SCC in an elderly patient presents a unique clinical scenario. This emphasises the need for vigilant diagnosis and tailored treatment strategies, highlighting the gap in understanding the pathogenesis of CCA, particularly its potential association with HPV. Further research is crucial for elucidating the complex interactions governing these conditions and for developing targeted interventions.
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Affiliation(s)
- Roberto Cuomo
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Warren M. Rozen
- Department of Plastic Surgery, Peninsula Health, Melbourne, VIC 3199, Australia
| | - Paola Pentangelo
- Plastic Surgery Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Alessandra Ceccaroni
- Plastic Surgery Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Carmine Alfano
- Plastic Surgery Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Ishith Seth
- Department of Plastic Surgery, Peninsula Health, Melbourne, VIC 3199, Australia
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Bartley B, Cho WC, Rady PL, Dai J, Curry JL, Milbourne A, Tyring SK, Torres-Cabala CA. Condyloma and coincidental epidermodysplasia verruciformis acanthoma positive for human papillomavirus-14 and -21. J Cutan Pathol 2023; 50:47-50. [PMID: 36039682 DOI: 10.1111/cup.14319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/19/2022] [Accepted: 08/28/2022] [Indexed: 01/03/2023]
Abstract
Epidermodysplasia verruciformis (EDV) is a rare genodermatosis that predisposes individuals to persistent infection with β-human papillomavirus (HPV) genotypes. The term EDV acanthoma may be applied to lesions with incidental findings of EDV-defining histopathological features without clinical signs of EDV. We report a case of HPV-14- and -21-positive EDV acanthoma arising in association with condyloma in a female patient with a history of low-grade squamous intraepithelial lesion of the cervix positive for high-risk HPV (non-16/18), chronic kidney disease, and systemic lupus erythematosus. The patient had no family or personal history of EDV, but the patient was on immunosuppressive therapy with mycophenolate mofetil and prednisone. A biopsy specimen from one of the perianal lesions revealed histopathologic changes consistent with EDV in the setting of condyloma. Molecular testing showed HPV-14 and -21, which supported the coexistence of condyloma with EDV acanthoma.
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Affiliation(s)
- Brooke Bartley
- Department of Dermatology, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Woo Cheal Cho
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Peter L Rady
- Department of Dermatology, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Julia Dai
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jonathan L Curry
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Andrea Milbourne
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephen K Tyring
- Department of Dermatology, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Carlos A Torres-Cabala
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Manalo I, Miller A, Siniakov I, Blalock TW. Epidermodysplasia verruciformis in Mohs micrographic surgery. JAAD Case Rep 2021; 16:41-43. [PMID: 34522745 PMCID: PMC8426167 DOI: 10.1016/j.jdcr.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Iviensan Manalo
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | | | - Igor Siniakov
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Travis Wayne Blalock
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
- Division of Dermatology, Atlanta Veterans Administration Medical Center, Decatur, Georgia
- Correspondence to: Travis Wayne Blalock, MD, Department of Dermatology, Emory University School of Medicine, 1525 Clifton Road, Suite 100, Atlanta, GA 30329.
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The Clinical Implication of Incidental Epidermodysplasia Verruciformis. Am J Dermatopathol 2020; 43:156-158. [PMID: 32649343 DOI: 10.1097/dad.0000000000001727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lee TJ, Wu YH. Epidermodysplasia verruciformis acanthoma. DERMATOL SIN 2018. [DOI: 10.1016/j.dsi.2017.06.001] [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] Open
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Champagne C, Moore L, Reule R, Dyer JA, Rady P, Tyring SK, North JP. Cornoid Lamella-Like Structures in HIV-Associated Epidermodysplasia Verruciformis: A Unique Histopathologic Finding. Am J Dermatopathol 2015; 37:929-32. [PMID: 26588337 PMCID: PMC4894799 DOI: 10.1097/dad.0000000000000325] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Epidermodysplasia verruciformis (EV) is an uncommon inherited skin condition with increased vulnerability to widespread infection by certain human papillomavirus types, resulting in extensive verruca plana-like papules coalescing to large confluent plaques. Since the AIDS epidemic starting in the 1980s, an acquired type of EV has been described in patients infected with human immunodeficiency virus. The histopathologic features of EV consist of papillated epidermal hyperplasia with hypergranulosis and a distinct bluish-gray color in the large human papillomavirus-infected keratinocytes in the stratum granulosum. The authors present a case of HIV-associated EV with a unique histopathologic finding of multiple cornoid lamella-like structures. To the authors' knowledge, this finding has not been previously described in the literature.
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Affiliation(s)
| | - Lindsey Moore
- Department of Dermatology, University of Missouri, Columbia, MO
| | - Ross Reule
- Department of Dermatology, University of Missouri, Columbia, MO
| | | | - Peter Rady
- Department of Dermatology, Laboratory for Molecular Studies in Mucocutaneous Diseases, University of Texas Health Science Center at Houston, Houston, TX; and
| | - Stephen K. Tyring
- Department of Dermatology, Laboratory for Molecular Studies in Mucocutaneous Diseases, University of Texas Health Science Center at Houston, Houston, TX; and
| | - Jeffrey P. North
- Departments of Dermatology, and
- Pathology, University of California, San Francisco, San Francisco, CA
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Improved detection reveals active β-papillomavirus infection in skin lesions from kidney transplant recipients. Mod Pathol 2014; 27:1101-15. [PMID: 24390217 DOI: 10.1038/modpathol.2013.240] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 11/21/2013] [Accepted: 11/26/2013] [Indexed: 01/10/2023]
Abstract
The aim of this study was to determine whether detection of β-HPV gene products, as defined in epidermodysplasia verruciformis skin cancer, could also be observed in lesions from kidney transplant recipients alongside the viral DNA. A total of 111 samples, corresponding to 79 skin lesions abscised from 17 kidney transplant recipients, have been analyzed. The initial PCR analysis demonstrated that β-HPV-DNA was highly present in our tumor series (85%). Using a combination of antibodies raised against the E4 and L1 proteins of the β-genotypes, we were able to visualize productive infection in 4 out of 19 actinic keratoses, and in the pathological borders of 1 out of 14 squamous cell carcinomas and 1 out of 31 basal cell carcinomas. Increased expression of the cellular proliferation marker minichromosome maintenance protein 7 (MCM7), that extended into the upper epithelial layers, was a common feature of all the E4-positive areas, indicating that cells were driven into the cell cycle in areas of productive viral infections. Although the present study does not directly demonstrate a causal role of these viruses, the detection of E4 and L1 positivity in actinic keratosis and the adjacent pathological epithelium of skin cancer, clearly shows that β-HPV are actively replicating in the intraepidermal precursor lesions of kidney transplant recipients and can therefore cooperate with other carcinogenic agents, such as UVB, favoring skin cancer promotion.
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Wititsuwannakul J, Ko CJ. Myrmecia wart inclusions as an incidental histopathologic finding. J Cutan Pathol 2012; 39:936-9. [PMID: 22882280 DOI: 10.1111/j.1600-0560.2012.01968.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 05/30/2012] [Accepted: 06/29/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Latent infection by human papillomavirus (HPV) has been described for genital (mucosal) and epidermodysplasia verruciformis subtypes. Only rarely has cutaneotropic, non-oncogenic HPV been found by polymerase chain reaction studies in normal skin. METHODS We noted myrmecia wart inclusions as an incidental histopathologic finding in four specimens from diverse sites (eyebrow, scalp, forehead, leg). The final diagnoses for these four cases were intradermal nevus, scarring alopecia, benign keratosis and stasis dermatitis. Anti-HPV antibody staining was performed in all cases. This antibody detects HPV-1,6,11,16,18 and 31 in formalin-fixed paraffin-embedded tissue. RESULTS The foci of myrmecia wart inclusions were characterized by smooth to angular cytoplasmic inclusions in the granular layer, spanning one to three rete. The inclusions stained with an anti-HPV antibody in three specimens. CONCLUSIONS This finding of incidental myrmecia wart inclusions in skin biopsies supports latent infection by cutaneotropic, non-carcinogenic HPV.
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Affiliation(s)
- Jade Wititsuwannakul
- Department of Dermatology, Yale University School of Medicine, New Haven, CT 06520, USA.
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Management of benign skin lesions commonly affecting the face: actinic keratosis, seborrheic keratosis, and rosacea. Curr Opin Otolaryngol Head Neck Surg 2009; 17:315-20. [DOI: 10.1097/moo.0b013e32832d75e3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Affiliation(s)
- Christine J Ko
- Department of Dermatology, Yale University School of Medicine, New Haven, CT 06520, USA.
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Eccrine Syringofibroadenoma Associated With Well-Differentiated Squamous Cell Carcinoma. Am J Dermatopathol 2008; 30:572-4. [DOI: 10.1097/dad.0b013e31817d4c90] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Incidental epidermodysplasia verruciformis human papillomavirus infection (EV acanthoma): evidence for ‘field cancerization’ and a putative cofactor in seborrheic keratosis. J Cutan Pathol 2008; 35:1151-5. [DOI: 10.1111/j.1600-0560.2007.00920.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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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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