Benign Epithelial Proliferations Research Articles

Therapeutic Role of HPV Vaccination on Benign HPV-induced Epithelial Proliferations in Immunocompetent and Immunocompromised Patients: Case Study and Review of the Literature.

Human papillomavirus (HPV) vaccination represents a milestone in primary prevention of sexually transmitted infections. However, little is known about its possible effects on already established HPV infections. We report the case of a 9-year-old immunosuppressed girl with refractory warts, successfully treated with the nonavalent-HPV vaccine and review the literature about the therapeutic effects of HPV vaccination on benign HPV-induced epithelial proliferations in immunocompetent and immunosuppressed patients. In the literature, promising results were shown on cutaneous warts after HPV vaccination, especially in children and young adults, also in immunosuppressed patients, whereas controverse results were found on anogenital warts. These findings suggest a critical need for randomized clinical trials to assess the efficacy of HPV vaccination in the treatment of benign HPV-induced epithelial proliferations.

Low-grade appendiceal mucinous neoplasms: Histomorphological spectrum in a tertiary care hospital.

Low-grade appendiceal mucinous neoplasms (LAMNs) are benign non-invasive epithelial proliferations of the appendix. These usually present clinically as mucoceles and these rarely exceed 2 cm in diameter. Lesions confined to the lumen are labelled as LAMN; however those in which mucin spreads outside the peritoneum are labeled as pseudomyxoma peritonei (PMP). A retrospective study was conducted over a period of three years and all cases of appendectomies were studied. Twelve cases of LAMN were identified, which is a diagnostic dilemma for the pathologists and clinicians. LAMN was identified based on the histopathological features. Out of the 12 cases, 9 were classified as LAMN and 3 as appendiceal neoplasm with PMP. There was villous or flat proliferation of epithelial lining, loss lymphoid aggregates, and dissecting mucin within muscularis. LAMNs are rare neoplasms of the appendix, with clinical presentation similar to acute appendicitis. Mucinous collections within the appendiceal wall should be extensively searched for mucosal changes and, if found, should prompt a careful search for pushing invasion of LAMNs. A thorough and vigilant gross examination can be of great help. Appendicectomy is the treatment of benign and grossly intact mucinous neoplasm.

Warts among Patients Visiting the Outpatient Department of Dermatology in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Warts are benign epithelial proliferations caused by a double-stranded deoxyribonucleic acid virus called human papillomavirus. They may cause significant concern and frustration on the part of the patient affecting social activities as lesions can be uncomfortable, and treatment is often painful and frustratingly ineffective. The study aimed to find out the prevalence of warts among patients visiting the outpatient Department of Dermatology in a tertiary care centre. This descriptive cross-sectional study was conducted in a tertiary care centre from 20 January 2021 to 21 February 2022. The ethical approval was taken from the Institutional Review Committee (Reference number: IRC-NMCTH 588/2021). A convenience sampling technique was used. A detailed history including distribution, size, morphology, progression and duration of the lesions was taken. Point estimate and 95% Confidence Interval were calculated. Out of 4802 outpatients, 140 (2.92%) (2.44-3.40, 95% Confidence Interval) had warts. Genital wart was found in 24 (17.14%) and non-genital warts in 116 (82.85%) patients. The prevalence of warts among outpatients was similar when compared to other studies from similar settings.

Oral Melanoacanthoma: A series of 33 cases and Review of the Literature

<h3>Background</h3> Oral Melanoacanthoma (OM) is an unusual, likely reactive heavily pigmented, benign epithelial proliferation. OM often grows rapidly mimicking melanoma and leading to anxiety for both the patient and the clinician. We present a large series of OM including demographics, description of clinical appearance and characteristics, histology, and literature review. To the best of our knowledge, this is the largest series of OM reported to date. <h3>Materials and Methods</h3> Following IRB approval, OM cases from the University of Florida Oral Pathology Biopsy Service archives (1998-2020) were included. Demographics and clinical features were collected and slides were reviewed. <h3>Results</h3> 33 cases were included with a mean age of 38 years, female: male ratio of 2.6:1. The most common location was buccal mucosa (n = 16, 48.48%), followed by palate (n = 11, 33.33%), tongue and labial mucosa (n = 2 each, 6.06%), maxillary and mandibular gingiva (n = 1 each, 3.03%). Most lesions are dark black/brown, and often described as macular in nature. Duration ranged from one week to twelve months, and all cases were asymptomatic. The clinical impression in the majority of cases were that of a benign melanotic lesion. Ethnicity was only documented in 6/33 cases, of which five cases were African American and one was Caucasian. Histomorphologically, majority of cases (n=27, 81.8%) were hyperplastic/acanthotic, while atrophic epithelium cases were (n=4, 12.1%) and less commonly, spongiotic epithelium cases were (n=2, 6.06%). <h3>Conclusion</h3> The findings of this study are consistent with those in the literature concerning demographics and clinical presentation. Histologically, presence of dendritic melanocytes extending into the spinous cell layer along with acanthosis of the spinous cell layer is diagnostic for OM when combined with the clinical presentation. However, it is important to add cases of OM to the literature so clinicians can be more aware of this lesion.

Mesonephric Remnants of the Diaphragm: A Major Pitfall in a Patient with Oesophageal Carcinoma

Mesonephric remnants represent a benign epithelial glandular proliferation derived from the lack of complete regression of the mesonephric ducts in embryogenesis. They are usually incidental findings and can cause confusion and diagnostic failures since they appear as glands outside the context of a glandular organ. Here we introduce the case of an 80-year-old man presented to the Chirurgical Department due to oesophageal stenosis in a context of a signet-ring cell carcinoma of the gastroesophageal junction. The CT-scan study demonstrated liquid retention in the esophagus and peritoneal carcinomatosis was suspected. Laparoscopy revealed multiple white spots on the peritoneal oesophageal hiatus which were biopsied. On microscopic examination, tubular formations with a monomorphic, cubic epithelial lining were seen which showed immunohistochemically a strong reactivity of CK-7 and Ber-EP4 and negativity for TTF-1, WT1, Calretinin, PAX-8, and CDX2 (Figure 2). A local metastasis of the oesophageal carcinoma was excluded based on morphology and immunohistochemistry and the diagnosis of mesonephric remnants was made. Here we present a rare but potentially grave pitfall and to our best knowledge the first case of mesonephric remnants within the diaphragm.

Resistant Plane Warts Treated by 40% Salicylic Acid and 16% Lactic Acid Combination on the Face

Human papillomaviruses (HPV) cause warts, which are the benign epithelial proliferation of the mucous membrane and skin. HPV-3 and HPV-10 commonly cause plane warts. Multiple treatment options must be used as no specific treatment option is available. We have a lot of limitations for the face as treatment can cause permanent scarring on the face. We report a case of 41 years immunocompetent male presenting with many plane warts on the face who was successfully treated with topical application of 40% Salicylic acid cream and 16% lactic acid cream made up of 44% of bees wax on lesions after a failure of many other treatment options, a) Topical zinc oxide twice per day for 3 months, b) Topical 5% salicylic acid dispensing cream made in 95% bees wax, c) Topical 5% fluorouracil cream, d) Topical imiquimod cream, e) Topical retinoids cream only at night for one month, f) Oral Isotretinoin 20mg twice per day for 2 months, and 3 sessions of cryotherapy. The patient's last treatment was oral isotretinoin 20 mg twice per day for the last 2 months. In general, doctors avoid using more than 5% salicylic acid, but after a detailed discussion with the patient, we decided to try this combination and succeeded.

New aspects in the classification of epithelial tumors of the mammary gland

The classification of breast tumors continues to evolve, with new knowledge from research being applied in practice. The new volume of the World Health Organization (WHO) Classification from 2019 is an update of the fourth edition of breast tumors, published in 2012. The descriptions of breast diseases follow the familiar systematic approach of previous volumes. The content is organized in the following sequence: from benign epithelial proliferations and precursors, through benign neoplasms, to in situ and invasive breast cancer, followed by fibroepithelial and nipple tumors, mesenchymal and hematolymphoid neoplasms, tumors of the male breast and genetic tumor syndromes. A brief introduction precedes the contents of each chapter of the book to provide an overview of the nosological units involved and to highlight key changes in the current classification. New histological variants of mammary carcinoma have been introduced, others have completely disappeared, some of them have been moved to another category of tumors, and still others have been transformed from a special subtype carcinoma into a growth pattern of invasive breast carcinoma of no special type. Neuroendocrine tumors are consistent with the same tumors located in other organs and systems, and the criteria for both microinvasion and mixed forms of breast cancer are indicated. The classification of breast tumors is a dynamic process that uses many sources of up-to-date information that have emerged since the publication of the latest WHO update. Some of the innovations could be integrated very successfully into the algorithms of digital pathology, which would improve the diagnostic accuracy and thus would lead to optimization of the choice of therapeutic strategies and estimation of the correct prognosis.

Intralesional Measles Mumps Rubella vaccine versus BCG in the treatment of multiple cutaneous warts: a comparative study

Background: Verrucae or warts are benign epithelial proliferations that occur due to accumulation of keratinocytes induced by HPV. Immunotherapy is a new promising modality which uses the principle of activation of one’s own immunity against the disease. Materials and methods: The study included 40 patients with multiple cutaneous warts in two groups of 20 each. Assigned treatment was injected into the single largest wart at an interval of 3 weeks until complete clearance or for a maximum of 3 times. Results: A statistically significant difference (p=0.018) was seen in the therapeutic response when compared to that of the BCG. All 20(100%) patients in the MMR group showed &gt;50% clearance while in the BCG group 14(70%) patients showed &gt;50% clearance according to Physician’s Global Assessment scores. Conclusions: Intralesional immunotherapy with MMR and BCG vaccines are both safe and promising whereas the therapy with MMR stands out with statistically significant results.

Masses of the Lacrimal Gland: Evaluation and Treatment.

Lacrimal gland lesions account for approximately 9 to 10% of all biopsied orbital masses. Potential causes include nongranulomatous and granulomatous inflammation, autoimmune disease, lymphoproliferative disorders, benign epithelial proliferation, malignant neoplasia, and metastatic disease. Inflammatory lesions and lymphoproliferative disorders are the most common and may be unilateral or bilateral; they may also be localized to the orbit or associated with systemic disease. Both benign and malignant epithelial lacrimal gland masses tend to be unilateral and involve the orbital lobe, but a more rapid onset of symptoms and periorbital pain strongly suggest malignant disease. On orbital imaging, both inflammatory and lymphoproliferative lesions conform to the globe and surrounding structures, without changes in adjacent bone, whereas epithelial lacrimal gland masses often show scalloping of the lacrimal gland fossa. Malignant epithelial lacrimal gland tumors can also have radiographic evidence of bony invasion and destruction. Masses of the lacrimal gland may be due to a broad range of pathologies, and a good working knowledge of common clinical characteristics and radiographic imaging findings is essential for diagnosis and treatment. All patients with inflammatory, lymphoproliferative, and epithelial neoplastic lesions involving the lacrimal gland require long-term surveillance for disease recurrence and progression.

LncRNA DIO3OS regulated by TGF-β1 and resveratrol enhances epithelial mesenchymal transition of benign prostatic hyperplasia epithelial cells and proliferation of prostate stromal cells.

BackgroundThe etiopathogenesis of benign prostatic hyperplasia (BPH) is extremely complicated which involving epithelial-mesenchymal transition (EMT) of epithelial cells and growth of stromal cells. Long non-coding RNAs (lncRNAs) belong to a group of noncoding RNAs which has been widely studied in other diseases but rarely in BPH. Here, we intend to investigate the roles of a lncRNA DIO3 opposite strand (DIO3OS) in BPH progression.MethodsBPH-1 cells were used to study EMT and WPMY-1 cells were applied to study proliferation induced by TGF-β1, resveratrol, DIO3OS and miRNAs.ResultsDIO3OS was over-expressed in BPH tissues and could be upregulated by Transforming growth factor beta 1 (TGF-β1) and downregulated by resveratrol. Smad2/Smad3/Smad4 complex could bind to the DIO3OS promotor region and thereby enhanced its transcription which was responsible for the regulation of TGF-β1 and resveratrol on DIO3OS expression. TGF-β1 promoted BPH-1 cells EMT and WPMY-1 cells proliferation via DIO3OS and this effect could be blocked by resveratrol. MiR-656-3p and miR-485-5p were targets of DIO3OS and DIO3OS promoted BPH-1 cells EMT and WPMY-1 cells proliferation via miR-656-3p and miR-485-5p. Connective tissue growth factor (CTGF) and zinc finger e-box binding homeobox 1 (ZEB1) were confirmed to be targets of both miR-656-3p and miR-485-5p and could be modulated by TGF-β1, resveratrol, DIO3OS, miR-656-3p and miR-485-5p.ConclusionsDIO3OS is highly expressed in BPH tissues and regulated by TGF-β1 as well as resveratrol in a Smads dependent manner. DIO3OS facilitates BPH-1 cells EMT and WPMY-1 cells proliferation by upregulating CTGF and ZEB1 via miR-656-3p and miR-485-5p.

Evaluation of Interleukin-17 in Viral Warts

Background: Warts are common benign epithelial keratinocytes proliferations caused by human papillomavirus (HPV) infection that may involve the skin and the mucous membranes Interleukin-17A (IL-17A), is a prototypic member of cytokines. It is recognized as an inflammatory cytokine and exerts its function mainly on myeloid cells and mesenchymal cells to induce the expression of certain kinds of chemokines, which in turn increase granulopoiesis and recruit neutrophils to the infectious site. Aim and objectives: The aim of the work was to evaluate the serum level of interleukin 17 in patients with viral warts and its correlation with the disease severity. Subjects and methods: this was a case control study, in which participants were selected from the outpatient clinic of Dermatology, Venereology & Andrology department of Benha University Hospitals, carried on sixty patients of wart and thirty healthy subjects serving as a matched control subjects group. Serum IL17 was detected by ELISA Results: The results of the study revealed that there was high statistically significant difference between groups regarding IL 17 serum level where it was higher in wart patients’ group. Conclusion: This study reported increased IL17 in sera of patients with warts irrespective of their clinical type (plane, plantar or common).This finding may denote that IL17 may have a role in pathogenesis of viral warts.

Wart removal without anesthesia using long-pulse 1064-nm Nd:YAG laser.

BackgroundWarts are benign epithelial proliferations that result from human papillomavirus (HPV) infection occurring on the skin and mucosa. Patients express a significant reduction in quality of life due to this cosmetic nuisance, as well as functional problems and physical discomfort. Newer methods of wart removal include different energy‐based devices, mostly lasers. Nonablative lasers such as Nd:YAG have a higher success rate and are usually used with topical or infiltrative anesthesia. The procedure may be safer without anesthesia but still tolerable with an appropriate cooling and technique.AimsThe purpose of this study is to report on our experience over 3 years since the approach without anesthesia has been utilized.Patients/MethodsA retrospective chart review analysis of all 85 patients who underwent 1064 nm Nd:YAG wart removal without anesthesia between November 2016 and August 2019 was conducted. One of the main outcome measures was determining the number of sessions required in order to get full clearance.ResultsThe mean number of sessions was 2.2 (range 1‐7). The mean VAS pain score during the procedure was 6 (range: 2‐10), and side effects were negligible.ConclusionLong‐pulse 1064‐nm Nd:YAG laser without any chemical anesthesia is safe and effective for the treatment of warts.

Paratesticular Cyst with Benign Epithelial Proliferation Arising from a Mesonephric Duct Remnant

A 65-year-old male presented with a cystic scrotal mass that fluctuated in size. The cyst was associated with aberrant epididymal tissue and was found to have benign epithelial proliferations, with immunohistochemistry supporting a mesonephric origin (GATA3, CD10, and WT1 positive). Clinical presentation, imaging, and pathologic findings are described.

A Rare Case of Polypoidal Cystitis in Adult without History of Prolong Catheterization

Introduction: Polypoidal cystitis is a rare lesion of the bladder mucosa characterized by benign exophytic inflammation,epithelial proliferation and development of polypoid mass without evidence of neoplasm histologically. Polypoid cystitis is rarely seen in patient without prolong used of indwelling catheter. Other cases of polypoidal cystitis are associated with post-radiation, post chemotherapy bladder reaction, colovesicular fistula are extremely rare. Case Report: 66 year old Malay male ,underlying hypertension and Benign Prostatic Hyperplasia (BPH) on treatment, complaining of difficulty in urination, straining on voiding for the past 6 months and on and off  hematuria for the past 2 months. He denied any history of CBD insertion or prolong cataheterization. Blood investigations are Normal. X-Ray KUB showed unremarkable. Ultrasound KUB revealed Prostatomegaly, no evidence of renal or ureteric calculi or evidence of Obstructive uropathy,No obvious bladder mass. Cystoscopy Examination (CE) showed enlarged occlusive prostate and noted bladder growth at base of bladder. The growth is malignant looking however no active bleeding seen. No bladder stone seen. Patient subsequently underwent TransUrethral Resection of Bladder Tumor (TURBT) and Trans-Urethral Resection of Prostate (TURP) in same setting. Intra operatively was uneventful. HistoPathological Examination (HPE) from TURBT specimens showed in favour of Polypoidal Cystitis and TURP revealed Nodular Hyperplasia. Discussion: Polypoidal Cystitis is a form or chronic cystitis characterized by exophytic inflammatory  lesion of bladder mucosa. The polypoidal mass is mimicking neoplasm. At the initial evaluation, it may be confused with transitional cell carcinoma of the urinary bladder, especially in patient without an indwelling catheter. The most common aetiology of this condition is long-standing indwelling catheterization.. There is also reported that any factors that irritates the bladder mucosa may result in Polypoidal Cystitis.  In our patient ,there was no history of such other causes, including prolong catheterization, fistula, urinary calculi or radiation therapy.

Variant of Dermoscopy and Histopathological Features of Seborrheic Keratoses in 66 Years-Old Male: A Case Report

Seborrheic keratosis (SK) is one the most common skin tumour to be misdiagnosed clinically as melanoma. Seborrheic keratosis may grow rapidly, the incidence of this benign epithelial proliferation is increasing with age and exposure to UV light; it can recurrence. Dermoscopy can be a preliminary examination of suspected malignancy and noninvasive tool useful for the early recognition of pigmented skin tumours, especially SK as it helps in differentiating with other disease, because it can look like a wart, pre-cancerous skin growth, or skin cancer.A case of a seborhheic keratoses in 66 years-old male was reported. He complained there were reappeared brown blackish spots that multiple on face, neck and trunk that are increase in number and size since 1 years ago that felt itchy sometimes. Dermatological examination showed multiple brown blackish papules, brown blackish plaques and papules skin colour on face, neck and trunk were noticed. On dermoscopy showed sharped borders and numerous comedo-like, cerebriform pattern, linear hypopigmented ridges andglobular pattern opening on face and trunk. On histopathological examination showed the epithelium was placed hyperplasia, hyperkeratosis, acanthosis and appeared ‘horn cysts’ on epidermis. Diagnosis in this case was made from a complete history and physical examination, dermoscopy and histopathology examination. This patient was treatment with elecrodessication and curretage serial.

Evaluation of serum interleukin 17 and zinc levels in recalcitrant viral wart.

Warts are benign epithelial proliferations of the skin and mucosa caused by infection with HPV. Low IL-17 levels may contribute in occurrence, maintenance, severity, and recurrence of different types of cutaneous wart that depend mainly on the cell-mediated immunity defect. In a majority of the patients, zinc deficiency was associated with persistent, progressive, or recurrent viral warts. A careful dose of oral zinc sulfate may be helpful in the management of such patients. Zn deficiency negatively affects the Th17 cells. IL 6 induced STAT3 activation during chronic inflammation and Th17 development suppressed by Zn via attenuating this activation critically controls Th17-cell development. To evaluate the role of interleukin 17 and zinc in recalcitrant warts. All studied patients were subjected to history taking and dermatological examination. The evaluation of serum IL-17 level was done by ELISA in 25 recalcitrant wart patients and 25 wart patients. The measurement of serum zinc level was determined by colorimetric methods, using Au 480 Beckman coulter chemistry analyzer. The results revealed a significant decrease in serum IL-17 and zinc levels in recalcitrant wart patients. Both IL-17 and zinc deficiency have a role in the pathogenesis of recalcitrant warts through the imbalance of immune system and deficiency of immune cells. There is no significant correlation between serum levels of IL-17 and zinc, suggesting that they have different mechanisms in affecting the immune system.

Comparative Study between Intralesional Injection versus Intradermal Injection of Candida Albicans Antigen as An Effective Treatment of Common Warts

Background: Warts, or verrucae, are benign epithelial proliferations of skin and mucosa caused by infection with human papilloma virus (HPV). They are common skin condition that can range in severity from a minor nuisance that resolves spontaneously to troublesome, chronic condition. Objective: The aim of the present study is to compare between intralesional injection of candida albicans antigen versus intradermal injection as an effective treatment of common warts. Patients and methods: This study included 60 (sixty) patients (adult males and females) were suffering from common warts. The patients were divided into two equal groups of 30 patients each: Group A treated by intradermal injection of candida albicans antigen. Group B treated by intralesional injection of candida albicans antigen in one of their warts (mother wart) which was chosen and marked. The patients were collected from the outpatient's clinics of Dermatology and Venereology Department of Al- Hossein University Hospital. Results: As we compared the response to candida albicans antigen injection, we found a highly significant cure response in intralesional injections over intradermal injections. After 6 months follow up in patients who responded by complete cure (29 patients), there was no recurrence in 26 patients (89.6%) and only 3 cases (10.4%) developed partially recurrence. As regard to side effects there were no side effects in 43 cases (71.7%). Conclusion: candida albicans antigen injection seems to be promising effective and safe remedy for cutaneous warts with good cure rates and excellent safety profile.

Seborrheic Keratoses - The Most Common Benign Skin Tumor of Humans. Clinical presentation and an update on pathogenesis and treatment options.

Seborrheic keratoses (SK) are the most common skin tumour of humanity. The incidence of this purely benign epithelial proliferation is increasing with age and exposure to ultraviolet light. It has a remarkable variability in its clinical presentation raising some differential diagnoses. Recently, oncogenic mutations have been detected involved in the development of SK, which, however, do not bear the risk of malignant transformation. SK may also develop with the use of modern targeted drugs for the treatment of malignancies. The classical treatment options for SK are cryotherapy and curettage. Recently, topical treatment with 40% hydrogen peroxide and the nitric-zinc complex has been investigated. Ablative laser therapy is an effective treatment as well.

A topical nitric-zinc complex solution as an alternate therapy for difficult-to-treat and resistant common warts and external genital warts

Background: Verrucae are benign epithelial proliferations, caused by human papilloma virus (HPV) infection occurring on the skin and mucosa. Traditional therapeutic options for warts, such as cryotherapy, topical salicylic acid, trichloroacetic acid (TCA) or podophyllin applications, induce a local

Dermatoscopy: an auxiliary resource for the diagnosis of poroid neoplasms

AbstractPoroid neoplasms are benign epithelial proliferations with eccrine sweat gland differentiation. They are a challenging diagnosis because of the clinical heterogeneity, being able to mimic several malignant neoplasms. They are classified into classic poroma, hidroacanthoma simplex, dermal duct tumor and poroid hidradenoma. Association of histological subtypes occurs in more than 25% of cases. We report a case of a combined poroid neoplasia of classical poroma and poroid hidradenoma, reviewing its dermatoscopic features.