Verrucous Lesions Research Articles

Investigation of foreign materials in gingival lesions: a clinicopathologic, energy-dispersive microanalysis of the lesions and in vitro confirmation of pro-inflammatory effects of the foreign materials

This study aimed to evaluate the clinical and histopathologic features of gingival lesions containing foreign material (GLFMs). In parallel, the composition of the foreign material and its effects in primary human gingival fibroblasts (HGFs) were investigated. Eighty-six GLFMs were retrieved from an oral pathology biopsy service. Clinical and microscopic data were analyzed, and the composition of the particles was identified by using energy-dispersive X-ray spectroscopy (EDX). Furthermore, HGFs were stimulated with silica (SiO2) microparticles to investigate the production of collagen type 1 (COL-1), matrix metalloproteinase 2 (MMP2), and inflammatory cytokines. GLFMs were most commonly found in women (60.5%) and most frequently described as white plaques. Histopathologic examination identified verrucous hyperplasia in 59% and epithelial dysplasia in 28% of the cases. EDX microanalysis revealed that Si (94%) was the most frequently detected foreign element. SiO2 microparticles induced higher COL-1 expression; higher levels of proinflammatory cytokines, such as interleukin-6 (IL-6), IL-8, and transforming growth factor-β, and increased MMP-2 activity in HGFs. There was a strong association between the presence of foreign material in the gingiva and white verrucous clinical lesions. In addition, the most common element in the foreign material was Si, and our in vitro findings demonstrate the importance of silica-mediated effects on gingival fibroblasts.

糖尿病神経障害を有する患者に発症した verrucous skin lesions on the feet in diabetic neuropathy の 1 例

糖尿病神経障害を有する患者に発症した verrucous skin lesions on the feet in diabetic neuropathy の 1 例

Does implantation of verruca plantaris into the abductor hallucis muscle belly in conjunction with CO2 laser ablation prevent recurrence?

Often times, conservative treatment is unsuccessful in long-term resolution of recalcitrant verrucae plantaris lesions. In addition to being aesthetically displeasing, severe cases that are left untreated can be debilitating, often leading to chronic pain, gait abnormalities, and further cutaneous spread. Inoculation through implantation of verrucae plantaris into a muscle was previously postulated to provoke an immune response against the human papilloma virus, resulting in auto-immunization. The purpose of this study was to determine the rate of recurrence following two methods of treatment: A) Surgical removal and subsequent implantation of verruca plantaris into the contralateral abductor hallucis muscle belly and B) Surgical excision of verrucae plantaris. A retrospective chart review of 43 consecutive patients was performed. Group A was comprised of 25 patients who underwent surgical removal of verrucae plantaris followed by implantation of a biopsied specimen into the contralateral abductor hallucis muscle belly. Group B was comprised of 18 patients who underwent only surgical removal of the verrucae. The presence or absence of verrucous lesions was recorded at a post-operative follow-up at an average of 27.5 months. Correlations between recurrence of disease and age, sex, and medical comorbidities were evaluated. Our results suggest that implantation of verruca plantaris into the abductor hallucis muscle belly yields no significant difference in clinical recurrence rates when compared to surgical removal.

Successful Treatment of Intra-Arterial Peplomycin Infusion for Recurrent Oral Florid Papillomatosis

A 56-year-old woman had noticed the erosion of oral mucosa and tongue 8 years ago. The mucosal lesions had been initially diagnosed as oral lichen planus and resistant to various treatments with prednisolone, etretinate and mizoribine and so on. One year ago, rapidly growing verrucous lesion occurred on her upper lip. Although we administered intralesional radiation therapy, the tumor recurred and new whitish lesions on the buccal mucosa and hard palate occurred 9 months after treatment. We confirmed an anatomical blood supply to the tumors by a fluorescent real-time imaging system and subsequently administered the intra-arterial infusion of peplomycin through retrograde catheters from bilateral superficial temporal arteries under the final diagnosis as oral florid papillomatosis (OFP). The tumors were dramatically shrunk and did not recur 16 months after treatment. OFP is known as clinically multiple whitish and verrucous lesions over the oral cavity and lip and a subtype of SCC with high differentiation. We suppose that an intra-arterial infusion therapy of peplomycin should be considered as the curative treatment for OFP.

Pemphigus vegetans with isolated involvement of the nose and chest: rare variant of pemphigus vulgaris

AbstractPemphigus vulgaris is chronic bullous disease that manifests as bullae and erosions of skin and mucosas, with intraepidermal suprabasal cleft formation seen in the histological examination. It has a rare variant called pemphigus vegetans, where vesicles and bullae are replaced by pustular, verrucous and hyperpigmented lesions, mainly in skin folds. The treatment is similar to that for classic pemphigus vulgaris. The authors present an exuberant case of pemphigus vegetans, covering the nose and chest exclusively, without oral or flexural lesions.

Incontinentia pigmenti – a description of three cases

Incontinentia pigmenti (IP) or the Bloch-Sulzberger syndrome is a rare genetic dermatosis that occurs in females, which is classified as an ectodermal dysplasia. Papulovesicular eruptions appear on the skin in the first days of a patient’s life and then, with the lapse of time they become verrucous and hyperpigmentation lesions evolving into incontinentia pigmenti achromians. Apart from such characteristic cutaneous lesions, female patients suffering from incontinentia pigmenti may also present other cutaneous symptoms, as well as motor system and ophthalmological dysfunctions. In 54 per cent of patients dental symptoms are observed, those including mainly hypodontia, pegged teeth and delayed tooth eruption. <b>Aim.</b> The aim of this study was to describe three cases of female patients diagnosed with the IP syndrome who were being treated in the Department of Orthodontics of the Medical University of Warsaw. <b>Case descriptions.</b> Descriptions of three cases of female patients with diagnosed IP were presented. The patients had cutaneous lesions typical for IP. Medical interviews and physical examinations were conducted with them all; radiographs were performed and diagnostic casts were made. Class III malocclusions were diagnosed as well as dental abnormalities characteristic for IP (hypodontia, malformation of teeth). Conclusions. An early diagnosis allows for a child to receive a multispecialist medical and dental care. An interdisciplinary approach makes it possible to reach, functionally and esthetically, satisfactory results in the treatment and maintain patients’ teeth in good health until the period of adultness thus ensuring that the physical and mental state of female patients affected by the syndrome improves.

Benign proliferative epithelial lesions of oral mucosa are infrequently associated with α-, β-, or γ human papillomaviruses.

BackgroundOral papillomas and verruca vulgaris have been associated with human papillomavirus (HPV) infection. However, approximately half of these have remained HPV‐negative when tested for mucosal HPV genotypes. In this study, we evaluated presence of α‐, β‐, and γ‐HPVs in benign papillary and verrucous lesions.MethodsEighty‐three clinical lesions with suspected HPV etiology were analyzed for HPV types of genus α (n = 24), β (n = 46), and γ (n = 52). Immunohistochemistry was used for p16 as a possible surrogate marker of high‐risk HPV, accompanied by Ki‐67 proliferation marker.ResultsAltogether, α‐HPVs were detected in 6.4%, β‐HPVs in 2.4%, and γ‐HPV in 4.8%. The following genotypes were identified: HPV6, 8, 11, 16, 22, 161, and 170. Neither Ki‐67 nor p16 positivity alone were associated with HPV but combined staining showed significant inverse association (P = .042).ConclusionHPV infection is found only in a minority of benign verrucous and papillary oral lesions, with the predominance of α‐HPVs.Level of Evidence4

Oral Cancer with Verrucous Pattern is Not Associated with Human Papilloma Virus in Indian Population

AbstractBackground: The etiology of verrucous lesions of the oral cavity is debatable, and many western studies attribute it to human papillomavirus (HPV) infection. Although most Indian studies have found a strong association with tobacco chewing, the role of HPV has not been studied in the Indian context. Materials and Methods: A prospective study was conducted on the clinicopathological profile of 21 consecutive patients of verrucous lesions of the oral cavity. The patients were evaluated on the basis of addictions, pretreatment biopsy, p16 immunohistochemistry (IHC), and histopathological parameters. Results: Preoperative incisional biopsy revealed no dysplasia in 52.38%, mild-to-moderate dysplasia in 19.04%, and invasive carcinoma in 28.57% of the patients. About 67% of patients underwent surgical excision in our institute all of whom had invasive malignancy on final histopathology. This included 42.85% patients whose initial biopsy was no or mild dysplasia. All of the patients were negative for p16 IHC. Conclusions: Verrucous lesions in Indian population are caused by smokeless tobacco unlike that in the western countries where HPV is the main etiology. Clinical distinction between benign and malignant lesions is difficult, and we recommend complete surgical excision of the lesion with adequate margins whenever possible.

Treatment of verrucous carcinoma in penis with topical aminolevulinic acid photodynamic therapy: An effective and safe treatment method.

Verrucous carcinoma of the penis is a rare disease characterized by verrucous lesions. The traditional treatment methods for verrucous carcinoma result in loss of sexual function are not satisfactory. The purpose of this study was to evaluate the safety and effect of topical aminolevulinic acid photodynamic therapy in the treatment of verrucous carcinoma in penis. In this study, four male patients, average age of (47 ± 7.58) years old, with penile verrucous carcinoma were treated with topical aminolevulinic acid photodynamic therapy (ALA-PDT) combined with curettage. First, the lesions were removed under local anesthesia. Then, the first session of PDT was performed right away. Ten percent 5-ALA cream was applied to surface of the lesions with occlusive dressing for a 3-h incubation period and the lesions were irradiated for 10 min by using a 635-nm laser beam of 177 mW/cm2 intensity. The ALA-PDT was repeated after 1 and 3 weeks and two other treatments applied if necessary. Three patients were cured by this treatment, with one case relapsed at 3 months. There was no other recurrence at 5 years off treatments. The satisfaction rate of patients was 75% at 3 months after treatments. Topical PDT can be an effective and successful treatment modality for verrucous carcinoma in penis.

Overview of Cutaneous Mycobacterial Infections.

Mycobacterial infections may affect any human organ and produce disseminated disease in immunocompromised individuals. Their most common clinical presentations include pulmonary, cutaneous (skin and soft tissues), and disseminated forms. The skin and soft tissues are frequent targets of affection by mycobacterial pathogens manifesting as localized or diffuse disease. Overall, infections due to Mycobacterium leprae, Mycobacterium ulcerans, and Mycobacterium tuberculosis are the most frequently recognized mycobacterial pathogens involving the skin and soft tissues. Additionally, all mycobacterial species of the nontuberculous group may also produce cutaneous disease. Of these, the most commonly identified organisms causing localized infections of the skin and subcutaneous tissues are the rapidly growing species (Mycobacterium fortuitum, Mycobacterium chelonae, and Mycobacterium abscessus complex), Mycobacterium marinum, and M. ulcerans. Since the skin and soft tissues are important protective barriers for environmental pathogens, their disruption often represents the portal of entry of nontuberculous environmental mycobacteria (soil, natural water systems, engineered water networks, etc.). Additionally, some mycobacterial diseases affecting cutaneous structures occur after exposure to infected animals or their products (i.e., Mycobacterium bovis). Mycobacterial infections of the skin and soft tissues may manifest with a broad range of clinical phenotypes such as cellulitis, single or multiple abscesses, subacute or chronic nodular lesions, macules, superficial lymphadenitis, plaques, nonhealing ulcers, necrotic plaques, verrucous lesions, and many other dermatologic manifestations. Geography and environmental exposure play an important role in the epidemiology of cutaneous mycobacterial infections. Mycobacterial infection of the skin and subcutaneous tissue is an important cause of human suffering in terms of morbidity, deformity, dysfunction, and stigma. The diagnosis of cutaneous mycobacterial infections is challenging requiring a low threshold of clinical suspicion for obtaining skin biopsies of cutaneous lesions for acid-fast staining and cultures, and molecular probe assays to detect the presence of mycobacterial pathogens. The choice of antibacterial therapy combinations and length of therapy for cutaneous mycobacterial infections is species-specific.

Orthokeratinized odontogenic cysts: a Spanish tertiary care centre study based on HPV DNA detection

BackgroundThe role of human papillomavirus (HPV) in orthokeratinized odontogenic cysts (OOCs) has rarely been studied. The objective is to describe the clinicopathological findings in a series of OOCs from a Spanish population that were investigated in relation to the possible presence of HPV.MethodsA clinicopathological retrospective analysis followed by a molecular analysis of 28 high- and low-risk HPV genotypes was performed in OOC samples of patients seen during the last 15-years in a Spanish tertiary care center.ResultsOf 115 odontogenic cysts with keratinization, 16 cases of OOCs were confirmed and evaluated. OOCs occurred predominantly in the mandible of males (mean age 36.06 ± 13.16 years). Swelling of the jaw followed by pain were the most common clinical symptoms, and 56.5% of the OOC cases were associated with an unerupted tooth. After a mean post-cystectomy follow-up of 3.8 years, only one recurrent case was observed, resulting in a verrucous cystic lesion that was considered premalignant after immunohistological examination. DNA extraction was successful from 14 of the 16 OOC cases. None of the primary OCCs or the single recurrent OOC were positive for HPV in the molecular analysis.ConclusionsOOCs show a very limited potential for recurrence. Our results suggest that neither high- or low-risk HPV subtypes are likely to play a role in the etiology or neoplastic transformation of OOC, at least in the Spanish population.

A Case of Oral Florid Papillomatosis (Verrucous Carcinoma) With Lack of Evidence for Human Papillomavirus Involvement

To the Editor: Oral florid papillomatosis is best defined as a type of verrucous carcinoma, although some consider it a separate entity.1 It is characterized histopathologically by local invasion with minimal dysplasia, and biologically it is characterized by a low incidence of metastases.1 In contrast to the anogenital and plantar types of verrucous carcinoma which have shown a strong correlation with human papillomavirus (HPV) infection,2,3 there is conflicting evidence for HPV involvement in oral florid papillomatosis. Some studies have demonstrated a low presence of HPV in oral verrucous carcinoma,3–11 whereas others did not find evidence for its involvement in the pathogenesis of the oncogenic process.12–16 We report a case of oral florid papillomatosis (verrucous carcinoma) which failed to demonstrate HPV involvement altogether, using several techniques. An 83-year-old woman was referred to our clinic for verrucous lesion that appeared 5 years ago on the right buccal mucosa and then spread to the right lip. There was no history of smoking or oral lichen planus. The lesions were painful and caused functional impairment. On physical examination, she demonstrated confluent, verrucous, keratotic plaques in the entire right buccal mucosa, right oral commissures, and lips (Fig. 1). Three biopsies which were taken 4, 2, and 1 year before were reported to show: “pseudoepitheliomatous hyperplasia with inflammation,” “hyperkeratosis with lichenified features,” and “hyperplastic epithelium with mild atypia,” respectively. None of them showed clinicopathological features suggestive of HPV infection. The biopsy, which was performed in our clinic, demonstrated histopathological findings compatible with verrucous carcinoma (Fig. 2). Immunohistochemical staining for P16 was negative. In situ hybridization for HPV DNA 16 & 18 and polymerase chain reaction for HPV DNA extracted from the paraffin-embedded biopsy as previously described17,18 were all negative. Immunohistochemical staining using anti-HPV antibody [BPV-1/1H8 + CAMVIR] (ab 2417, Abcam), which identifies HPV 1,6,11,16-16, 18, and 31, was negative in the initial biopsy (4 years before) and in the current biopsy.FIGURE 1.: Verrucous hyperkeratotic plaques on the right buccal mucosa (A) extending to the right commissure and lateral upper and lower lips (B).FIGURE 2.: Histopathology of the lesion in Fig 1. A, Marked papillomatosis and downgrowth of the epithelium into the dermis. B, Higher magnification showing irregular crowding of keratinocytes with atypical nuclei and scant cytoplasm in the basal cell layer and above it. There is also “horn pearl” and several dyskeratotic keratinocytes. C, Downgrowth of the epithelium into the upper dermis surrounded by a dense inflammatory cell infiltrate. D, Higher magnification showing exocytosis of lymphocytes and dyskeratotic keratinocytes. There are also interface vacuolar changes in the basal cell layer.Positron emission tomography–computed tomography did not show involvement beyond the primary site and the patient was treated palliatively by local radiotherapy. In conclusion, our case study did not provide evidence for the role of HPV in the pathogenesis of oral florid papillomatosis (verrucous carcinoma).

MCM-2 expression differentiates potentially malignant verrucous lesions from oral carcinomas.

Mcm-2 is a biomarker belonging to Mcm family of proteins which has rarely been used in oral potentially malignant and malignant lesions of the verrucous type. The objective of this study is to assess the expression of Mcm-2 in Normal Oral Mucosa (NM), Verrucous Hyperplasia (VH), Verrucous Carcinoma (VC) and Oral Squamous Cell Carcinoma (OSCC) and compare it with the clinicopathological characteristics. A total of 70 formalin fixed paraffin embedded tissue samples (10 cases of Normal Mucosa NM- Group A, 10 cases of Verrucous Hyperplasia- VH without Dysplasia- Group B, 10 cases of Verrucous Hyperplasia- VH with Dysplasia- Group C, 20 cases of Verrucous Carcinoma VC-Group D, 20 cases of Oral Squamous Cell Carcinoma OSCC- Group E) were subjected to immunohistochemistry with Mcm-2 antibody. Statistical analysis was carried out with various tests like ANOVA, Tukey HSD, Chi-Square and Shapiro-Wilk test by using the SPSS software. There was a significant difference in Mcm-2 expression with quantitative analysis among all the groups (p < 0.05). There was a significant progressive increase in nuclear Labelling Indices (nLI) from NM (49.08%), VC (60.45%), VH with Dysplasia (64.10%), and OSCC (89.22%). The findings suggest that Mcm-2 may be a sensitive proliferation marker in oral potentially malignant and malignant lesions which may be useful for differentiating between VH with/ without dysplasia, VC and OSCC.

Human gene expression microarray analysis of the HPV 6bE7-HaCaT stable cell line

ObjectiveHuman papillomavirus (HPV) is the most common sexually transmitted agent in the world. HPV6b is a low-risk type of HPVs that causes benign verrucous hyperplastic lesions of the skin and anal genital mucosa. Previous research has indicated that HPV genotype 6 is sometimes associated with high-grade lesions and anal cancer. The pathogenesis of low-risk HPV infection and its relationship to high-risk HPV is not clear at present. The E7 protein, which is encoded by HPV early –expressing genes, plays an important role in HPV infection. The aim of this study is to investigate the human gene expression signature of the HPV6b E7-transfected HaCaT stable cell line. The identification of differentially expressed genes might provide a more comprehensive understanding of HPV6b infection and will allow us to explore the specific role of E7 protein. MethodsWe established a stable cell line transfected with the HPV6b E7 gene and analyzed the line's genome-wide expression profile by microarray. Quantitative real-time PCR (qRT-PCR) was used to verify the differentially expressed genes. GO enrichment analysis was applied for gene annotation according to functions. KEGG analysis, a system for analyzing gene function and genome information, was used to help us integrate differentially expressed genes into pathways. ResultsA total of 3519 genes were identified to be significantly differentially expressed between the HPV 6bE7-HaCaT stable cell line and a control cell line, among which 1884 genes were up-regulated and 1635 genes were down-regulated with a fold-change > 2.0 between the two groups. The expression profiles of the top 20 up-regulated and the top 20 down-regulated genes in the HPV 6bE7-HaCaT stable cell line as analyzed by qRT-PCR were consistent with the microarray data. The most significantly enhanced genes HPV 6bE7-HaCaT cells were SIMC1, S100A8 and S100A9, whereas PXDN expression was markedly down-regulated. GO analysis showed that HPV 6bE7 primarily affected biological processes and that the most significant difference was in heart induction (GO:0003129). Many differentially expressed genes were linked to histone H4-K20 demethylation (GO:0035574). KEGG analysis showed that the most significant changes in gene expression were related to primary bile acid biosynthesis, and the most diverse biological processes were related to systemic lupus erythematosus pathogenesis. ConclusionsThe global gene expression profile of the HPV 6bE7-HaCaT stable cell line was analyzed, revealing the genes regulated by E7 protein and providing insight into the pathogenesis of HPV6b infection.

Correlation of serum lactate dehydrogenase and alkaline phosphatase in different histological grades of head and neck squamous cell carcinoma and premalignant lesions.

Head neck cancer (HNCA) in North-East India accounts for 54.48% cancers at all sites, one of the highest in the country. Increased serum lactate dehydrogenase (LDH) activity is considered as a marker of cellular necrosis while serum alkaline phosphatase (ALP) is recognized as an important marker of induction of tumor cell differentiation. Considering the importance and need of biomarker in HNCA and there being no previous study on tumor markers from this highly prevalent region, we intended to examine the role of serum LDH and ALP in head and neck squamous cell carcinoma (HNSCC) and epithelial precursor lesions (EPLs) and also to find their correlation with the different histological grades of tumor. This is a prospective observational study on patients with HNSCC and precancerous lesions attending Department of ENT of a Teaching Hospital. Serum LDH and ALP was measured in HNSCC, EPL and control groups and the results were statistically analyzed and compared using analysis of variance, Pearson correlation coefficient, and sensitivity-specificity analysis. Serum LDH was found to be a significant marker of HNSCC. Total serum LDH level was high in both premalignant and HNSCC cases. There was a significant correlation between serum LDH and grades of HNSCC showing highest levels of expression in moderately differentiated SCC. Elevated serum LDH was also seen in erythroleukoplakia, leukoplakia, and verrucous lesion, but serum ALP levels were not significant. This is the first study from this highly prevalent region of HNCA showing that serum LDH could be regarded as a biomarker for malignant and premalignant conditions of the head and neck.

Oral verruciform xanthoma: Report of 13 new cases and review of the literature.

BackgroundOral verruciform xanthoma (OVX) is a rare lesion. The purpose of the present study is to describe the clinical features of 13 OVXs and review all cases reported in the English literature.Material and MethodsThirteen cases of OVX diagnosed during a 47-year period were retrospectively collected. The patients’ gender and age, as well as the main clinical features of the lesions were retrieved from the biopsy request forms. Pubmed®, Scopus® and Google ScholarTM electronic databases were searched with the key word “verruciform xanthoma”. Only cases of histologically confirmed OVX were included in the study.ResultsThe 13 OVXs represented approximately 0.04% of 35,617 biopsies accessioned during the study period. They affected 13 patients, 8 males and 5 females with a mean age of 48.8±14 years. They mainly appeared as asymptomatic granular nodules or plaques, with elastic or normal consistency and white color, in the gingiva or hard palate. Literature review yielded 416 cases of OVX. With the addition of cases of the present study, 429 cases of OVX have been presented in the English literature. OVX has a slight male predominance with a male to female ratio of 1.4:1 and the majority of patients are in the 5th to 7th decade of life. Clinically, OVX mainly presents as an asymptomatic, single, papillary or granular plaque or nodule, with elastic or soft consistency and white, red or pink color. It measures approximately 1cm and is most commonly located on the gingiva, tongue, hard palate or buccal mucosa. The treatment of choice is surgical excision with little rates of recurrence.ConclusionsVerruciform xanthoma is a rare lesion most often encountered on the ginigival mucosa. As its clinical presentation is not pathognomonic, it should be included in the differential diagnosis of verrucous or papillary lesions. Key words:Oral verruciform xanthoma, oral tumors.

Genitogluteal porokeratosis in an HIV-positive man: a case report and review of the literature on genital porokeratosis

Genitogluteal porokeratosis is a disorder of keratinization that may present in men in their fourth decade of life. We describe a 52-year-old human immunodeficiency virus (HIV)-positive man with history of anal squamous cell carcinoma who developed verrucous lesions on the buttocks and genitals. The buttock lesions presented shortly after radiotherapy for anal carcinoma a decade prior, whereas the genital lesions presented three months prior in areas treated with injectable medication for erectile dysfunction. Skin biopsy revealed a cornoid lamella, leading to the diagnosis of genitogluteal porokeratosis. The buttock lesions were treated with shave excision and the genital lesions were treated with topical agents. Using the PubMed database, a literature search was performed with combinations of the following key words: acuminata, condyloma, cornoid lamella, genital, genitogluteal, HIV, penile, porokeratosis, verrucous, vulvar. The generated papers and their references were reviewed. To the best of our knowledge, we present the first reported case of genitogluteal porokeratosis in an HIV-positive man. Notably, these lesions developed in sites of prior radiation or injection. This condition should be included in the differential diagnosis of chronic lesions of the genitals and buttocks in patients with HIV and/or history of radiation treatment and/or trauma to the genitogluteal region.

Florid cutaneous papillomatosis as a marker of neoplastic recurrence

Florid cutaneous papillomatosis is a rare paraneoplastic dermatosis, most commonly associated with gastric adenocarcinoma. It is characterized by a sudden onset of hyperkeratotic papules, clinically indistinguishable from viral warts. We report an 80-year-old man who presented to our department with a two-month history of multiple verrucous lesions affecting the face, perioral region, and hands. Two years before, he was treated for a gastric adenocarcinoma with a subtotal gastrectomy, but showed no evidence of residual disease or recurrence. Given the clinical background, a diagnosis of florid cutaneous papillomatosis was considered. Skin biopsy excluded a viral origin, and tumour recurrence was later identified through an abdominal ultrasound. The onset of this entity is typically prior or concurrent with the diagnosis of the internal malignancy, but it may also represent the first sign of recurrence of a previously treated neoplasm. Its early recognition is essential to ensure a thorough investigation and prompt treatment.

Herpes Vegetans and Review of Verrucous Lesions of the Anogenital Region

Abstract Herpes vegetans is one of the rare atypical presentations of herpes simplex virus in immunocompromised patients such as those with human immunodeficiency virus (HIV) infection, which presents as an exophytic, proliferative lesion that resembles either a verrucous or a malignant growth. Patients with immunosuppression as in HIV infection may experience more frequent and more severe recurrences of genital herpes. They are also more likely to be resistant to standard antiherpetic agents such as acyclovir. Herpes simplex virus infection in patients with immune suppression such as HIV can also be atypical in morphology and present a diagnostic and therapeutic challenge. The verrucous lesions of the anogenital region can be similar in many causes of, and it is important to look for subtle differences in appearance and use a variety of diagnostic methods to arrive at a correct diagnosis. We performed a literature review of the verrucous lesions in the anogenital region and also report a case of herpes vegetans.

The Spectrum of Oral Lesions Presenting Clinically With Papillary-Verrucous Features

We sought to study the spectrum of oral pathologies presenting clinically with papillary-verrucous features. A 10-year (2007 to 2016) retrospective study of oral papillary lesions was undertaken. All biopsy reports that included a clinical description of papillary or verrucous architecture were retrieved. The data collected included clinical features, size, color, location, histopathologic diagnosis, age, and gender. The study included 137 patients, with a total of 150 lesions. The ages ranged from 10weeks to 84years (mean, 49years).Histopathologically, 60% of cases were human papillomavirus (HPV) related, 19% showed hyperplasia, 11% had hyperplastic candidiasis, 7% were dysplastic or malignant, and 3% were benign of unknown etiology. Among the 7% of lesions diagnosed with dysplasia or malignancy, only 60% were suspected to have malignancy at the time of biopsy. HPV-related lesions and hyperplasia were most frequently found on the tongue (38% and 41%, respectively) and soft palate (21% and 14%, respectively). Hyperplastic candidiasis was most frequently found on the buccal mucosa and tongue (35% and 24%, respectively). Squamous cell carcinoma was found in 1.3% of total lesions and verrucous carcinoma in 1.3%. Of the verrucous or papillary malignant lesions, 50% were found on the gingiva. Most malignant lesions occurred in the 40- to 60-year age group. The results of this study suggest that, because of the wide spectrum of entities presenting clinically with a papillary-verrucous architecture, biopsy is necessary for diagnosis. The clinical presentation allowed for overall accurate diagnosis in only 47% of cases and 60% accuracy in dysplastic or malignant cases. It is of considerable importance to correctly identify those lesions that are HPV related but at the same time to rule out those lesions that are unrelated to HPV to help alleviate a patient's anxiety.Most important, biopsy is mandatory for the recognition of malignant lesions with a papillary-verrucous architecture, which may mimic other benign entities in the group of papillary-verrucous lesions.