Wart-like Lesions Research Articles

Surgical Management and Treatment of Papillomatous Growth on the Trunk of a Young Captive African elephant (Loxodonta africana) in Dubai Safari Park.

The Papilloma virus, a member of the Papillomaviridae family, is responsible for the benign wart-like cutaneous lesions known as Papillomas1. It has been observed on the skin over the shoulder, hip, leg, and trunk in addition to the nasal or oral mucosa, most frequently at the oral mucocutanous junctions, and it is contagious between elephants. One captive African elephant in the Dubai Safari Park displayed a few tennis ball-sized cutaneous Papillomatous growths on the trunk that required surgical excision and management. The report discusses surgical growth control, autohemotherapy for elephants, and the effectiveness of autogenous vaccines.

Dermoscopy in Darier Disease: A Missing Link in an Unusual Hyperkeratotic Disorder

Darier disease is a rare autosomal dominant skin disorder resulting from mutation of the ATP2A2 gene on chromosome 12. Its progressive course makes its precise diagnosis crucial for a good prognosis. A 60-year-old female presented with multiple non-itchy papules over the face, trunk, and extremities since childhood and photosensitivity with similar lesions in the mother and two elder sisters. Examination revealed skin-coloured-to-hyperpigmented, firm and greasy papules with cobblestone appearance. Dirty yellowish-white wart-like lesions were noted over the toes. Histopathology revealed parakeratosis, papillomatosis, suprabasal acantholysis, and cleft with corps rounds in the granular layer. Dermoscopy revealed cobblestone appearance of the toes with tire-tread and cracked river-bed-like appearance and nails showing palmar hemorrhages and V-shaped nicking. The patient was diagnosed with Darier disease and treated accordingly. Uniquely, the cobblestone appearance was noted first over the dorsa of hands and feet. Dermoscopy may be used diagnose the disease while awaiting histopathological evidence.

Invited Review: Pathology and Epidemiology of FP Virus

Fowl Pox (FP) is a contagious slow-spreading viral disease caused by the FP virus, a DNA virus belonging to the genus avipoxvirus, subfamily chordopoxvirinae of the poxviridae family. It affects all ages, sexes, and breeds of chickens and is distributed worldwide with high prevalence in tropical and subtropical countries. FP is transmitted by direct contact with an infected chicken or indirectly by biting arthropods, (mostly mosquitoes) and through infective fomites. In chickens it is characterized by two forms: (1) The cutaneous or dry form that is characterized by wart-like proliferative lesions and scabs on the featherless areas of skin and (2) the diphtheritic or wet form that is characterized by canker lesions found in the upper digestive and respiratory tracts. In the case of the cutaneous form, the mortality rate is usually low and affected chickens are more likely to recover than those with the diphtheritic form. In the diphtheritic form, proliferative lesions involving the nasal passages, larynx, or trachea cause respiratory distress and death from suffocation. The disease can be diagnosed based on history, presence of typical lesions, and by microscopic examination of affected tissues and virus isolation. Like many other viral diseases, there is no specific treatment for FP but due to its slow-spreading characteristic, the disease can be controlled by vaccination. Therefore, vaccination, arthropod control, and good management programs are important prevention and control methods of chicken FP to be undertaken both at the field and farm level.

Cytopathogical characterization of papillomatosis in cattle of Wolaita Sodo district, Southern Ethiopia

Bovine papillomatosis is a neoplastic disease of the skin manifested as multiple benign tumors that can progress to the malignant tumor. Thus, this study aims to characterize and determine the type and frequencies of bovine papillomatosis in the Wolaita Sodo district. In a cross-sectional study performed from October 2019 to May 2020, 51 skin biopsy samples were collected from purposively selected cattle (with typical wart-like lesions) located in four selected peasant associations of the Wolaita sodo district and examined for characterization of variants of papillomatosis using gross, cytological, and histological methods. Besides, potential risk factors that predispose the cattle to papillomatosis were assessed. The current study revealed that bovine papillomatosis was located in different body parts such as the head, neck, body surface, hind, and forequarter of cattle. In this study, young and female cattle were highly exposed to papillomatosis. Out of (7/51) cattle, 13.7% were infected by concurrent fascioliosis. The frequencies of papillomatosis showed variations at low land as compared to midland. Cytopathological characterization of bovine papillomatosis revealed that 61% were squamous cell papilloma whereas 39% were fibropapilloma. Grossly, it was characterized by solitary to coalescing mass and cauliflower-like lesions having rough and dense surfaces. Cytologically, Squamous cell papilloma was characterized by hypercellularity, bizarre nuclei; cords of neoplastic cells with anisocytosis and anisokaryosis while fibropapilloma was characterized by oval to spindle-shaped fibroblast-like cells. Histologically, rete pegs, squamous differentiation of keratinocytes, excessive proliferation of spindle to plump shaped fibroblasts, and the fibrovascular core were noted. It was concluded that cattle were widely suffering from bovine papillomatosis of two variants. Thus, studies involving a large sample size, and wider diagnostic tools should be conducted in the Wolaita Zone.

A Unique Case of Chronic Cough

A 49-year-old man with a history of coronary artery disease presented to pulmonary clinic with a progressive chronic cough that started 1 year previously, associated with scant hemoptysis and recent onset dyspnea on exertion. He denied smoking, fevers, night sweats, and weight loss. Results of the physical examination were unremarkable. Chest computed tomography (Figure 1) showed a large longitudinal filling tracheal defect. Follow-up bronchoscopy revealed several large wart-like nodular lesions on the vocal cords and in the trachea (Figure 2), causing severe tracheal narrowing.

An Update on the Cutaneous Manifestations of Darier Disease

Knowledge about the clinical features of Darier disease, an orphan autosomal-dominant genetic disorder, is sparse and has been evaluated only in few studies. To investigate the clinical features of a large group of patients with Darier disease, and to explore for associations between disease characteristics and severity of the disease. Seventy-six individuals with Darier disease were evaluated utilizing a structured questionnaire-based interview, a physical examination, and a retrospective assessment of their medical records. The most frequent locations of lesions were hands (99%) and fingernails (93%). Wart-like lesions on the hands were more visible after soaking them in water for 5 minutes, we therefore named this phenomenon the "wet hand sign". Oral involvement was found in 43% of patients, while 48% of women and 16% of men showed genital lesions. Patients with severe Darier disease had a tenfold greater risk of developing genital lesions than those with mild disease (P = .01). Most patients (88%) in our study exhibited a combination of the four types of the disease patterns of distribution (flexural, seborrheic, nevoid, and acral). Documentation of disease on the hands and fingernails provides a highly sensitive means to aid in the diagnosis of Darier disease. It is important to evaluate mucosal lesions including genital and oral mucosa.

Respiratory papillomatosis with small cell carcinoma: case report and brief review

Respiratory Papillomatosis is a rare disease in which multiple exophytic squamous wart-like lesions occur within the respiratory tract. Recurrent Respiratory Papillomatosis (RRP) has the potential for malignant transformation to squamous lung cell carcinoma with a dismal prognosis. Most of the prior literature has shown malignant transformation of respiratory papillomatosis into squamous cell carcinoma. Here, we report a rare presentation of respiratory papillomatosis coexisting with small cell carcinoma and a review of relevant literature.

Human genetic dissection of papillomavirus-driven diseases: new insight into their pathogenesis.

Human papillomaviruses (HPVs) infect mucosal or cutaneous stratified epithelia. There are 5 genera and more than 200 types of HPV, each with a specific tropism and virulence. HPV infections are typically asymptomatic or result in benign tumors, which may be disseminated or persistent in rare cases, but a few oncogenic HPVs can cause cancers. This review deals with the human genetic and immunological basis of interindividual clinical variability in the course of HPV infections of the skin and mucosae. Typical epidermodysplasia verruciformis (EV) is characterized by β-HPV-driven flat wart-like and pityriasis-like cutaneous lesions and non-melanoma skin cancers in patients with inborn errors of EVER1-EVER2-CIB1-dependent skin-intrinsic immunity. Atypical EV is associated with other infectious diseases in patients with inborn errors of T cells. Severe cutaneous or anogenital warts, including anogenital cancers, are also driven by certain α-, γ-, μ or ν-HPVs in patients with inborn errors of T lymphocytes and antigen-presenting cells. The genetic basis of HPV diseases at other mucosal sites, such as oral multifocal epithelial hyperplasia or juvenile recurrent respiratory papillomatosis (JRRP), remains poorly understood. The human genetic dissection of HPV-driven lesions will clarify the molecular and cellular basis of protective immunity to HPVs, and should lead to novel diagnostic, preventive, and curative approaches in patients.

First report of Dermatophilus congolensis infection in native Omani cattle.

Skin lesions were reported in a group of quarantined Omani native cattle for exportation purpose during January 2018. The skin lesions were reported in 17 animals out of 140 and were scattered over the head, neck, back and perineal region of the animals. Lesions varied from paint-brush matted hairs to wart-like lesions that are up to 2 cm in diameter. Skin scraping samples were obtained from the living animals and were directly stained with gram stain. Histologically, there was severe multifocal exudative dermatitis with hyperkeratosis. Dermis was infiltrated with neutrophils, mononuclear cells, and numerous branching filaments coccoid bodies. Bacterial culture on sheep blood agar revealed gray to white, beta hemolytic, raised and irregularly shaped colonies. Gram staining showed gram positive branching filaments with both transverse and longitudinal fragments formed from packs of coccoid cells confined with Dermatophilus congolensis. Animals were treated successfully with 3 doses of intra muscular injection of long-acting oxytetracycline with topical application of antibiotic spray. To the best of our knowledge, this is the first report of dermatophilosis in Omani cattle.

Paving the way for more precise diagnosis of EcPV2-associated equine penile lesions

BackgroundThere is growing evidence that equine papillomavirus type 2 (EcPV2) infection is causally associated with the development of equine genital squamous cell carcinomas (SCCs). Early stages of disease present clinically as plaques or wart-like lesions which can gradually progress to tumoural lesions. Histologically these lesions are inconsistently described as benign hyperplasia, papilloma, penile intraepithelial neoplasia (PIN), carcinoma in situ (CIS) or SCC. Guidelines for histological classification of early SCC precursor lesions are not precisely defined, leading to potential misdiagnosis. The aim of this study was to identify histologic criteria and diagnostic markers allowing for a more accurate diagnosis of EcPV2-associated equine penile lesions.ResultsA total of 61 archived equine penile lesions were histologically re-assessed and classified as benign hyperplasia, papilloma, CIS or SCC. From these, 19 representative lesions and adjacent normal skin were comparatively analysed for the presence of EcPV2 DNA and transcripts using PCR and RNA in situ hybridisation (RISH). All lesional samples were positive by EcPV2 PCR and RISH, while adjacent normal skin was negative. RISH analysis yielded signal distribution patterns that allowed distinction of early (hyperplasia, papilloma) from late stage lesions (CIS, SCC). Subsequently, the 19 lesions were further assessed for expression of p53, Ki67, MCM7 and MMP1 by immunohistochemistry (IHC). All four proteins were expressed in both normal and lesional tissue. However, p53 expression was up-regulated in basal keratinocyte layers of papillomas, CIS and SCCs, as well as in upper keratinocyte layers of CIS and SCCs. MCM7 expression was only up-regulated in upper proliferating keratinocyte layers of papillomas, CIS and SCCs.ConclusionThis study proposes combining a refined histological protocol for analysis of equine penile lesions with PCR- and/or RISH based EcPV2-screening and p53/MCM7 IHC to more accurately determine the type of lesion. This may help to guide the choice of optimum treatment strategy, especially at early stages of disease.

Adolescent Vulvar Angiokeratoma Associated with Lichen Sclerosus.

We present an adolescent with multiple vulvar angiokeratomas within a background of lichen sclerosus. A 13-year-old girl presented with vulvar pruritus and wart-like vulvar lesions. Four lesions were resected because of discomfort and uncertainty of the diagnosis. Pathology revealed angiokeratomas with chronic inflammation suggestive of lichen sclerosus. Postoperatively, pruritus continued in the largest excised lesion, which was associated with lichen sclerosus, and symptoms were treated successfully with topical steroids. Vulvar angiokeratomas are asymptomatic red papular lesions and are rare in the female adolescent population. In this case, the pathology revealed the rare co-occurrence of angiokeratomas and lichen sclerosus. Biopsies of vulvar vascular lesions in symptomatic adolescents are recommended. Vulvar angiokeratomas might manifest rare genetic disease in otherwise asymptomatic female patients and warrant further follow-up.

The usefulness of narrow band imaging in the assessment of laryngeal papillomatosis.

Objectives/HypothesisRecurrent respiratory papillomatosis (RRP) is a benign disease caused by human papillomavirus 6 and 11. The characteristic feature of this disease are wart-like lesions covering the respiratory epithelium with a predilection for the larynx. There is no curative treatment for the disease. The goal of the treatment is a total surgical removal of the papillomatous lesions in order to reduce the number of relapses. Therefore, a good visualization method of papillomas is crucial during surgery. The aim of the study was to compare the accuracy of narrow band imaging (NBI) to the use of white light alone in detecting RRP.MethodsThe study was carried out between April 2013 and November 2015 at Poznan University of Medical Sciences, Department of Otolaryngology, Poland. Rigid endoscopy with conventional white light (WL) and NBI (CV-260SL processor and CLV- 260SL light source, Olympus Optical Co. Ltd, Tokyo, Japan) was performed in all patients during direct laryngoscopy. All anatomical sites of the larynx and trachea were assessed using the Dikkers scale and Derkay total site scoring system with WL and NBI. The consensus was reached as to the number of lesions seen in WL compared to NBI.ResultsDuring 36 microlaryngoscopies, the number of papillomas detected in the larynx (by Derkay total site score) differed significantly between white light endoscopy and NBI (Wilcoxon test p = 0.000655). In endoscopy with NBI, a mean of 1.3 more papillomas in Derkay total site score was detected in comparison to white light endoscopy NBI showed additional areas of diseased tissue in 15/36 (41.67%) patients.ConclusionsNBI as an additional tool during microlaryngoscopy can improve the detection of papillomatous lesions.

Papillomavirus Infection in Humans and Dromedary Camels in Eastern Sudan

Cases of wart-like lesions in humans and dromedary camels occurred in eastern Sudan in 2015 were described. Involvement of papillomavirus (PV) in causing these cases was affirmed by PCR and immunoperoxidase test. Mostly, the lesions were observed on the skin of the chest and forearms in addition to lips and mandible. Sequence analysis revealed Camelus dromedarius PV types 1 and 2 genotypes as the causative genotypes. We also observed cases of wart-like lesions on hands and legs of two herders attending the infected camel herd. Partial genome sequencing revealed human PV type 2 in one of the two human samples providing no indications for interspecies transmission of camel PVs, yet provides, for the first time evidence of active circulation of this virus in eastern Sudan.

Laryngeal papillomatosis: A rare cause of dysphonia in the child. Case series

Juvenile laryngeal papillomatosis is an uncommon disease caused by human papilloma virus, mainly types 6 and 11. It is the most common benign laryngeal tumor in children. This condition should be suspected in any children with persistent and progressive dysphonia with or without stridor and respiratory distress. Flexible laryngoscopy under local anesthesia allows to visualize the typical wart-like lesions. The diagnosis is confirmed by pathological anatomy. Existing treatment is palliative and consists mainly of the surgical excision of the papillomas to maintain the airway without obstruction and to improve the quality of the voice, but it has a high rate of relapse. We present 20 patients with juvenile laryngeal papillomatosis. We describe the clinical manifestations, the diagnostic methods and the treatment of this pathology.

Hand warts among butchers in a supermarket in São Paulo.

Butchers are exposed to biological hazards as a function of their continuous handling of meat containing blood, fat and fluids. Biological hazards include contamination with viruses, such as the papillomavirus (HPV), especially HPV type 7, which is associated with the so-called "butcher's wart." To investigate wart-like lesions among meat handlers. Cross-sectional descriptive study conducted at a supermarket in São Paulo in 2017. Twenty-four employees allocated to the meat handling section were interviewed and subjected to skin visual examination; lesions were photographed. Most participants were male (87.5%) and half of them (50.0%) were within age range 31 to 40 years old. Only one employee had started working in this section less than 2 years earlier. Wart-like lesions or scars with black dots on their center were found on the hands of 11 butchers (45.8%). Almost half of the participants had history of hand warts. Most of the participants with lesions were male, aged up to 40, right-handed and had worked as meat handlers for 2 years at least. We might infer we found cases of wart-like occupational dermatosis among butchers at a supermarket in São Paulo.

Lymphocyte profile and cytokine mRNA expression in peripheral blood mononuclear cells of patients with recurrent respiratory papillomatosis suggest dysregulated cytokine mRNA response and impaired cytotoxic capacity.

ObjectivesRecurrent respiratory papillomatosis (RRP) is a relatively rare, chronic disease caused by Human Papilloma Virus (HPV) 6 and 11, and characterized by wart‐like lesions in the airway affecting voice and respiratory function. The majority of HPV infections are asymptomatic and resolve spontaneously, however, some individuals are afflicted with persistent HPV infections. Failure to eliminate HPV 6 and 11 due to a defect immune responsiveness to these specific genotypes is proposed to play a major role in the development of RRP.MethodsWe performed a phenotypic characterization of peripheral blood mononuclear cells (PBMC) collected from 16 RRP patients and 12 age‐matched healthy controls, using immunoflow cytometry, and monoclonal antibodies against differentiation and activation markers. The cytokine mRNA profile of monocytes, T helper‐, T cytotoxic‐, and NK cells was assessed using RT‐qPCR cytokine analysis, differentiating between Th1‐, Th2‐, Th3/regulatory‐, and inflammatory immune responses.ResultsWe found a dominance of cytotoxic T cells, activated NK cells, and high numbers of stressed MIC A/B expressing lymphocytes. There was an overall suppression of cytokine mRNA production and an aberrant cytokine mRNA profile in the activated NK cells.ConclusionThese findings demonstrate an immune dysregulation with inverted CD4+/CD8+ ratio and aberrant cytokine mRNA production in RRP patients, compared to healthy controls.

Multiple gene typing and phylogeny of avipoxvirus associated with cutaneous lesions in a stone curlew.

Avipoxvirus (APV) infections have been observed in a wide variety of wild, captive and domestic avian hosts, recently including a range of island endemic and endangered species. However, not enough is known about genome diversity and phylogenetic relationships of APVs, as well as their host-range specificity. A wild stone curlew (Burhinus oedicnemus) was recovered in Sardinia (Italy), showing large wart-like lesions and nodules on both legs and toes, which resulted positive to poxvirus by PCR. Histopathological examination of the lesions showed ballooning degeneration and large intracytoplasmic inclusion bodies consistent with APV infection. A multiple gene sequencing approach was applied to highlight the phylogenetic relationships of this virus with a panel of selected APVs at the clade and subclade levels. This novel isolate was characterized by sequencing partial 4b core protein, P35 (locus fpv140) and DNA polymerase genes and phylogenetic analyses assigned it to clade A, (Fowlpox virus, FWPV), subclade A2. Conservation implications of avian pox presence in Sardinian stone curlews and possibly in other island bird species are discussed.

Epidermodysplasia verruciformis associated with peripheral T-cell lymphoma, squamous cell carcinoma, and langerhans cell histiocytosis

Epidermodysplasia verruciformis (EV) is an extremely rare autosomal recessive genodermatosis characterized by abnormal susceptibility to human papilloma virus (HPV) infection. The inability to terminate HPV infection leads to widespread and persistent wart-like and macular skin lesions. The extent of cutaneous inivolvement and progress of the lesions vary considerably, but the persistence of skin lesions throughout the life is a characteristic feature of EV. The interaction among potentially oncogenic HPV genotypes, ultraviolet radiation, altered immunity, and genetic factors will lead to the development of nonmelanoma skin cancers in 30%–60% of cases. Although there is lifelong increased risk of squamous cell carcinoma, the association with hematological or solid malignancies is rare. Literature search shows very few isolated reports of non-Hodgkin's lymphoma, astrocytoma, thymoma, adenocarcinoma intestine, and leiomyosarcoma in patients with EV. Herein, we report a case of EV with an uncommon occurrence of peripheral T-cell lymphoma, squamous cell carcinoma, and Langerhans cell histiocytosis. EBV-associated squamous cell carcinoma carries increased number of viral proteins and this may play role in cell immortalization, chromosomal destabilization, and activation of telomerase. The development of lymphoma and Langerhans cell histiocytosis may be due to the defect in immune system and due to the oncogenic potential of the virus. These point to the importance of regular long-term follow-up of EV patients for the possible cutaneous and extracutaneous malignancy.

A sporadic case of epidermodysplasia verruciformis in a young boy

Epidermodysplasia verruciformis (EV) is a rare disorder that is usually transmitted in an autosomal recessive manner, caused by human papillomavirus which presents with tinea versicolor-like or flat wart-like lesions. It has propensity for malignant transformation, especially squamous cell carcinoma. Here, we present a case of 7 year boy with complaints of asymptomatic hypopigmented macular lesions over the face, neck, and forearms. Histopathology was suggestive of EV and was given oral zinc, advised strict photoprotection.

CLINICAL MANAGEMENT OF LOCALIZED BCG ADVERSE EVENTS IN CHILDREN.

SUMMARYBCG adverse events (BCG-AE) are rare conditions with no well-established treatment. This study aims to describe clinical characteristics and outcome of localized BCG-AE. Children with BCG-AEs who were treated at the Reference Center for Special Immunobiologicals of the Federal University of São Paulo from 2009 to 2011 were included. Patients were followed monthly until 3 months after healing. One hundred and twenty-seven patients with localized BCG-AE were followed: 67 (52.7%) had suppurative lymphadenitis; 30 (23.6%) injection-site abscess; five (3.9%) had enlarged lymph node > 3 cm; four (3.1%) had ulcer > 1 cm; and one (0.8%) had a local bacterial infection. Five patients (3.9%) had more than one BCG-AE simultaneously. Fifteen patients (11.8%) had atypical manifestations: seven wart-like lesions; five BCG reactivations; two other dermatologic lesions and one with vasomotor phenomenon. Isoniazid was used in 96 patients with typical BCG-AE (85.7%) until lesion resolution which took place 3.1 months later (in median); the healing rate was 90.6%. Patients with atypical manifestations had an individual approach. Regarding the outcome, 105/112 patients with typical AE and 13/15 patients with atypical AE had resolution of BCG-AE. Localized BCG-AE caused by BCG Moreau RJ had positive outcome when treated with a short course of isoniazid. Atypical BCG-AE are not infrequent.