Like liver spots, seborrheic keratoses are seen more often as people age. Case report a 27yearold man presented with nonitchy hyperpigmented papular skin lesions involving the trunk since 3 years. Majority of the cases were verruca vulgaris 37 cases, followed by 33 cases of seborrheic keratosis. The filiform wart of the face and scalp is closely related, and there is good evidence for classifying condyloma acuminatum in this group. Verruca planus, also known as flat warts, are benign skin tumours that involve the skin and other epithelial mucosa. Verruca vulgaris, plantar warts verruca plantaris, and flat warts verruca plana, which occur. Verruca plana skin colored flattopped papules often in linear arrays typically hpv 3 and 10 treatment. Dec 03, 2018 there were 99 verruca vulgaris vv, 66 palmoplantar warts ppw, 49 plane warts pw, 34. The upper epidermis shows hypergranulosis and numerous koilocytes figures 2, 3. Verruca vulgaris common wart skin, histology, pathologyslides for the practical part of the pathology exam at masaryk university. Flat wart verruca plana, a small, smooth flattened wart, fleshcoloured, which can occur in large numbers. Epidermolytic acanthoma on fingers, mimicking flat warts.
Histopathologically it shows prominent hypergranulosis, thickened stratum spinosum, and vacuolized keratinocytes. The warts are contagious, usually establishing an infection through breaks in the skin. The differential diagnosis for ln includes verruca. Figure 4 ahowh tho niicrdscopit tippeiiraiife with magnification x850, stain h. Whereas these lesions have a high malignant potential, it is important to elucidate the histologic spectrum of this entity and to. Based on the clinical features and histopathologic findings, diagnosis of giant verruca vulgaris was made. In this time they can cause pain, which can either be a slight annoyance or prevent performance of. Genital warts gw and two histologically confirmed corneiform warts cw. Each stain was assessed for percent lesional expression and, when applicable, distribution of staining. This is the first reported case of verruca plana, with its extensive and exclusive involvement of the trunk, and absolute sparing of the sunexposed areas in a healthy individual.
Various dermoscopic features of verruca vulgaris, verruca. Verrucae vulgaris and plantaris were positive controls, and inverted follicular keratoses ifks. Sign out skin lesion, right lower leg, shave biopsy. Verruca plana is easily differentiated from ln on pathology with findings of epidermal hyperkeratosis, irregular acanthosis, and koilocytic changes. Pathology of the skin with clinical correlations, 2nd ed. The nuclei demonstrate a characteristic cytopathic effect of the virion, blurring the nuclear chromatin due. Human papillomavirus hpv and management of abnormal pap tests.
Flat warts verruca plana commonly occur on the face, arms and legs. Confocal laser scanning microscopy clsm has been proved to be useful in the diagnosis of skin diseases. Verruca plana appears as a fleshcolored or reddish, warty, flattopped papule that often forms clusters. Keratotic papule on the abdomen mdedge dermatology. Inward turning of the elongated rete ridges was noted and diagnosed with verruca vulgaris with mildtomoderate. Verruca plana is one of the dermatological manifestations of hiv related immunecompromised and hpv coinfection 1. A pilot study with confocal laser scanning microscopy the effect of cimetidine on verruca plana juvenilis.
Other skin lesions seen in ev may show a verruca plana or verruca vulgaris morphology. Palmar plantar warts verruca palmaris and verruca plantaris arch pathol lab med 2018. Verruca plana can be caused by traumatic inoculation on the face, including abrasion wound, eyebrow threading, and cosmetic procedures for hair removal 3 4 5. Introduction the most common clinical manifestation is the verruca, with its different morphological forms. Verruca vulgaris and verruca plana juvenilis are classified by jadassohn1 among the benign epitheliomas of infectious origin. The diagnosis of warts is made from clinical examination if typical features are shown. Verruca plana, he 10x 1841 verruca plana, he 40x 1898 another case. Case presentation this 36yearold man presented with a 6month history of skincoloured flattopped papules within a black coloured tattoo figure 1. Lesions are usually located on the face, shins, and dorsal area of the hands. Common wart verruca vulgaris, a raised wart with roughened surface, most common on hands, but can grow anywhere on the body. Bowenoid papulosis is histopathologically indistinguishable from. Histopathology of verruca plana usually shows basketweave. The warts spread by autoinoculation and seldom show koebner. Verruca plantaris 1,2,4 verruca vulgaris 2,4,29,38 verruca plana 3,10,28.
The dermoscopic aspects found in vv were the presence of multiple dense papillae 100%, centered by red loops surrounded by whitish halos 64. Excision of the lesion from the right lateral border of the tongue was done under local anaesthesia and sent for histopathology examination, the. Verruca plana or flat warts frequently present on the hands or face as flat papules with a smooth surface. Pdf on jul 1, 2005, jerry e bouquot published oral and maxillofacial pathology case of the month.
Most often, these lesions affect the hands, legs, or face, and a linear arrangement is not uncommon. Whereas these lesions have a high malignant potential, it is important to elucidate the histologic spectrum of this entity and to differentiate it from its mimics. The patient was treated with salicylic acid 40% ointment. Hpv 5 may be seen in human immunodeficiency virus hivpositive patients. Verruca plana of the face treated by posthypnotic suggestion. Clinico pathological study of 300 cases of cutaneous warts in. Epidermodysplasia verruciformis versus disseminated. Flat warts, technically known as verruca plana, are reddishbrown or fleshcolored, slightly raised, flatsurfaced, welldemarcated papule of 2 to 5 mm in diameter. Sections show orthokeratosis, mild papillomatosis, and mild acanthosis figure 1. Differential diagnosis of epidermodysplasia verruciformis pathology. Histopathological examination showed hyperkeratosis of a loose lamellar type, acanthosis without papillomatosis and slight elongation of the rete ridges, but no area of parakeratosis. Viral warts are caused by different subtypes of the human papillomavirus hpv. Whereas these lesions have a high malignant potential, it is important to elucidate t. On the face and limbs, warts can sometimes have a small base and longer, fingerlike projections, a morphological type called verruca filiformis.
Extensive presentation of verruca plana in a healthy. I have attempted to show that the existing confusion with regard to. Histopathological examination showed flaky hyperkeratosis, massive acanthosis papillomatosis and koilocytes. They are usually small, only slightly raised and skin colored, making them harder to see. This case adds to the literature of tattooassociated hpv infections and serves as a reminder of the risk of tattooing even with advanced ster ile technique. Like liver spots, seborrheic keratoses are seen more often as people age the tumours also called lesions appear in various colours, from light tan to black. Verruca plana shares with verruca vulgaris the presence of acanthosis, hyperkeratosis, and koilocyticappearing cells, but there is no. The sections show skin with elongated rete ridges, acanthosis, hypergranulosis, hyperkeratosis in vertical columns, focal parakeratosis, dilated blood vessels at the dermalepidermal junction and koilocytic change. Occasionally, histopathology may be required for confirmation. Cells with prominent perinuclear vacuolization around pyknotic, strongly basophilic, centrally located nuclei may be in the granular layer. Verruca plana juvenilis find, read and cite all the research you. In this serial cases, there were verruca vulgaris, verruca palmaris and verruca filiformis based on location and clinical featured. The viral warts also known as verruca vulgaris are caused by papova group of viruses. Verrucous cancer rarely spreads, but it is locally destructive.
The histopathology of the diseases of the skin, translated by norman walker, new york, the macmillan company. What are histological features of discoid lupus erythematosus. They are round or oval, feel flat or slightly elevated, like the scab from a healing wound, and range in size from very. The diagnosis of ev verruca plana like was confirmed. Verruca plana can occur as 1 to 5mm, grouped, fleshcolored papules on the face, neck, dorsal hands, wrists, or knees. Verruca plana plane warts are typically associated with human papillomavirus hpv types 2, 3, and 10.
The histology corresponds to the epidermolytic hyperkeratosis. Macroscopically it presents as small 25mm redishbrown, slightly elevated or flat papules. The classic histologic presentation of epidermodysplasia verruciformis is a verruca plana type lesion with minimal hyperkeratosis and acanthotic areas where the cells contain perinuclear halos and bluegray pallor. Figiue 3 shovvh the mkioscopic appeiwiiiico with miigtiifitiation x l l i i. A 59yearold woman with a history of basal cell carcinoma, uterine and ovarian cancer, and verrucae presented with an asymptomatic 3mm lesion on the left side of the lower abdomen.
Verruca plana ii hpv10 panatar warts verruca planatairs iii hpv1 calluses callus verrucous carcinoma verruca epidermodysplasia verruciformis iv plana. Cutaneous warts are classified by morphology, histology and anatomic location, for example. Figures 1 and 2 show tlie niaeroscopic appearance of the lesions described in the text. Pdf verruca vulgaris is due to human papilloma virus infection is a. Verruca plana elastosis perforans serpiginosa ctcl. Clinical clues for differential diagnosis between verruca plana and verruca plana like seborrheic keratosis. Verrucae plana are usually caused by hpv types 3 or 10, and less often by hpv type 28 and 291,2. Verruca vulgaris, respiratory laryngeal papillomatosis, condiloma acuminatum, treatment. Verruca plana histopathology resemble common warts but the features tend to be muted. Histopathology showed hyperkeratosis, slightly thickened epidermis, enlarged keratinocytes, some with basophilic and others with eosinophilic cytoplasm, hypertrophic nuclei with perinuclear halos, and intracytoplasmic keratohyalin granules.
It is attributed to human papilloma virus infection2. May 28, 2020 histopathology was reported as hyperplastic stratified squamous epithelium with focal hyperkeratosis, papillomatosis, prominent granular cell layer with many coarse keratohyalin granules, and koilocytes in the superficial layer. Histopathologic correlates of clinically verrucous lesions. Usually the diagnosis of verruca plana is clinical. Epidermolytic acanthoma on fingers, mimicking flat warts fulltext. Interhospital dermatology conference 2016 case 27 a 76 yearold. Special studies for epidermodysplasia verruciformis. Verruca plana after therapy, he 60x 627 verruca plana. Histology and immunohistochemistry of squamoproliferative lesions. Siulapwa ntungo and alumani alan, challenges in anaging verruca plana in a resource constrained nvironment com plicated with retroviral disease. Pdf oral and maxillofacial pathology case of the month.
Histologically, they are characterized by acanthosis, orthokeratosis, hypergranulosis and mild to minimal papillomatosis. Lesions on the sole or bottom of the foot are often compressed or appear flat. Keratinocytic dyplasia and squamous cell carcinoma may be seen associated with the hpvinduced lesions in ev. This is thought to reflect the subtype of hpv involved.
Human papillomavirus hpv and management of abnormal. Hpv3,5,8,9,10,14,15,17,1925,28,29,3638,46,47,49,50,59 have been isolated. Verruca plana, usually related to the lowrisk hpv2, 3, or 10 genotypes, appears as flat, grayishyellow, possibly hyperpigmented, and slightly elevated papules of a few millimeters in diameter, with a smooth surface. Histopathology showed hyperkeratosis, focal parakeratosis, papillomatosis, and marked hypergranulosis with pale gray cytoplasm of the spinouslayer keratinocytes. A seborrheic keratosis is a noncancerous skin tumour that originates from cells in the outer layer of the skin. The incubation period of such warts varies from 6 weeks to a year. There are three types of warts namely verruca plana. Differentiation of some seborrheic keratosis sk and verruca plana vp lesions is a challenge. Vverruca plana following eyebrow erruca plana following. In this serial cases, there were verruca vulgaris, verruca palmaris and verruca. Such warts are commonly seen on the skin but occasionally may appear in the oral cavity.
Epidermodysplasia verruciformis pathology dermnet nz. Mar 25, 2011 the viral warts also known as verruca vulgaris are caused by papova group of viruses. Acral fleshcolored papules on the fingers mdedge dermatology. The histologic spectrum of epidermodysplasia verruciformis. Upon close inspection, these lesions have a surface that is finely verrucous. Evlike changes foci of ev changes may rarely be seen incidentally on actinically damaged skin, or as part of an acanthoma evacanthoma. Pathology of virally induced epidermal lesions dr sampurna. Detection of human papillomavirus infection in trichilemmomas and. Aug 15, 2005 verruca vulgaris figures 1 and 2, plantar warts verruca plantaris figure 3, flat or planar warts verruca plana, and genital warts condyloma acuminata are some of the clinical. Open access common clinical manifestations of human papilloma. They are typically self limiting and regress with time months to years. Verruca dorsi manus et pedis, australasian journal of. Facial verruca plana verruca plana, also know as the flat wart, is commonly found on the face or hands but can be found anywhere on the body. At histopathology, flat warts have cells with prominent.
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