Craig Leonardi

Basal cell carcinoma of the scrotum: Report of three cases and review of the literature

BACKGROUND Although basal cell carcinoma (BCC) is the most common human malignancy, only 21 cases involving the scrotum have been previously reported. OBJECTIVE Our purpose is to describe three additional cases of scrotal BCC and review the literature summarizing the clinical features and identifying any predisposing factors. METHODS We retrospectively reviewed 21 cases of scrotal BCC and described three new cases. Polymerase chain reaction (PCR) was used to detect human papillomavirus (HPV) DNA in our biopsy specimens. RESULTS Scrotal BCCs present as persistent ulcerations or plaques without identifiable predisposing factors. Lymphatic, pulmonary, or skin metastases were present in 3 of 24 cases (13%) resulting in death in one case. PCR did not detect HPV DNA in our three cases. CONCLUSION Scrotal BCC rarely occurs and should be considered in the diagnosis of a persistent scrotal ulcer or plaque. Metastatic disease may be more common than with other BCCs and wide local excision or Mohs micrographic surgery may be the most appropriate initial therapeutic approach.

Human papillomavirus and herpes virus DNA are not detected in benign and malignant prostatic tissue using the polymerase chain reaction

Fresh prostatic tissue removed at the time of surgery was assayed for the presence of human papillomavirus (HPV) types 6, 11, 16, 18 and 33 and herpes and varicella-zoster viruses (HV) using DNA amplification followed by specific hybridization. Thirty samples representing both benign and malignant prostatic disease were assayed. Although appropriate amplimers were present for beta globulin gene indicating successful extraction of DNA, no HPV or HV amplimers could be obtained with appropriate primers. We conclude that HPV and HV are not routinely found in human prostate.

Epidermolytic acanthoma does not contain human papillomavirus DNA

The histologic changes of epidermolytic acanthoma can mimic those of human papillomavirus infection. Sections from paraffin‐embedded tissues identified histologically as epidermolytic acanthoma were examined for the presence of human papillomavirus (HPV) types 6, 11, 16, 18, and 33 using the polymerase chain reaction followed by dot‐blot analysis with specific radiolabelled detecting probes. Although present in appropriate controls, human papillomavirus DNA was not detected in epidermolytic acanthoma. We conclude that epidermolytic acanthoma is not a skin lesion that is associated with human papillomavirus infection.

Detection of human papillomavirus DNA in seborrheic keratosis by polymerase chain reaction

We searched for HPV DNA in 72 cases of seborrheic keratosis (nongenital SK 29, genital SK 43) using polymerase chain reaction. Amplification of HPV DNA was found in 24 (nongenital, 1; genital, 23). HPV DNA type 6 was present in 18 cases and type 11 in four and type 33 in two. Twenty-three (53%) cases of genital region SK and one (3%) case of nongenital region SK contained HPV DNA sequences. Histopathologically, the perinuclear vacuolization of epithelial cells, mitosis and dyskeratotic cells were more marked in HPV DNA-positive SK than those in negative SK (P < 0.01). We suppose HPV may play an important role in epidermal proliferation of SK in the genital region.

Detection with the polymerase chain reaction of human papillomavirus DNA in condylomata acuminata treated in vitro with liquid nitrogen, trichloroacetic acid, and podophyllin.

BACKGROUND The mechanisms of action for local treatments used against condylomata acuminata are unknown, but most are believed to cause physical destruction of infected tissue. OBJECTIVE Our purpose was to determine whether liquid nitrogen, trichloroacetic acid (TCA), and podophyllin damage HPV DNA found in condylomata acuminata. METHODS Fourteen genital warts were excised from 14 patients and divided. One part was treated with liquid nitrogen, the second and third parts were treated with TCA and podophyllin, respectively, and the remainder served as a control. DNA was then extracted from tissue by proteolytic digestion and amplified by the polymerase chain reaction. Dot blots were performed with the use of radiolabeled consensus and HPV type-specific probes. RESULTS HPV DNA was amplified and detected in 100% of untreated specimens, in 92% of specimens treated with liquid nitrogen, and in 15% and 7% of specimens treated with podophyllin and TCA, respectively. CONCLUSION TCA and podophyllin damage HPV DNA more effectively than does liquid nitrogen.

Herpes simplex virus DNA in occult lesions: Demonstration by the polymerase chain reaction

Herpes simplex virus DNA was identified by the polymerase chain reaction with primers specific for the herpes DNA polymerase gene. A herpes-specific amplimer was detected in two of three cases in which the clinical and histologic features were inconclusive.

Polymerase chain reaction: relevance for dermatopathology

Medical knowledge has been significantly expanded by the techniques of molecular genetics. A new technology, the polymerase chain reaction (PCR) (1–6), has produced a quantum leap in the field of molecular genetics. PCR uses an in vitro chemical reaction to amplify impure DNA, either fragmented or intact. A defined DNA fragment can be amplified a millionfold in a relatively brief incubation (a few hours). The ability to amplify minute quantities of crude DNA gives the method extraordinary power and sensitivity, DNA can be amplified from fixed pathologic specimens (7), buccal cells from mouth washes (8), a single human hair (9), and solitary cells (10). Once amplified, large DNA samples can be studied by electrophoresis, Southern and slot blot, and other techniques.

Irritated seborrheic keratoses and benign verrucous acanthomas do not contain papillomavirus DNA

Sections from paraffin‐embedded tissues of lesions thought to represent verrucous lesions (benign verrucous acanthomas: BVA) as well as materials from controls including seborrheic keratoses (SK), irritated SK, and verruca vulgaris from areas other than the genitalia were analyzed for the presence of multiple human papillomaviruses (HPV) including types 6, 11, 16, 18, and 33 using DNA amplification methodology. HPV DNA sequences were not found in amplified samples of BVA, SK, and irritated SK samples, but were identified in those obtained from verruca vulgaris. Our results suggest that BVA, SK, and irritated SK are generally not associated with HPV DNA even though certain of these lesions may histologically mimic the architecture of verruca.

Human papillomavirus type 6 infection involving cutaneous nongenital sites

Human papillomavirus (HPV) type 6 is classically considered a mucosatropic virus. Interestingly, clinical manifestations of HPV 6 infection that involve nonmucosal or nongenital sites have rarely been described. The reasons for this site specific infectivity of HPV 6 are unknown. We describe a patient who had condylomata acuminata-like lesions that involved cutaneous nongenital sites; HPV 6 DNA was detected in skin biopsy specimens with use of the polymerase chain reaction, followed by hybridization with use of type-specific DNA probes.

Swollen keratinocytes: a histologic marker of unusual human papillomavirus‐type infection and immunosuppression

Cutaneous papillomavirus infection is common in patients who are immunosupprcsscd. We describe swollen keratinocytes in the granular layer in lesions from four patients who had human immunodeficiency virus infection. These cells were similar to those described in skin lesions of epidermodysplasia verruciformis. Amplification of DNA from the lesions revealed an amplimer for human papillomavirus using a consensus primer for a highly conserved region of the LI open reading frame: however, specific binding was not noted when radiolabelled probes for human papillomavirus types 6, 11, 16, 18, and 33 were used. We conclude that the presence of these distinctive swollen cells strongly suggests immunosuppression and quite possibly infection by a less common papillomavirus type.