G. De Dobbeleer

Demonstration of Human Papillomavirus Type 2 in a Verrucous Carcinoma of the Foot

This report describes one case of verrucous carcinoma of the foot containing human papillomavirus type 2 DNA which was detected by the polymerase chain reaction DNA amplification method. Our findings suggest that human papillomavirus type 2, which was classically associated with palmoplantar warts, may also play a role in the pathogenesis of peripheral verrucous carcinoma.

Verrucous carcinoma of the penis: Importance of human papillomavirus typing for diagnosis and therapeutic decision

One case of penile verrucous carcinoma (Buschke-Löwenstein tumor) undergoing anaplastic transformation and containing human papillomavirus type 6 is presented. The viral genome is detected by in situ hybridization using biotin-labeled cDNA probes. The clinical, histological and virologic criteria of verrucous carcinoma are discussed in comparison to giant condyloma and highly differentiated squamous cell carcinoma. The importance of viral typing determination for further diagnostic and therapeutic procedures is emphasized.

Reproduction of the characteristic morphologic changes of familial benign chronic pemphigus in cultures of lesional keratinocytes onto dead deepidermized dermis

We report the in vitro reproduction of the classic histologic and ultrastructural features of familial benign chronic pemphigus (FBCP) by seeding suspensions of lesional keratinocytes onto healthy heterologous dead deepidermized dermis (DED). With the use of normal keratinocytes, control cultures showed a well-differentiated epidermis, with keratohyaline granules and lamellar bodies. To the best of our knowledge this is the first successful culture of FBCP with the use of dispersed lesional keratinocytes. The results suggest that in FBCP the epidermis is the site of the defect leading to acantholysis, without any dermal contribution.

A Case of Pyoderma gangrenosum Stabilized with Lymecycline, Topical Benzoyl Peroxide and Treated by Autograft

Pyoderma gangrenosum is a chronic inflammatory ulcerative skin disease of unknown etiology, often associated with various systemic disorders such as inflammatory bowel disease, rheumatoid arthritis, chronic active hepatitis, diabetes mellitus and hematologic malignancies. The ulcers are characterized by their undermined violaceous borders. The disease remains a therapeutic challenge. Corticosteroids are the mainstay of therapy; however, side effects from this treatment and recalcitrant pyoderma gangrenosum require therapeutic alternatives. We report the case of a large subacute pyoderma gangrenosum stabilized with lymecycline, topical benzoyl peroxide and successfully treated by an autograft. This observation supports the opinion that the risk of pathergy of a graft can be avoided by the stabilization of the disease.

Carcinoma of the Glans penis Arising 20 Years after Lichen sclerosus

Lichen sclerosus (LS) is an inflammatory disease of incompletely characterized pathogenesis. The relation between LS and carcinoma is well known in women, but in men it is still a matter of debate whether LS is a premalignant lesion or not. We describe a case of LS of the glans penis which occurred in 1976. Within the next 20 years, the patient developed carcinoma at this site.

Transformation of common warts into squamous cell carcinoma on sun-exposed areas in an immunosuppressed patient.

We report one case of renal transplant recipient who developed widespread multiple verrucous skin lesions. Histologic examination revealed typical warts and, only from several sites exposed to sun (hands and face), a development of dysplasia within the warts and a transformation of some of them toward infiltrating squamous cell carcinoma (SCC). Human papillomavirus (HPV) testing for DNA by polymerase chain reaction DNA amplification identified HPV type 1 in both warts and SCC. Our findings suggest that classic warts may progress to high-grade lesions and that, in addition to the oncogenic potential of the virus alone, other factors including the hosts immunosuppressed state and ultraviolet radiation seem to be essential to malignant transformation.

Lethal Course of X-Linked Dominant Chondrodysplasia punctata in a Male Newborn

We report a newborn with some manifestations of chondrodysplasia punctata. Additional abnormalities were hydrocephalus, bilateral syndactyly of the fourth and fifth fingers and toes, absence of the middle phalanx of all toes, hypoplasia of the second and third phalanges of all fingers and cryptorchidism. This observation suggests that we are possibly dealing with a rare male case of X-linked dominant chondrodysplasia punctata.

Progressive nodular histiocytomas: CORRESPONDENCE

Sir, Epidermal grafting with suction blisters is used in treatment of stable vitiligo. Previous reports have shown various complications including postinflammatory hyperpigmentation, peripheral hypopigmentation and hypertrophic scarring. However, the risk of infection has not been reported to date. We report an unusual case of verruca vulgaris that appeared after epidermal grafting. It seems likely that virus particles might have been transferred from the operator, who had verruca vulgaris on his hand, to the patient during the surgical procedure. A 12-year-old girl with localized stable vitiligo was treated by epidermal grafting. Blisters on the recipient site formed within 24 h after three freeze±thaw cycles with liquid nitrogen. Blisters on the donor site were made by suction on the inner portion of the thigh. After approximately 3 h of suction at 200 mmHg, large unilocular bullae appeared. After removal of the blisters at the recipient site, the epidermal sheets were grafted to the denuded recipient site and held in place. Two weeks after grafting, once weekly systemic psoralen-ultraviolet A treatment was started. Almost complete repigmentation was observed 3 months after grafting. Four months after grafting, the patient noticed two verrucous plaques in the grafted site (Fig. 1). She denied warts on any other body sites. There was no history of similar lesions in her family or close friends. The operator, who wore gloves, had a verrucous papule on his hand during the surgery. Skin biopsy of two different lesions, on the patients back and the operators hand, demonstrated histological features of verruca vulgaris. Human papillomavirus (HPV) typing was not performed. Although epidermal grafting appears to be an effective and safe method for the treatment of vitiligo, various complications have been reported, of which some are associated with the application of liquid nitrogen, such as postinflammatory hyperpigmentation, hypertrophic scarring, peripheral hypopigmentation and uneven pigmentation. Koebner phenomenon and recurrence have also been considered complications of epidermal grafting. The possibility of transmission of virus from patient to patient or from patient to doctor has been reported. One study showed that virus may survive on a cotton swab dipped into liquid nitrogen and suggested that virus transmission from patient to patient may occur via this route. Charles and Sire reported the possibility of transmission of papovavirus indirectly by cotton-tipped applicators which had been used earlier to treat verruca in other patients. In our case, the same liquid nitrogen and cotton-tipped applicators were not used for multiple patients. Bergbrant et al. reported that there is a risk of contamination of the operator by HPV DNA, during both carbon dioxide laser and electrocoagulation treatment. Once an individual has been infected, new warts may develop in sites of inoculation over a period of weeks to months. After experimental HPV inoculation, it requires from 2 to 9 months for a verruca to become clinically apparent. This observation implies a relatively long period of subclinical infection. In our patient, the verruca appeared 4 months after grafting. It is unclear whether the verruca vulgaris resulted from direct contact with the operators hand during the surgical procedure, or with another person after grafting. However, there are several possible mechanisms of viral transmission from the operator to the patient: the operator may have palpated the lesion with his bare hand immediately after cryosurgery to evaluate the effectiveness of the freezing, or transmission may have occurred during application of a dressing after surgery. We suggest that the risk of transmission of infection from doctor to patient should be considered as a new complication of epidermal grafting.

Vulvar localisation of epidermolytic acanthoma: a light- and electron-microscopic study

A patient had several verrucoid lesions on the vulva, which showed light- and electron-microscopic features of epidermolytic acanthoma.

p53 Protein Overexpression in Verrucous Carcinoma of the Skin

BACKGROUND Verrucous carcinoma is a rare variant of well-differentiated squamous cell carcinoma which is characterized by a marked local aggressivity and a poor metastatic potential. Until now, little has been known about the oncogenic mechanisms of this tumor. Recently, extensive investigations have shown that p53 protein, a nuclear protein with oncogene-suppressing activity, may play a crucial role in cell transformation and immunoreactivity for this protein is found in a wide variety of cancers. OBJECTIVE AND METHODS The aim of the present study is to examine the frequency of immunohistochemically detectable p53 protein by using two monoclonal antibodies (D07 and BP53-12) in 8 cases of formalin-fixed and paraffin-embedded specimens of verrucous skin carcinoma. RESULTS Overexpression of p53 protein was detected in 6 (75%) of the cases examined with the D07 antibody and in 5 (62.5%) cases with BP53-12. The p53 positivity was shown in a peripheral distribution affecting mainly the basal cell layers of tumoral islands. CONCLUSION In a high percentage of verrucous carcinoma, p53 immunoreactivity has not been previously described in the literature and our findings suggest that abnormal expression of p53 tumor suppressor protein is a common event in the pathogenesis of this tumor.