International Journal of Infectious Diseases
Volume 14, Supplement 3 , Page e378, September 2010

Invasive squamous cell carcinoma arising from a human papillomavirus genotype 16-associated verrucous cyst

Institute of Anatomic Pathology, S. Maria del Carmine Hospital Rovereto, Rovereto, Trento, Italy

Received 15 January 2010 published online 20 July 2010.

Corresponding Editor: Mark Holodniy, California, USA

Article Outline

 

We have recently observed the first case of invasive squamous cell carcinoma arising from a human papillomavirus genotype 16 (HPV16)-associated verrucous cyst. The lesion was found in the perineal area of an 86-year-old woman. Using in situ hybridization (ISH), we detected the presence of HPV16 in the cystic wall. HPV16 DNA sequences were detected in formalin-fixed, paraffin-embedded tissue sections using the DNA–DNA ISH method, as described previously.1 For immunohistochemical analysis, a p16 monoclonal antibody (clone E6H4, CINtec p16INK4a Histology Kit; mtm laboratories AG, Heidelberg, Germany) was used. p16INK4a immunostaining showed diffuse and intense positivity throughout the dysplastic epithelium and in the areas of invasive carcinoma (Figure 1).

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  • Figure 1. 

    The cystic wall was lined by squamous epithelium with papillomatosis, hypergranulosis, parakeratosis with adjacent squamous in situ and invasive carcinomatous component. (H&E; 40X). Insert : p16INK4a immunostaining showed diffuse and intense positivity throughout the dysplastic epithelium and in the areas of invasive carcinoma.

In 1991 Meyer et al.2 described five cases of verrucous cysts in which they detected HPV genomes by PCR, without specifying HPV type. Subsequently, numerous other reports have described HPV-specific DNA sequences in verrucous cysts, most prevalently in plantar and palmar regions. Specific HPV types were not identified until 1992, when Matsukura et al.3 cloned the HPV type from a cyst that showed no homology with other known prototypes of HPV (from HPV1 through HPV59), so that it was named HPV60. Matsukura et al. found this HPV type in three cases of plantar cysts.

In 1994 Egawa et al.4 described immunohistochemical staining positive signals indicating an HPV antigen in two cystic lesions of the left foot. The authors found that the DNA sequences were identical to HPV60. In 1994 Kawase et al.,5 examined 10 cases of plantar cysts. Six of them were found to have cytopathic effects in the cyst wall and inner contents. HPV60 was detected in these cases by ISH. In 1995 Egawa et al.6 examined 119 palmoplantar epidermoid cysts. Hybridization experiments to detect HPV DNA were performed in 47 cases, revealing the presence of HPV60 DNA sequences. In 1998, Egawa et al.7 detected HPV57 DNA by PCR and ISH in the plantar cyst of a 23-year-old Japanese man. After routine histopathologic review, PCR of extracted DNA, sequencing of PCR products and, finally, a homology search were undertaken by Lee et al.8 in 63 epidermal cysts. As a result, nine of 63 (14.3%) cysts showed a positive reaction on PCR. By homology search after PCR, all were demonstrated to be HPV60.

Our case demonstrates that HPV type 16 may be found in the HPV-associated verrucous cyst.

Conflict of interest: No conflict of interest to declare.

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References 

  1. Egawa K, Shibasaki Y, de Villiers EM. Double infection with human papillomavirus 1 and human papillomavirus 63 in single cells of a lesion displaying only a human papillomavirus 63-induced cytopathogenic effect. Lab Invest. 1993;69:583–588
  2. Meyer LM, Tyring SK, Little WP. Verrucous cyst. Arch Dermatol. 1991;127:1828–1829
  3. Matsukura T, Iwasaki T, Kawashima M. Molecular cloning of a novel human papillomavirus (type 60) from a plantar cyst with characteristic pathological changes. Virology. 1992;190:561–564
  4. Egawa K, Honda Y, Inaba Y, Kojo Y, Ono T, de Villiers EM. Multiple plantar epidermoid cysts harboring carcinoembryonic antigen and human papillomavirus DNA sequences. J Am Acad Dermatol. 1994;30:494–496
  5. Kawase M, Honda M, Niimura M. Detection of human papillomavirus type 60 in plantar cysts and verruca plantaris by the in situ hybridization method using digoxigenin labeled probes. J Dermatol. 1994;21:709–715
  6. Egawa K, Honda Y, Inaba Y, Ono T, De Villiers EM. Detection of human papillomaviruses and eccrine ducts in palmoplantar epidermoid cysts. Br J Dermatol. 1995;132:533–542
  7. Egawa K, Kitasato H, Honda Y, Kawai S, Mizushima Y, Ono T. Human papillomavirus 57 identified in a plantar epidermoid cyst. Br J Dermatol. 1998;138:510–514
  8. Lee S, Lee W, Chung S, Kim D, Sohn M, Kim M, et al. Detection of human papillomavirus 60 in epidermal cysts of nonpalmoplantar location. Am J Dermatopathol. 2003;25:243–247

PII: S1201-9712(10)02392-1

doi:10.1016/j.ijid.2010.05.011

International Journal of Infectious Diseases
Volume 14, Supplement 3 , Page e378, September 2010

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