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VERRUCA VULGARIS
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Verruca vulgaris (common
wart) is caused by various strains of human papilloma virus (HPV 1, 2,
4, 7, 26-29).
Gross features:
Verruca vulgaris may present as a hard, rough surfaced papule 0.2 -
2cm. Lesion may be solitary or multiple.
Microscopic features:
Exophytic, symmetric, papillomatous lesion with large keratohyaline
granules and characteristic inturning of the rete ridges ;
Parakeratotic columnar tiers of stratum corneum overlie the
papillomatous surface ; Small amounts of haemorrhage may be present
within the columns of parakeratosis ;
Other characteristic
features - Koilocytosis ; hypergranulosis and presence
of multinucleated cells. Koilocytes are not seen in older lesions ; In
the filiform type of verruca vulgaris there is marked papillomatosis.
VERRUCA PALMARIS
OR PLANTARIS (MYRMECIA OR PALMOPLANTAR WART)
These are painful
endophytic lesions found on palms and soles of adolescents.
Microscopic features:
Symmetric and endophytic lesions characterised by epidermal hyperplasia and
presence of large intracytoplasmic, keratohyaline granules in the
superficial keratinocytes.
VERRUCA PLANA
(PLANE WART)
These are usually
multiple flat to slightly papular lesions, located on the face, neck
or extremities.
Microscopic features:
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Symmetric lesions with slightly hyperplastic epidermis ; Verrucous
changes and parakeratosis are minimal ; There is vacuolation of cells
in the upper epidermis and basket weave pattern is noted in the
overlying stratum corneum.
EPIDERMODYSPLASIA
VERRUCIFORMIS
This lesion usually
occurs in infancy and childhood and presents as flat or papular wart
or macule. Numerous HPV subtypes are associated with EV. Malignant
transformation occurs in 25% of patients with EV. HPV 5 and 8 are
known to have highest oncogenic potential.
Microscopic features: Images(DermAtlas)
Some lesions are similar to plane warts where as others resemble seborrheic keratosis ; The lesions display epidermal thickening with
swollen cells in the upper epidermis ; There are nests of large cells
with prominent perinuclear halo and clear cytoplasm; Both basket
weave orthokeratosis and parakeratosis may be present ; Epidermal
cells may show dysplastic changes.
CONDYLOMA
ACUMINATUM
Condyloma acuminatum occurs
on the anogenital mucous membrane and is associated with HPV (HPV6
and HPV 11 are most commonly identified).
These are usually sexually transmitted lesions.
Clinical presentation:
The appearance ranges from a 5mm papule to large fleshy tumour mass
involving anogenital region.
Microscopic features: Image Hyperkeratosis, acanthosis, papillomatosis together with superficial
koilocytosis and hypergranulosis.
Following treatment with Podophyllin the histological changes include-
- pallor of epidermis
- numerous degenerate keratinocytes in the lower half of the epidermis
- marked increase in number of mitotic figures in the lower epidermis.
Differential diagnosis includes- carcinoma-in-situ,
bowenoid papulosis
and
seborrheic keratosis .
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