Kaddu Steven, Dong Huiting, Mayer Gerlinde, Kerl Helmut, Cerroni Lorenzo
Department of Dermatology, University of Graz, Austria.
J Am Acad Dermatol. 2002 Sep;47(3):423-8. doi: 10.1067/mjd.2002.122756.
The clinicopathologic spectrum of warty dyskeratoma (WD) is not well characterized and the pathogenesis of this unusual lesion is still unclear.
We reviewed the clinical and histopathologic spectrum of WD and investigated a possible involvement of human papillomavirus (HPV) infection in onset of this lesion.
A total of 46 cases of WD were analyzed clinically and histopathologically. Polymerase chain reaction (PCR) analysis for HPV-DNA was performed in 13 lesions of WD.
A total of 46 lesions of WD from 45 patients (M/F ratio, 1:1.8; mean age 59.8 years, median 61 years, age range 3-88 years) presented as solitary papules or small nodules on the head and neck (32 cases), trunk (9 cases), lower extremities (4 cases), and upper extremities (1 case). One patient had 2 lesions. No patient had clinical signs of Darier's or Grover's disease. Histopathologically on scanning magnification, lesions showed mainly 3 architectural patterns, namely, cup-shaped (29 cases), cystic (6 cases), and nodular (2 cases). In 9 cases, a combination of two of these morphologic patterns was observed. Characteristically, the epithelial component in all WDs displayed foci of acantholytic dyskeratosis. Variable features suggestive of follicular differentiation toward the infundibular portion of a normal hair follicle were also observed, including a focal contiguity to pilosebaceous units in most cases (63%), and the presence of small infundibular cystic structures in a subset of lesions (46%). The majority of lesions (83%) also revealed a hyalinized or fibrous stroma with intrastromal clefts. PCR analysis for HPV-DNA performed in 13 cases inclusive of all representative architectural patterns was negative.
We conclude that WD shows a wider spectrum of morphologic features than previously recognized. Despite some histopathologic similarities to viral warts, WD is not a manifestation of HPV infection. On the other hand, the majority of these lesions display overall histopathologic features consistent with a follicular adnexal neoplasm. On the basis of this finding, we propose the alternative term follicular dyskeratoma to better reflect the distinctive features of this peculiar lesion.
疣状角化不良瘤（WD）的临床病理谱特征尚不明确，这种不寻常病变的发病机制仍不清楚。
我们回顾了WD的临床和组织病理学谱，并研究了人乳头瘤病毒（HPV）感染在该病变发病中的可能作用。
对46例WD病例进行了临床和组织病理学分析。对13例WD病变进行了HPV-DNA的聚合酶链反应（PCR）分析。
45例患者的46个WD病变（男/女比例为1:1.8；平均年龄59.8岁，中位数61岁，年龄范围3 - 88岁）表现为头颈部（32例）、躯干（9例）、下肢（4例）和上肢（1例）的孤立丘疹或小结节。1例患者有2个病变。无患者有达里埃病或格罗弗病的临床体征。在扫描放大倍数下，组织病理学显示病变主要有3种结构模式，即杯状（29例）、囊性（6例）和结节状（2例）。9例观察到其中两种形态模式的组合。特征性地，所有WD中的上皮成分均显示棘层松解性角化不良灶。还观察到向正常毛囊漏斗部的毛囊分化的可变特征，包括大多数病例（63%）与皮脂腺单位的局灶性连续性，以及一部分病变（46%）中存在小的漏斗状囊性结构。大多数病变（83%）还显示有玻璃样变或纤维性间质及间质内裂隙。对包括所有代表性结构模式的13例病例进行的HPV-DNA的PCR分析为阴性。
我们得出结论，WD显示出比先前认识到的更广泛的形态学特征谱。尽管在组织病理学上与病毒疣有一些相似之处，但WD并非HPV感染的表现。另一方面，这些病变中的大多数显示出与毛囊附属器肿瘤一致总的组织病理学特征。基于这一发现，我们提出用“毛囊角化不良瘤”这一术语来更好地反映这种特殊病变的独特特征。
