Weill Cornell Medicine, New York, NY, United States of America.
The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America; Discovery Life Sciences, Powell, OH, United States of America.
Ann Diagn Pathol. 2019 Dec;43:151402. doi: 10.1016/j.anndiagpath.2019.151402. Epub 2019 Aug 22.
Heck's disease (focal or multifocal epithelial hyperplasia) is a benign, rare condition of the skin and mucous membranes induced by human papillomavirus (HPV) infection. Other entities that can induce large papillomatous lesions that involve the mucous membranes and skin include condyloma acuminatum, which is sexually transmitted, and white sponge nevus, often due to a mutation of cytokeratin 4 or 13. Six cases diagnosed as either Heck's disease (n = 2) or white sponge nevus (n = 4) and 6 oral condyloma were compared on histologic grounds and analyzed in situ for HPV DNA, including HPVs 6,11, and 13, as well as cytokeratins 4 and 13. Each case showed marked acanthosis, and para/hyperkeratosis. More variable histologic findings included rete ridge elongation, keratinocyte degeneration, and perinuclear halos. High copy HPV 13 DNA was evident in the squamous cells towards the surface in the two cases diagnosed as Heck's disease and in two cases diagnosed as white sponge nevus on clinical grounds. HPV 6/11 was found in each of the six condyloma. Marked decrease in either cytokeratin 4 or 13 was evident in the two cases diagnosed as white sponge nevus that were HPV DNA negative. It is concluded that in situ hybridization analyses including HPVs 6, 11, and 13 as well as immunohistochemistry for cytokeratins 4 and 13 can differentiate Heck's disease from condyloma and white sponge nevus, which can be difficult to differentiate on clinical and histologic grounds.
海克氏病（局灶性或多灶性上皮增生）是一种由人乳头瘤病毒（HPV）感染引起的皮肤和黏膜良性、罕见病变。其他可引起累及黏膜和皮肤的大型乳头状病变的实体包括性传播的尖锐湿疣和常因角蛋白 4 或 13 突变引起的白色海绵状痣。我们比较了 6 例诊断为海克氏病（n=2）或白色海绵状痣（n=4）和 6 例口腔尖锐湿疣的病例，基于组织学特征进行分析，并原位分析 HPV DNA，包括 HPV 6、11 和 13 以及角蛋白 4 和 13。每个病例均表现为明显的棘层肥厚和过度角化。更具变异性的组织学发现包括网嵴延长、角质形成细胞变性和核周晕。在临床上诊断为海克氏病的 2 例和临床上诊断为白色海绵状痣的 2 例中，均可见到向表面移行的鳞状细胞中存在高拷贝数的 HPV 13 DNA。在 6 例尖锐湿疣中均发现 HPV 6/11。在临床上诊断为白色海绵状痣且 HPV DNA 阴性的 2 例中，角蛋白 4 或 13 明显减少。综上，包括 HPV 6、11 和 13 的原位杂交分析以及角蛋白 4 和 13 的免疫组织化学可以区分海克氏病、尖锐湿疣和白色海绵状痣，这三种疾病在临床上和组织学上都难以区分。
