Alam Zaryab, Bach Michelle S, Shalabi Mojahed, Brown Shannon C
Medicine, Texas A&M College of Medicine, Bryan, USA.
Medicine, University of Texas at Austin Dell Medical School, Austin, USA.
Cureus. 2024 Jan 31;16(1):e53343. doi: 10.7759/cureus.53343. eCollection 2024 Jan.
Verrucous cysts are uncommon types that cannot be distinguished from epidermal inclusion cysts clinically and require histopathological analysis and human papillomavirus (HPV) polymerase chain reaction (PCR) for accurate diagnosis. The pathogenesis of verrucous cysts is thought to involve HPV infection, either of an existing cyst or through direct infection of keratinocytes, leading to new cyst formation. While verrucous cysts can affect individuals of any sex and are typically found on the trunk, extremities, and face, they are particularly notable for their potential association with high-risk HPV types, such as 16 and 18, which may lead to malignant transformation. In this report, we present the case of a 48-year-old female with a history of endometriosis and pelvic inflammatory disease, who sought evaluation for a persistent subcutaneous nodule on her right flank. The patient reported pain, a recent color change, and an increase in the nodule size. Clinical examination revealed a 2.7 cm subcutaneous nodule with a central brown-gray papule. Despite no history of dermatologic malignancies, the nodule was excised, and subsequent histopathological examination confirmed a diagnosis of a ruptured verrucous cyst. The cyst exhibited acanthotic papillomatous squamous epithelium without cytologic atypia and koilocytic change in cells. This case offers direct and valuable insights into the clinical presentation, diagnosis, and management of verrucous cysts. It highlights the importance of a thorough diagnostic approach, combining histopathological examination with HPV PCR testing, to accurately differentiate verrucous cysts from other similar cutaneous lesions. The report also emphasizes the need for vigilance in managing these cysts due to their potential association with high-risk HPV types and the consequent risk of malignant transformation. These insights contribute significantly to the existing body of literature on verrucous cysts and aim to enhance clinical awareness and patient care in dermatology.
疣状囊肿是一种罕见类型，临床上无法与表皮样囊肿区分开来，需要进行组织病理学分析和人乳头瘤病毒（HPV）聚合酶链反应（PCR）才能准确诊断。疣状囊肿的发病机制被认为与HPV感染有关，感染途径要么是已有囊肿感染，要么是角质形成细胞直接感染，进而导致新囊肿形成。虽然疣状囊肿可发生于任何性别个体，且通常见于躯干、四肢和面部，但它们因其与高危HPV类型（如16型和18型）的潜在关联而尤为值得关注，这种关联可能导致恶性转化。在本报告中，我们介绍了一名48岁女性的病例，该女性有子宫内膜异位症和盆腔炎病史，因右侧胁腹持续性皮下结节前来就诊。患者自述有疼痛、近期颜色改变以及结节增大。临床检查发现一个2.7厘米的皮下结节，中央有一个棕灰色丘疹。尽管该患者无皮肤恶性肿瘤病史，但仍切除了结节，随后的组织病理学检查确诊为破裂的疣状囊肿。囊肿表现为棘层肥厚的乳头瘤样鳞状上皮，细胞无细胞学异型性及挖空细胞改变。该病例为疣状囊肿的临床表现、诊断和管理提供了直接且有价值的见解。它强调了采用全面诊断方法的重要性，即将组织病理学检查与HPV PCR检测相结合，以准确区分疣状囊肿与其他类似的皮肤病变。该报告还强调，鉴于这些囊肿与高危HPV类型的潜在关联以及随之而来的恶性转化风险，在管理这些囊肿时需要保持警惕。这些见解对现有的疣状囊肿文献有重要贡献，旨在提高皮肤科的临床认识和患者护理水平。
