Inter- and intra-observer variability in three grading systems for oral epithelial dysplasia. Aside from koilocytosis, cytologic atypia is absent (Figure 2, B). Benign alveolar ridge keratosis: clinical and histopathologic analysis of 167 cases. WebHistologically, it is characterized by stratified squamous epithelium with few atypical cells. [42] Class 3 endophytes are restricted to growth in above ground plant tissues and form in localized areas of plant tissue. May P. Chan; Verruciform and Condyloma-like Squamous Proliferations in the Anogenital Region. Squamous keratinocytes are more common in this variant compared to basaloid cells. Amongst these are relatively rare entities such as bowenoid papulosis, epidermolytic acanthoma, and verruciform xanthoma, which are underrecognized by surgical pathologists. [23], However, the specific biochemical mechanisms behind these behavioral changes are still largely unknown and lower-level signal cascades have yet to be discovered. 2016 Sep;43(9):759-65. doi: 10.1111/cup.12738. Krishnan L, Karpagaselvi K, Kumarswamy J, et al. Feller L, Wood NH, Raubenheimer EJ. Figure 2Giant condyloma acuminatum. A common diagnostic quandary is regarding anogenital seborrheic keratosis (SK)like lesions without identifiable koilocytes (Figure 1, C). Would you like email updates of new search results? Proliferative verrucous leukoplakia and its progression to oral carcinoma: a review of the literature. As a general rule, anogenital SK-like lesions with an undulating appearance (Figure 1, C), with or without pseudohorn cysts, are probably best treated as condyloma acuminatum, as opposed to those with a flat base.15, Pirog et al16,17 have found positive Ki-67 (MIB-1) immunostaining, defined as any cluster of at least 2 positive nuclei in the upper two-thirds of the epithelium, in all vulvar and anal condylomas examined, a finding that correlated well with positive HPV results by polymerase chain reaction (PCR) and DNA sequencing. [59] The alkaloid beauvericin has been isolated from the fungus Fusarium oxysporum and has shown cytotoxicity against the tumor cells PC3, PANC-1, and A549. The site is secure. The increased growth and resilience is likely caused by the endophytes ability to improve plant nutrition or secondary metabolite production, as in the case of Phoma eupatorii's inhibition of the phytopathogen Phytophthora infestans. Shear M, Pindborg JJ. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Background: The second method divides fungal endophytes into four groups based on taxonomy and six other criteria: host range, host tissues colonized, in planta colonization, in planta biodiversity, mode of transmission and fitness benefits. The many diverse terms used to describe the wide spectrum of changes seen in proliferative verrucous leukoplakia (PVL) have resulted in disparate clinical management. C, An anogenital seborrheic keratosis with an undulating base and numerous pseudohorn cysts without evidence of koilocytosis. 2015;120(4):47482. Am J Dermatopathol. Class 1 endophytes are all phylogenetically related and proliferate within cool and warm season grasses. Classification of these lesions is often challenging owing to significant histopathologic overlap and sometimes controversial and confusing diagnostic criteria. Atypical Squamous Proliferation: What Lies Beneath?, Dermatologic Surgery | 10.1111/j.1524-4725.2011.01895.x | DeepDyve DeepDyve Get 20M+ Full-Text Papers For Less Than $1.50/day. FOIA When verrucous carcinoma forms on your feet, they manage it as a skin cancer. 2008;58(1):1517. [30], One or more endophytic organisms are found in nearly every land plant. government site. Gillenwater AM, Vigneswaran N, Fatani H, Saintigny P, El-Naggar AK. Google Scholar. 2015;9(7):Zc17-22. DEVIL is a rare form of squamous proliferation characterized by prevalent PIK3CA and HRAS mutations. Please enable it to take advantage of the complete set of features! The lesion is acanthotic and hyperkeratotic with variable degree of papillomatosis and/or invagination (Figure 8, A).76,79 The histopathologic pattern is that of epidermolytic hyperkeratosis (EHK), in which the keratinocytes in the granular and spinous layers display cytoplasmic vacuolation, reticular degeneration, coarse keratohyalin granules, and perinuclear eosinophilic inclusions (Figure 8, B).73,76,79 Despite superficial resemblance to koilocytosis, these unique characteristics of EHK effectively exclude condyloma acuminatum and VV. Figure 7Verruca vulgaris. B, Koilocytes are readily found in the upper epidermis, while the remaining keratinocytes are cytologically uniform and bland (hematoxylin-eosin, original magnifications 10 [A] and 200 [B]). The papillae contain prominent fibrovascular cores and lack significant hyperkeratosis, imparting a relatively soft appearance. Figure 6Bowenoid papulosis. Frictional keratoses on the facial attached gingiva are rare clinical findings and do not belong to the category of leukoplakia. These interaction range from pathogenic to symbiotic and symptomatic to asymptomatic. Villa A, Menon RS, Kerr AR, et al. The latter refers to well-differentiated SCC with a papillary architecture. Angulated tumor nests infiltrate the underlying stroma. However, this view has been challenged by the frequent detection of HPV in giant condylomas but rarely in verrucous carcinomas.24,25 As in ordinary condyloma acuminatum, giant condylomas usually harbor HPV 6 and 11.24 Recurrence rate is high,21 and malignant transformation to invasive SCC has been reported in more than 50% of cases, most commonly in HIV-positive patients.20,21 Not surprisingly, coinfection with high-risk HPV has been demonstrated in carcinoma ex giant condyloma acuminatum.26, The microscopic features of giant condyloma acuminatum are similar to those of its ordinary counterpart except for its large size and more florid excrescences. Montague LJ, Bhattacharyya I, Islam MN, Cohen DM, Fitzpatrick SG. Conclusion: Authors Sheldon Sebastian 1 , Inter-observer variability in the diagnosis of proliferative verrucous leukoplakia: clinical implications for oral and maxillofacial surgeon understanding: a collaborative pilot study. 2007;36(5):25561. Ten of the 14 tumors that remained classified as SCC had detectable TP53 mutations. Class 1 endophytes are mainly transmitted from host to host by vertical transmission, in which maternal plants pass fungi on to their offspring through seeds. Epidermolytic acanthoma. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. While the basaloid subtype rarely mimics condyloma acuminatum, it shares overlapping features with the warty-basaloid subtype, which has a condyloma-like, verruciform silhouette (Figure 4, C).37 The epithelium is basaloid due to a high nuclear to cytoplasmic ratio and nuclear hyperchromasia (Figure 4, C; inset). Woo SB. The objective of this study was to produce an expert consensus guideline for standardized assessment and reporting by pathologists diagnosing PVL related lesions. Hansen LS, Olson JA, Silverman S. Proliferative verrucous leukoplakia. van der Meij EH, Reibel J, Slootweg PJ, et al. Rosebush MS, Briody AN, Cordell KG. 2020. https://doi.org/10.1111/odi.13363. https://doi.org/10.1007/s12105-020-01262-9, DOI: https://doi.org/10.1007/s12105-020-01262-9. 1997;84(2):1547. This is a preview of subscription content, access via your institution. 2019;96:12130. Plant-microbe interactions are not strictly mutualistic, as endophytic fungi can potentially become pathogens or saprotrophs, usually when the plant is stressed. Approximately 40% of warts in the genital area of young girls are VV (positive for HPV 2) while the rest are condylomas (positive for HPV 6 or 11).70 The clinical morphologies of VV and condyloma acuminatum are similar in that both are exophytic and verrucous papules, but VV tends to be more hyperkeratotic than condyloma acuminatum. 2008 Aug;33(5):625-8. doi: 10.1111/j.1365-2230.2008.02785.x. The epithelium in condyloma acuminatum is acanthotic with variable degree of papillomatosis. They typically colonize plant shoots where they form a systemic intercellular infection. [42], Non-clavicipitaceous endophytes represent a polyphyletic group of organisms. Indian J Dent Res. 2019;13(1):1624. [16] Studies have also shown that during experimental circumstances endophytes contribute significantly to plant growth and fitness under light-limited conditions, and plants appear to have increased reliance on their endophytic symbiont under these conditions. This site needs JavaScript to work properly. The disseminated form most frequently affects genital skin, particularly the scrotum and the vulva.7375 The lesions are skin-colored or whitish papules with a smooth or verruciform surface, frequently confused with condyloma acuminatum clinically.74,76 Multiple reports have confirmed the absence of HPV in epidermolytic acanthomas,73,76,77 although 1 reported case of scrotal epidermolytic acanthoma tested positive for HPV 16 when using a highly sensitive HPV DNA chip.78 It is possible that HPV was an incidental finding, rather than a pathogenic agent, in this isolated case. [15], Studies have shown that endophytic fungi grow in a very intimate interaction with their host plant cells. Recipient(s) will receive an email with a link to 'Verruciform and Condyloma-like Squamous Proliferations in the Anogenital Region' and will not need an account to access the content. [68] Epichlo endophytes are being widely used commercially in turf grasses to enhance the performance of the turf and its resistance to biotic and abiotic stresses. A case of multiple epidermolytic acanthoma of the scrotum: is the human papillomavirus a culprit? [24] However, unique to this experiment was the mode by which this was thought to happen. Head Neck. In a series of 108 cases, it was concluded that a background of maturing keratinocytes and sparing of the follicular epithelium could distinguish bowenoid papulosis from basaloid HSIL.53 Another morphometric analysis showed significantly larger and more irregular nuclei in basaloid HSIL compared to bowenoid papulosis.64 In practice, however, the histopathologic differences are often subtle, and definitive diagnosis relies heavily on stringent clinical correlation: Presence of multiple small pigmented papules in a young adult, as opposed to a solitary, slowly progressive plaque or erythematous patch in an older patient, would support a diagnosis of bowenoid papulosis over basaloid HSIL.53,60, High-risk HPV in bowenoid papulosis can be detected by in situ hybridization or PCR-DNA sequencing.6567 Expression of both p16 and human telomerase reverse transcriptase (hTERT) by immunohistochemistry is associated with high-risk HPV infection and has been demonstrated in bowenoid papulosis.67 Diffuse p16 expression is especially helpful in differentiating occasional cases of bowenoid papulosis with more orderly maturation, subtle cytologic atypia, and koilocyte-like cells from condyloma acuminatum (Figure 6, B).18. A, A typical papillomatous papule with only mild hyperkeratosis. Microscopically, the squamous papillae are of variable lengths and shapes, lined by irregular well-differentiated squamous epithelium with overlying hyperkeratosis (Figure 5, A). 2019;13(3):42339. Conspicuous parakeratosis fills many gaps between the verrucous projections, giving rise to a firm and rigid appearance. ( A) Skin punch biopsy of the erythrodermic reaction. B, The lesion is diffusely positive for p16 (hematoxylin-eosin, original magnifications 40 [A] and 200 [A, inset]; original magnification 100 [B]). Case 2. [11] Studies have shown endophytic fungi are able to produce secondary metabolites previously thought to be manufactured by their plant hosts. 2012 May;103(4):308-16. doi: 10.1016/j.ad.2011.09.004. This is a bulky squamous proliferation, three to four times the thickness of the epithelium for the site, that is endophytic and/or exophytic in its growth pattern The authors declare that they have no conflict of interest. Background: Tongue squamous cell carcinoma (TSCC) is highly diverse, even in its early stages. [31], Among the many promising applications of endophytic microbes are those intended to increase agricultural use of endophytes to produce crops that grow faster and are more resistant and hardier than crops lacking endophytes. Dermatol Surg. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). [22], In an experiment investigating the interaction between Miscanthus sinensis and the plant endophyte Herbaspirillum frisingense, a roughly 20% increase in fresh biomass was observed in M. sinensis following inoculation with H. B, Parakeratosis is compact with a characteristic orange hue or peach color. Both condyloma acuminatum and VV are caused by low-risk HPV. Hypergranulosis is accentuated in the valleys between papillae. Endophytes can extensively colonize plant tissues and competitively exclude other potential pathogens. A, An exophytic and endophytic verrucous squamous proliferation with a bulbous, pushing base. [55], Two strains of the endophytic fungi Pestalotiopsis microspora isolated from stems of plants from the Ecuadorian rainforest were shown in laboratory experiments to be able to digest polyurethane plastic as the fungus's sole carbon source in anaerobic conditions, although many other non-endophytic fungi have demonstrated this ability, and most isolates of endophytic fungi in this experiment could perform this to some degree. Benign alveolar ridge keratosis (oral lichen simplex chronicus): a distinct clinicopathologic entity. 2007;138(5):64151. A, A small verrucous papule with marked hyperkeratosis. Mller S. Frictional keratosis, contact keratosis and smokeless tobacco keratosis: features of reactive white lesions of the oral mucosa. However, in contrast with condyloma acuminatum, which is typically caused by HPV types 6 and 11, VV is most commonly induced by HPV 2, followed by HPV 1, 4, 65, 27, and others.68,69 Distinction of VV and condyloma acuminatum has important clinical implication especially in the pediatric population, as condyloma acuminatum would raise suspicion for sexual abuse, whereas VV is nonsexually transmitted.
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