10.5826/dpc.1301a5
text/xml
2160-9381
2309
en
Aradhana Bhargava
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
angiokeratoma
High-risk Genital-mucosal Human Papilloma Virus Types 58 and 59 Associated With Solitary Angiokeratoma on the Elbow
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Letter to the Editor
2023-01-31
2022-01-11
2023-01-31
2023-03-01
e2023005
Dermatol Pract Concept
Aradhana Bhargava
2023/01/31
10.5826/dpc.1301a5
e2023005
Department of Dermatology and Sexually Transmitted Diseases, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
2160-9381
angiokeratoma
en
e2023005
Molho-Pessach V, Lotem M. Viral carcinogenesis in skin cancer. Curr Probl Dermatol. 2007;35:39-51. DOI: 10.1159/000106409. PMID: 17641489.
High-risk Genital-mucosal Human Papilloma Virus Types 58 and 59 Associated With Solitary Angiokeratoma on the Elbow
https://dpcj.org/index.php/dpc/article/download/2309/1911
        High-risk Genital-mucosal Human Papilloma
       Virus Types 58 and 59 Associated With Solitary
                Angiokeratoma on the Elbow
             Geeti Khullar1, Mithilesh Chandra2, Deepti Agarwal2, Aradhana Bhargava1


1 Department of Dermatology and Sexually Transmitted Diseases, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi,
  India
2 Pathology Consultancy Services, Uttar Pradesh, India



Key words: Human papilloma virus 58, Human papilloma virus 59, high-risk, genital-mucosal, angiokeratoma
Citation: Khullar G, Chandra M, Agarwal D, Bhargava A. High-risk genital-mucosal human papilloma virus types 58 and 59 associated
with solitary angiokeratoma on the elbow. Dermatol Pract Concept. 2023;13(1):e2023005. DOI: https://doi.org/10.5826/dpc.1301a5
Accepted: April 25, 2022; Published: January 2023
Copyright: ©2023 Khullar et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Geeti Khullar, Department of Dermatology and Sexually Transmitted Diseases, Vardhman Mahavir Medical
College and Safdarjung Hospital, New Delhi-110029, India. Phone- +91-9592818474 E-mail: geetikhullar@yahoo.com




To the Editor,                                                           hypergranulosis, acanthosis and papillomatosis. Numerous
                                                                         keratinocytes with raisinoid nuclei and perinuclear halo,
Human papilloma viruses (HPVs) are associated with a wide                characteristic of koilocytes were seen in stratum spinosum.
spectrum of cutaneous and mucosal infections and neo-                    Multiple thin-walled dilated vascular channels filled with
plasms. Though angiokeratoma can clinically mimic warts,                 erythrocytes were noted in papillary dermis (Figures 1C, 1D).
koilocytes and presence of high-risk HPV DNA have not                    HPV genotyping was performed with extracted DNA from
been reported in angiokeratoma. We describe a case of ex-                biopsy tissue using Applied Biosystem 7500 Fast Dx real-time
tragenital solitary angiokeratoma associated with high-risk              polymerase chain reaction (PCR) instrument. Target DNA
types of HPV in a child.                                                 was amplified for identifying either high-risk HPV (HPV types
    A 10-year-old girl presented with two-year history of an             16/ 18/ 31/ 33/ 35/ 39/ 45/ 51/ 52/ 56/ 58/ 59/ 66 and 68) or
asymptomatic bluish-black plaque on the left elbow. There                low-risk HPV genotypes (HPV 6/11) respectively. Test results
was no history of preceding trauma, bleeding from the lesion             identified HPV high-risk genotypes in the sample. TRUPCR
or immunosuppression. Cutaneous examination revealed                     high risk genotyping kit designed to qualitatively detect DNA
a well-circumscribed dark blue to black colored verrucous                of high-risk HPV of 14 genotypes by amplifying E6/ E7 re-
plaque of size 2.5 x 1.5 cm on the left elbow (Figure 1A).               gion by primers and probes specific for the particular geno-
Dermatoscopic examination showed dark blue, violaceous                   type by Real time PCR confirmed the presence of HPV-58 and
and black colored round to ovoid lacunae with bluish-white               HPV-59 genotypes (Cycle Threshold values 30.32 and 25.94
veil (Figure 1B). Excisional biopsy revealed hyperkeratosis,             ­respectively), with a cut off value of 36 (Figures 2 A and B).



Letter to Editor | Dermatol Pract Concept. 2023;13(1):e2023005                                                                         1
           Figure 1. (A) Well-circumscribed bluish-black verrucous plaque of size 2.5 x1.5 cm. (B) Dermoscopic examination revealed dark
           blue, violaceous and black round to ovoid lacunae with bluish-white veil (DermLite 4, original magnification x10). (C) There is
           marked h ­ yperkeratosis, hypergranulosis, acanthosis and papillomatosis. Papillary dermis shows thin-walled dilated vascular channels
           impinging onto the overlying epidermis (H&E, x100). (D) Stratum spinosum showing koilocytes characterized by raisinoid nuclei and
           ­perinuclear halo (H&E, x200).


            1.000e+007

   A                                                                                                                                       Internal Control
            1.000e+006                                                                                                                         HPV 58

                                                                                                                                                HPV 59
            1.000e+005



            1.000e+004
Delta Rn




            1.000e+003



            1.000e+002



            1.000e+001



            1.000e+000
                         1   2   3   4 5   6   7 8   9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 34 36 37 38 39 40

                                                                        Cycle Number


Figure 2. (A) Real-time polymerase chain reaction amplification plot showing curves of 14 high risk genotypes, with HPV-58 and HPV-59
DNA amplification curves above the cycle threshold value. (B) Cycle threshold (Ct) values for 14 high risk genotypes (cut-off value = 36)
obtained by performing real-time polymerase chain reaction of DNA isolated from skin biopsy sample



            The role of HPV in the pathogenesis of non-melanoma                                                                                               High-risk genital-mucosal HPV 58 and HPV 59 are risk
skin cancers was initially described in epidermodysplasia                                                                                                     factors for cervical carcinoma and uncommonly detected
verruciformis and transplant recipients. High-risk types,                                                                                                     in cutaneous lesions [2-4]. HPV 58 has been identified in
mainly HPV 16, are strongly linked with anogenital car-                                                                                                       cutaneous premalignant and malignant lesions includ-
cinomas and among cutaneous lesions, implicated in                                                                                                            ing, Bowen disease on the fingers and elbow, SCC and
Bowen’s disease and squamous cell carcinoma (SCC) [1].                                                                                                        ­keratoacanthoma [2,3]. HPV 59 genome is most closely



2                                                                                                                                                                 Letter to Editor | Dermatol Pract Concept. 2023;13(1):e2023005
related to HPV 18, and has been reported in Bowen dis-           References
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Letter to Editor | Dermatol Pract Concept. 2023;13(1):e2023005                                                                      3
