Histological distribution of polymerase chain reaction--amplified human papillomavirus 6 and 11 DNA in penile lesions.

The purpose of this study was to ascertain the histological pattern of distribution of human papillomavirus (HPV) 6 and 11 DNA in penile lesions by in situ hybridization after amplification by the polymerase chain reaction (PCR). HPV DNA was routinely detected by in situ hybridization with or without PCR amplification in granular layer cells that showed perinuclear halos and nuclear atypia. Cells that lack these histological features rarely exhibited HPV DNA with conventional in situ hybridization. However, after PCR amplification, in situ analysis showed that many of the cells that lacked halos and atypia contained HPV DNA. The hybridization signal often localized to crevices in the epithelium where there was relative hyperkeratosis and a thickened granular layer. HPV DNA was not noted in the basal cells and was rarely identified in other parts of the lesion. It is concluded that penile tissues may contain HPV DNA when lacking the diagnostic features of a condyloma/low-grade intraepithelial lesions and that such tissues usually demonstrate specific histological changes characterized by a focally thickened granular layer often associated with epithelial crevices.

Human papillomavirus segregation patterns in genital and nongenital warts in prepubertal children and adults.

This study compared the segregation patterns of human papillomavirus (HPV) in genital and nongenital warts in prepubertal children and adults. HPV 2 was detected in most nongenital warts in children and adults, whereas neither HPV 6 or 11 was detected at nongenital sites in either group with the use of in situ or Southern blot hybridization analyses. Of nine genital tract lesions in children. HPV 2 was detected in two and HPV 6 or 11 in six. More than 90% of cases of regional tract condylomata in adults contained HPV 6 or 11. HPV 2 was not detected in any of 99 genital tract lesions in adults. It is concluded that HPV 6/11 cannot proliferate at nongenital cutaneous sites and HPV 2 can proliferate in the genital tract of children but not adults. Thus, the detection of HPV 6 or 11 in a genital wart in a child implies, assuming cutaneous transmission, infection from a genital site, whereas the detection of HPV 2 presumes nongenital transmission.

Detection of human papillomavirus DNA in penile lesions histologically negative for condylomata. Analysis by in situ hybridization and the polymerase chain reaction.

The purpose of this study was to analyze penile lesions that lacked the histological features of condylomata for human papillomavirus (HPV) DNA. Most of these lesions were detected in men whose partners had an HPV-related lesion. Sequences homologous to HPV DNA were detected in 12 of 84 (14%) lesions using in situ hybridization analysis; nine of these lesions contained HPV 6 or 11. HPV DNA was found in 25 of 26 (96%) penile condylomata, all but two of which contained HPV 6 or 11. Using the highly sensitive polymerase chain reaction (PCR), we also detected HPV DNA in four of 20 (20%) of the penile lesions that lacked the histological features of condylomata negative for HPV by in situ analysis. Most of the lesions that were identifiable only after the application of an acetic acid solution were HPV negative when tested with either technique. We conclude that HPV DNA can be found in penile biopsy specimens that do not demonstrate the unequivocal histological features of condylomata but that the detection rate is much lower than for condylomata even when analyzing tissues in men at high risk for HPV-related lesions by PCR. This study underscores the need for caution when interpreting such tissues and the usefulness of in situ analysis for detecting assumed viral proliferation in noncondylomatous lesions.

Epidermal and follicular calciphylaxis.

A patient with secondary hyperparathyroidism due to chronic renal failure developed epidermal and follicular calcification without concomitant dermal calcification in the lesions of toxic epidermal necrolysis. We propose that the combination of keratinocyte necrosis and an elevated serum calcium-phosphorus product resulted in epidermal calciphylaxis.

Colposcopic evaluation of men with genital warts.

Colposcopy, which is the examination of the female genital tract that generally is performed after the application of acetic acid, has been an effective tool in the diagnosis of genital warts (condyloma acuminatum) in women for years. With the help of colposcopy, both microscopic and flat warts that cannot be visualized with traditional, noncolposcopic methods can be seen and, hence, treated. Recently, studies reported in the gynecologic and urologic literature have evaluated the usefulness of colposcopy in male patients. We present a patient whose genital warts were recalcitrant to treatment. When examined with colposcopy he was noted to have multiple additional areas of involvement. In view of the neoplastic potential of the human papillomavirus, the ease with which it is transmitted sexually, and the difficulty in discerning certain kinds of warts without colposcopy, we believe colposcopic examination should be routine in all men with genital warts and in those whose sexual partners have tested positive for human papillomavirus.

Seborrheic-like dermatitis of acquired immunodeficiency syndrome. A clinicopathologic study.

We studied twenty-five skin biopsies from twenty-one patients with acquired immunodeficiency syndrome or its prodrome who presented with the "seborrheic dermatitis" associated with acquired immunodeficiency syndrome and compared them with an equal number of biopsies from patients with seborrheic dermatitis who had neither acquired immunodeficiency syndrome nor its risk factors. We found that although the eruption in acquired immunodeficiency syndrome closely resembles seborrheic dermatitis, histologically it is distinctive because it shows spotty keratinocytic necrosis, leukoexocytosis, and a superficial perivascular infiltrate of plasma cells and, frequently, neutrophils that show occasional leukocytoclasis. In long-standing lesions, hyperkeratosis is often present. None of these histologic features are commonly encountered in seborrheic dermatitis, psoriasis, or other eruptions known to us.