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Ileostomy-Associated Chronic Papillomatous Dermatitis Showing Nevus Sebaceous–Like Hyperplasia, HPV 16 Infection, and Lymphedema: A Case Report and Literature Review of Ostomy-Associated Reactive Epidermal Hyperplasias

Raghu, Preethi BS*; Tran, Tien Anh MD; Rady, Peter MD, PhD; Tyring, Stephen MD; Carlson, J. Andrew MD, FRCPC*

The American Journal of Dermatopathology: October 2012 - Volume 34 - Issue 7 - p e97–e102
doi: 10.1097/DAD.0b013e3182562526
Extraordinary Case Report

Abstract: Chronic papillomatous dermatitis (CPD) is a stoma site complication due to chronic irritant contact dermatitis. Papillomatosis can also arise in the setting of Human Papillomavirus (HPV) infection or chronic lymphedema (elephantiasis). Herein, we report the case of a 57-year-old female who presented with a papillomatous growth surrounding a loop ileostomy suspected to be recurrent ovarian serous carcinoma. Excisional biopsy demonstrated nevus sebaceous (NS)–like organoid hyperplasia with koilocytes overlying a dermal scar that exhibited lymphangiectases. Polymerase chain reaction and sequencing for HPV DNA detected HPV 16. In situ hybridization for high-risk HPV DNA showed punctate nuclear pattern in the keratinocytes populating the NS-like hyperplasia indicating integrated HPV 16 DNA. No recurrence has been observed 11 months postexcision. Reports of CPD have documented a spectrum of reactive epidermal hyperplasias including pseudoepitheliomatous, verrucous, papillomatous, syringofibroadenomatous, and rudimentary follicular hyperplasias. HPV DNA has been detected in 3 of 4 CDP cases tested to date and in authentic NS. We postulate that localized lymphedema secondary to scarring coupled with chronic epidermal irritation and inflammation allowed for latent HPV infection to manifest as CPD with NS-like cutaneous hyperplasia.

*Divisions of Dermatology and Dermatopathology, Albany Medical College, Albany, NY

Department of Pathology, Florida Orlando Hospital, Orlando, FL

Departments of Dermatology, Microbiology/Medical Genetics, and Internal Medicine, University of Texas Health Science Center, Fannin, Houston, TX.

Reprints: J. Andrew Carlson, MD, FRCPC, Division of Dermatopathology and Dermatology, Albany Medical College MC-81, 47 New Scotland Ave, Albany, NY 12208 (e-mail: carlsoa@mail.amc.edu).

The authors have no funding or conflicts of interest to declare.

© 2012 Lippincott Williams & Wilkins, Inc.