title: Eccrine Syringofibroadenoma in Association With Acquired Epidermodysplasia Verruciformis.
abstract: A 75-year-old man with human immunodeficiency virus infection and numerous biopsy-proven warts for 10 years, refractory to cryosurgery, cimetidine, and topical imiquimod, presented with numerous pink to hypopigmented verrucous papules and plaques involving the face, trunk, buttocks, and groin. Laboratory evaluation revealed a CD4 T-cell count of 62 cells per microliter and human immunodeficiency virus viral load of <117 copies per milliliter. Biopsy of a plaque groin lesion was performed. Histopathology revealed vertically oriented anastomosing strands of basaloid epithelium arising from multiple points along the epidermis in a background fibrovascular stroma. Ductal differentiation was identified. Areas of epidermis showed compact orthokeratosis, coarse hypergranulosis, and keratinocytes with abundant steel-blue-gray cytoplasm, indicative of viral cytopathic changes. Cytologic atypia was not identified. Human papillomavirus (HPV) genotyping of this lesion was positive for types 5 and 14. Overall, the findings were consistent with epidermodysplasia verruciformis in association with eccrine syringofibroadenoma (ESFA). The patient was subsequently treated with acitretin and showed clinical improvement. ESFA is an uncommon benign adnexal tumor with unknown pathogenesis. Although its association with HPV has rarely been reported, ESFA in the setting of acquired epidermodysplasia verruciformis has not been described. The development of ESFA in this case may be the result of HPV-induced cellular transformation.
authors.affiliation: Departments of *Pathology, and †Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL; ‡Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL; §Division of Dermatology, Department of Medicine, NorthShore University HealthSystem Vernon Hills, IL; and ¶Dermatology and Aesthetics of Wicker Park, Chicago, IL.
authors.forename: Timothy
authors.initials: T
authors.lastname: Tan
authors.forename: Joan
authors.initials: J
authors.lastname: Guitart
authors.forename: Luzheng Lisa
authors.initials: LL
authors.lastname: Liu
authors.forename: Joaquin C
authors.initials: JC
authors.lastname: Brieva
authors.forename: Sapna
authors.initials: S
authors.lastname: Amin
authors.forename: Monica
authors.initials: M
authors.lastname: Rani
authors.forename: Pedram
authors.initials: P
authors.lastname: Gerami
authors.forename: Pedram
authors.initials: P
authors.lastname: Yazdan
mesh_terms: D000368:Aged; D002472:Cell Transformation, Viral; D004819:Epidermodysplasia Verruciformis / Q000150:complications* / Q000473:pathology / Q000821:virology; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D030361:Papillomavirus Infections / Q000150:complications*; D057091:Poroma / Q000150:complications* / Q000473:pathology / Q000821:virology; D013544:Sweat Gland Neoplasms / Q000150:complications* / Q000473:pathology / Q000821:virology