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Difference between revisions of "Verruca vulgaris"
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Verruca_vulgaris_-_very_low_mag.jpg | |||
| Width = | |||
| Caption = Verruca vulgaris. [[H&E stain]]. | |||
| Micro = | |||
| Subtypes = | |||
| LMDDx = [[Squamous cell carcinoma of the skin|Squamous cell carcinoma]], hypertrophic [[actinic keratosis]], | |||
actinic keratosis with superimposed [[lichen simplex chronicus]], [[seborrheic keratosis]], [[condyloma acuminatum]] | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Site = [[skin]] - classically hands | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = very common | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = benign | |||
| Other = | |||
| ClinDDx = | |||
}} | |||
'''Verruca vulgaris''', also known as '''common wart''', is a common [[non-malignant skin disease]] caused by [[human papilloma virus]]. | |||
==General== | |||
*Etiology - [[HPV]]. | |||
*Very common. | |||
Notes: | |||
*Related to [[condyloma acuminatum]]. | |||
==Gross== | |||
Features: | |||
*[[Papule]] or [[plaque]] with granular surface. | |||
*Classic location: hand. | |||
Images: | |||
*[http://commons.wikimedia.org/wiki/File:Porea_doet_djin_wi.jpg Wart (WC)]. | |||
*[http://commons.wikimedia.org/wiki/File:Wart_ASA_animated.gif Wart - animated (WC)]. | |||
==Microscopic== | |||
Features:<ref>URL: [http://missinglink.ucsf.edu/lm/DermatologyGlossary/verruca_vulgaris.html http://missinglink.ucsf.edu/lm/DermatologyGlossary/verruca_vulgaris.html]. Accessed on: 14 July 2010.</ref> | |||
*Hyperkeratosis (more keratin - thick stratum corneum) - in "columns"; keratin in separate towers - ''not'' a flat thick sheet. | |||
*Hypergranulosis (thicker stratum granulosum). | |||
*''Papillomatous hyperplasia'': | |||
**Rete ridge lengthening (~7-10x normal) and thickening. | |||
**Rete ridge curvature toward the centre of the lesion (like the roads to the ''Palace of Versailles'') - '''important'''. | |||
*Large blood vessels at the dermal-epidermal junction - between the rete ridges. | |||
*+/-Viral changes - perinuclear halo, nucleus small and hyperchromatic<ref name=Ref_Derm106-7>{{Ref Derm|106-7}}</ref> - virtually '''diagnostic''' when present. | |||
**+/-Binucleation. | |||
Memory device: there is more of everything - more s. corneum, s. granulosum, s. spinosum, longer rete ridges, more (larger) blood vessels. | |||
DDx: | |||
*[[Squamous cell carcinoma of the skin|Squamous cell carcinoma]] - nuclear atypia full thickness and often more pronounced. | |||
*Hypertrophic [[actinic keratosis]] - often accompanied by solar elastosis. | |||
**Actinic keratosis with superimposed [[lichen simplex chronicus]].<ref name=Ref_Derm353>{{Ref Derm|353}}</ref> | |||
*[[Seborrheic keratosis]] - may have focal clear cell changes. | |||
*[[Condyloma acuminatum]] - genital region. | |||
===Images=== | |||
<gallery> | |||
Image:Verruca_vulgaris_-_very_low_mag.jpg | Verruca vulgaris - very low mag. (WC) | |||
Image:Verruca_vulgaris_-_intermed_mag.jpg | Verruca vulgaris - intermed mag. (WC) | |||
</gallery> | |||
www: | |||
*[http://alf3.urz.unibas.ch/pathopic/getpic-fra.cfm?id=4528 Verruca vulgaris (unibas.ch)]. | |||
==Sign out== | |||
<pre> | |||
SKIN LESION, RIGHT LOWER LEG, SHAVE BIOPSY: | |||
- VERRUCA VULGARIS. | |||
</pre> | |||
===Micro=== | |||
The sections show skin with elongated rete ridges, acanthosis, hypergranulosis, hyperkeratosis in vertical columns, focal parakeratosis, dilated blood vessels at the dermal-epidermal junction and koilocytic change. Mild basilar nuclear atypia is present. | |||
====Without koilocytes==== | |||
The sections show skin with elongated rete ridges that curve toward the centre of the lesion, acanthosis, hypergranulosis, hyperkeratosis in vertical columns, and dilated blood vessels at the dermal-epidermal | |||
junction. Minimal basilar nuclear enlargement is present. No definite koilocytic change is | |||
apparent. | |||
No parakeratosis is identified. Mild solar elastosis is identified. No melanocytic nests | |||
are apparent. Mitotic activity is not apparent. | |||
==See also== | |||
*[[Non-malignant skin disease]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Non-malignant skin disease]] | |||