文献简介

出版社:Journal of Cutaneous Pathology

作  者:Song Lu, MD, PhD, Angela Rohwedder, PhD

编  号:10.1111/j.1600-0560.2011.01691.x

关键字:chronic inflammation, human papillomavirus, lymphedema, scar, verrucous xanthoma

年  份:2011   点击量:427

文献摘要

With great interest we read the article by Cumberland et al.1 describing multiple, co-existing anogenital verruciform xanthoma arising in the setting of trauma and skin grafting. The authors speculated that severe cutaneous trauma and chronic inflammation might have induced epidermal keratinocytes to respond aberrantly, eventuating with epidermal hyperplasia and foam cell accumulation within dermal papillae, as is characteristic of verruciform xanthoma. While these factors may play a role in verruciform xanthoma formation, we believe they are not primary events. Ostensibly, the authors reviewed the literature focusing on the pathogenesis of verruciform xanthoma. However, they omitted work documenting alternative etiologic and pathogenic viewpoints, including a case series2,3 and a critical review of verruciform xanthoma4 in which arguments are presented that lymphedema and secondary human papillomavirus (HPV) infection are essential factors in the etiopathogenesis of the entity. Furthermore, the clinical findings, the described histopathology and the photomicrographs presented in their report exhibit the cardinal features of localized lymphedema or elephantiasis,5 namely a history of trauma, dermal edema, fibrosis, dilated lymphatic vessels, uniformly distributed stromal cells, papillated/verrucous epidermal hyperplasia, an inflammatory infiltrate and hyperkeratosis. Herein, we argue that lymphatic stasis is a requisite pathogenic factor for verruciform xanthoma development. In such a framework, verruciform xanthoma can be considered a complication of lymphedema, i.e. a secondary tumor.