Ileostomy-Associated Chronic Papillomatous Dermatitis Showing Nevus Sebaceous–Like Hyperplasia, HPV 16 Infection, and Lymphedema

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.

Localized Chronic Fibrosing Vasculitis in a Tattoo

“…HPV 16 has been identified in the verrucoid hyperplasia of peristomal chronic papillomatous dermatitis and nevus sebaceus. 24 There was no HPV DNA by polymerase chain reaction in our case, militating against viral pathogenesis.…”

Chronic Papillomatous Dermatitis in a Patient with a Urinary Ileal Diversion: A Case Report and Review of the Literature

“…Specifically, it has been attributed to the alkaline pH of urine mechanical irritation and epidermodysplasia verruciformis Human Papilloma Virus (HPV) types [2]. 9.5% of stoma patients reportedly develop CPD after the stoma has been present for an average of 6.5 years [3].…”

Cutaneous acantholytic dyskeratotic acanthoma accompanying syringofibroadenomatous hyperplasia with proliferation of mature sebocytes: A case report

“…Chronic papillomatous dermatitis (CPD), characterized by pseudo verrucous, pseudo‐epitheliomatous, or acanthomatous epidermal hyperplasia, is a complication of the stoma site caused by chronic irritant contact dermatitis. Raghu et al 23 reviewed 58 cases of CPD and reported ESFA or syringofibromatous epidermal changes in four cases. They also reported CPD associated with proliferation of the sebaceous glands, mimicking nevus sebaceous, in their own case 23 .…”

“…Raghu et al 23 reviewed 58 cases of CPD and reported ESFA or syringofibromatous epidermal changes in four cases. They also reported CPD associated with proliferation of the sebaceous glands, mimicking nevus sebaceous, in their own case 23 . The presence of CPD indicated that almost all patients had evidence of some degree of edema, fibrosis, and lymphostasis.…”