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Human papillomavirus-negative ileostomal chronic papillomatous dermatitis

Authors


Marcelo G. Horenstein MD, Director of Dermatopathology, University of South Alabama Medical Center, 2451 Fillingim St., Mobile, AL 36617, USA
Tel: 251-471-7799
Fax: 251-471-7884
E-mail: horenstein@pol.net

Abstract

Background:  Papillomatous stoma-related skin lesions may result from irritant reactions or infection with epidermodysplasia verruciformis human papillomavirus (HPV) types.

Methods:   We report upon a papillomatous lesion at the ileostoma of a 63-year-old male with familial adenomatous polyposis and colorectal adenocarcinoma. We thoroughly tested the lesion for HPV using immunohistochemistry, transmission electron microscopy, and polymerase chain reaction analyses.

Results:   The lesion was a fleshy, multilobulated, and verrucous plaque, with hyperkeratosis, hypergranulosis, acanthosis and marked papillomatosis. The clinical and light microscopic features were suggestive of a condyloma. However, no HPV was detected.

Conclusions:  We suggest that the lesion most likely represents chronic papillomatous dermatitis, a reaction to mechanical and/or chemical irritation usually associated with urostomies and only rarely observed with ileostomies. This case highlights the clinical, diagnostic and therapeutic aspects of an unusual cutaneous morbidity associated with ileostomies.

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