Journal of Cutaneous Pathology 1978: 5: 88-89 Short Communication

Condyloma Acuminatum of the Nipple

COLINWOOD, M, D.

Department of Pathology, University of Maryland Hospital,Baltimore, Maryland, U,S,A,

A ease report of condyloma acuminatum of the nipple with eleetron microscopic demonstration ofintranuclear Papovavirus-like particles, in a patient with Darier's disease, is presented,

(Reeeived for publication December 20, 1977)

Genital warts result from infection by humanpapilloma virus. They occur on genital andanal squamous mucosa and skin, andoccasionally in the groin or on the buttocks.They are characterized microscopically bypapillomatosis with cytoplasmic vacuo-lization of superficial epithelial cells(Vaughan et al, 1976), Intranuclear virusparticles are less often seen by electronmicroscopy than in verruca vulgaris (Oriel &Almeida 1970), Only two cases of condylomaacuminatum in other sites were found in thefiles of the University of Maryland Hospitalsurgical pathology laboratory, both occur-ring in patients with other underlyingdiseases. One was on the thigh of a 17-year-old girl following renal transplantation. Thesecond is reported here.

Case reportA 20-year-old white male was referred to theUniversity of Maryland Dermatology Out-patient Clinic from a state mental hospitalwith a diagnosis of Darier's disease and ahyperkeratotic lesion that covered the leftnipple. The patient had a papular eruptionover the trunk and extremities. He attendedthe clinic with his sister who was also notedto have fine follicular keratotic lesions.

The nipple lesion of the male patientwas a papillary tumor 2,5 x 2,5 x 1,2 cm,It was excised with an additional 2,0 cm,length of skin at each end. Microscopicexamination showed normal male breastducts underlying a condyloma acuminatum,with marked vacuolization of superficial

epidermal ceUs covering papillary pro- ;jections, hyperkeratosis and parakeratosis. Inaddition, there were numerous foUicular and .non-foUicular papules of Darier's disease inthe skin adjacent to the base of the papil-loma, showing parakeratosis, suprabasalclefts, villi and corps ronds. Although closetogether, changes of condyloma acuminatumand Darier's disease were not both present atthe same point.

The specimen, which had been receivedfresh, was promptly fixed in 4% formalin,phosphate-buffered to pH 7,4, After 4 days,small pieces of remaining papillary tissuewere embedded in epon for electron micro-scopy. Examination of a large number ofnuclei of superficial keratinocytes showedone cell with clumped nuclear chromatin(Fig, 1), Chromatin-free areas of the nucleuscontained numerous scattered, uniformlyround dense bodies, each 45 —50nm,diameter (Fenner & White 1976), Someshowed a peripheral lucent band beneath afine outer membrane, together 7 nm, wide,

FoUowing the biopsy, the patient wastreated with topical 0,1% tretinoin cream(De Bersaques 1975) and 300,000 unitsof vitamin A by mouth 4 times daily. Onemonth later he was much improved withflattening of the papules and mild erythema.Verrucous papules remained on the sternumand left forearm. These were not biopsied.

The intranuclear round particles seen ina keratinocyte of the condyloma acumin-atum are characteristic of human papillomavirus, although lacking the lattice-like

CONDYLOMA ACUMINATUM OF NIPPLE 89

Fig. 1. Papovavirus-hke round dense partieles inchromatin-free areas of nucleus of superficial kera-tinocyte from condyloma acuminatum of nipple.Electron micrograph X 60,000,

arrangement seen when wart virus particles(Laurent et al, 1975) are more numerousand crowded. The case was considered aviral condyloma acuminatum of the nipplewith underlying Darier's disease that,perhaps because of its often exudativenature, may have contributed to the unusuallocation of the lesion.

Laurent, R,, Agache, P, & Coume-Marquet, J,(1975) Ultrastrueture of clear ceUs in humanviral warts. Journal of Cutaneous Pathology 2,140-148,

Oriel, J, D, & Almeida, M, D, (1970) Demon-stration of virus particles in human genitalwarts, British Journal of Venereal Diseases 46,37-42,

Vaughan, J, T,, Montes, L, F,, Bembibre, A, &Blaquier, P, C, P, (1976) Condylomata acu-minata. Journal of Cutaneous Pathology 3,244-245

References Address:Colin Wood, M. D.,

De Bersaques, J, (1975) Vitamin A acid treatment Department of Pathology, Room B~1265of warts, Acta Dermatovenereologiea Suppl,74, 169-170,

Fenner, F, & White, D, O, (1976) Medical Virology420-423, Academic Press, New York,

University of Maryland Hospital22 South Greene StreetBaltimore, Maryland, 21201U.S.A.