PMC6329021_01
Bilateral breast nipple warts and giant vulval warts. (a) Picture of the right breast and nipple showing the condylomata accuminata lesion involving the entire nipple as well as hyperpigmentation of the areola suggestive of HPV infection and skin fungal infection. (b) A picture of the left breast and nipple showing the condylomata accuminata lesion involving the entire nipple as well as hyperpigmentation of the areola suggestive of HPV infection and skin fungal infection. (c) Vulval condyloma acuminatum involving labia major and minor and extends to the posterior commissure.
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The warts covered the entire nipple with no extension to the areola (Figure 1(a)-(c)).
Picture of breast nipples and vulva at post-surgery follow-up. (a and b) The right and left breasts and nipples with spontaneous resolution of the lesions without surgical resection, destructive procedure or medical treatment of the warts. (c) Vulval area after vulvectomy and primary repair.
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To date there is no evidence of disease recurrence (Figure 2). The vulvectomy and both nipple biopsies underwent in-situ hybridization studies, which revealed positive staining for the low-risk VENTANA INFORM  HPV family 6 probe (Figures 2(d), 3(d) and 4(d)).
Photomicrogram of the vulva lesion. (a) A low-power photomicrograph of vulval condyloma acuminatum showing papillomatous, acanthotic squamous epithelium. (H&E 2 mum, original magnification: 20x.) (b) Intermediate power magnification showing koilocytes with perinuclear halos at the arrows. (H&E 2 mum, original magnification: 100x.) (c) High-power magnification showing koilocytes with perinuclear halos at the arrows. (H&E 2 mum, original magnification: 400x.) (d) Positive blue staining of low-risk HPV family 6 in-situ hybridization. (4 mum section original magnification: 100x.).
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Microscopic examination of sections from the vulvectomy specimen showed papillomatosis and acanthosis of the surface squamous epithelium (Figure 3(a)). The infected epithelial cells showed features of koilocytosis in which there was nuclear hyperchromasia, irregularities of nuclear membranes and the development of perinuclear halos (Figure 3(b) and (c)). The vulvectomy and both nipple biopsies underwent in-situ hybridization studies, which revealed positive staining for the low-risk VENTANA INFORM  HPV family 6 probe (Figures 2(d), 3(d) and 4(d)).
Photomicrogram of the left nipple. (a) A low-power photomicrograph of condyloma acuminatum of the left nipple showing papillomatous, acanthotic squamous epithelium. (H&E 2 mum, original magnification: 20x.) (b) Intermediate power magnification showing koilocytes with perinuclear halos at the arrows. (H&E 2 mum, original magnification: 100x). (c) High-power magnification showing koilocytes with perinuclear halos at the arrows. (H&E 2 mum, original magnification: 400x). (d) Positive blue staining of low-risk HPV family 6 in-situ hybridization. (4 mum section original magnification: 100x.)
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Histological sections from both the left and right nipples (Figures 4 and 5) showed prominent papillomatosis, acanthosis and parakeratosis of the epidermis, together with koilocytosis, consistent with condyloma acuminatum.
Photomicrogram of the right nipple. (a) A low-power photomicrograph of condyloma acuminatum of the right nipple showing papillomatous, acanthotic squamous epithelium. (H&E 2 mum, original magnification: 200x.) (b) Intermediate power magnification showing koilocytes with perinuclear halos at the arrows. (H&E 2 mum, original magnification: 100x.) (c) High-power magnification showing koilocytes with perinuclear halos at the arrows. (H&E 2 mum, original magnification: 400x.) (d) Positive blue staining of low-risk HPV family 6 in-situ hybridization. (4 mum section original magnification: 100x.)
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Histological sections from both the left and right nipples (Figures 4 and 5) showed prominent papillomatosis, acanthosis and parakeratosis of the epidermis, together with koilocytosis, consistent with condyloma acuminatum.