PMC3764972_01
a Large pseudotumoral neoangiogenic lesion of the left perioral area. b Magnification of the pseudotumoral neoangiogenic process. c Complete crusting after 2 weeks of antiviral therapy. d Residual erythematous post-inflammatory pigmentation at 4 weeks.
cde-0005-0236-g01.jpg
PMC3764972_01_cde-0005-0236-g01.jpg
F1
Clinical examination revealed a large, unilateral, annular, ulcerated, painful, indurated and easily bleeding lesion on her left cheek (fig. 1a, b). Following the discovery of the HSV-I antigens in the PG, oral treatment with valaciclovir (1,000 mg, thrice daily for 15 days) was initiated, and the lesion promptly resolved after 15 days (fig. 1c). After 1 month, a slightly erythematous postinflammatory pigmentation persisted (fig. 1d).
a Histology evidencing PG (HE. x10). The black arrow indicates epithelial cell islands in the PG. b, c High-power magnification illustrates some keratinocytes exhibiting CPE. d HSV-I-specific immunostaining (red signal) in giant epithelial cells (black arrows), some exhibiting cytopathic signs (x20).
cde-0005-0236-g02.jpg
PMC3764972_01_cde-0005-0236-g02.jpg
F2
The conjunctive stroma was severely edematous (fig. 2a). These epithelial cells sometimes showed signs of cytopathic effects (CPE), including intranuclear inclusions and giant syncytial cell formation, suggesting an alpha-herpesviridae infection (fig. 2b, c). A strong nuclear and cytoplasmic signal for HSV-I was evidenced in some epithelial cells (fig. 2d), whereas the HSV-II and varicella zoster virus stainings remained negative. Some of the HSV-I-positive cells presented CPE, whereas others did not (fig. 2d).
a Ulex europaeus lectin immunohistochemical expression in HSV-I-infected epithelial cells (=>) as well as in endothelial cells (->) (red signal, x20). b VEGF immunohistochemical expression in HSV-I-infected epithelial membranes (red signal, x40). c EGFR immunohistochemical expression in HSV-I-infected epithelial membranes (brown signal, x20). d Ki67 immunohistochemical expression in epithelial and endothelial cells, suggesting proliferation (red nuclear signal, x40).
cde-0005-0236-g03.jpg
PMC3764972_01_cde-0005-0236-g03.jpg
F3
IHC using the Ulex europaeus lectin revealed a strong signal on the cell membranes of the HSV-I-infected epithelial cells as well as on the endothelial cells of the PG (fig. 3a, red signal). The vascular endothelial growth factor (VEGF) immunostaining provided a positive signal in the HSV-infected keratinocytes as well as in endothelial cells (fig. 3b, red signal). The epidermal growth factor receptor (EGFR) immunostaining revealed intense membranous expression on HSV-I-infected epithelial cells (fig. 3c, brown signal). The Ki67 marker revealed a strong signal in the nuclei of some epithelial and endothelial cells (fig. 3d, red signal).