PMC3756806_01
Patient with multiple fine erythematous folliculocentric papules with central, fine, white, keratotic spiny projection over the central face, ears, and extremities.
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F1
ALL by bone marrow biopsy. At that time dermatology was consulted to biopsy "atypical eczema." On examination, there were multiple fine erythematous papules on the central face, ears, and extremities (Fig. 1).
Dilated anagen follicle with central keratotic and parakeratotic debris (hematoxylin and eosin, X40).
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F2
Histopathologically, distorted and dilated anagen hair follicles were filled with an expansion of enlarged, disorganized inner root sheath cells with cytoplasmic distensions by both enlarged trichohyaline granules and gray-blue cytoplasmic material (Figs. 2, 3).
Disorganized inner root sheath cells with cytoplasmic distensions by both enlarged trichohyaline granules and gray-blue cytoplasmic material and central accumulation of parakeratotic debris (hematoxylin and eosin, X600).
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F3
Histopathologically, distorted and dilated anagen hair follicles were filled with an expansion of enlarged, disorganized inner root sheath cells with cytoplasmic distensions by both enlarged trichohyaline granules and gray-blue cytoplasmic material (Figs. 2, 3).
Superficial follicular projecting white spiny keratotic spicule with central refractile thin fragmented hair shaft-like material (hematoxylin and eosin, X600).
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F4
Curiously, some thin dystrophic refractile hair shaft-like material was present in the follicular infundibular region and within the spiny hyperkeratotic spicule that projected from the biopsied hair follicle (Fig. 4). Moreover, MCPyV sequences were amplified from a MCPyV-positive Merkel cell carcinoma when run in parallel (Fig. 6a, lane 4).
Electronmicrograph of viral particle arrays admixed in central extracellular follicular keratotic material (X20,000, direct). Inset: viral particle arrays with icosahedral virus pattern and 42 nm average diameter (X100,000, direct).
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F5
EM demonstrated the presence of viral particle arrays distributed in the deep follicular lower segment within the central extracellular hair follicle region containing the aggregated parakeratotic and keratotic debris, but curiously virus particles were not identified in the affected hair follicle inner root sheath cells themselves (Fig. 5).
(a) PCR using the primer pairs listed (right) was performed using the input DNA (top) as described in the methods. MCC, Merkel cell carcinoma; dH2O, negative control lane. (b) PCR of TDS (trichodysplasia spinulosa) patient sample using 3 independent primer pairs (right) unique to TSPyV. dH2O, negative control lane.
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F6
Using 3 sets of primers specific for MCPyV, including completion of a highly sensitive nested primer set protocol, we were unable to detect MCPyV viral sequences from either the microscopic slides of affected hair follicles or the remaining paraffin tissue block (Fig. 6a and data not shown). Moreover, MCPyV sequences were amplified from a MCPyV-positive Merkel cell carcinoma when run in parallel (Fig. 6a, lane 4). TSPyV DNA was amplified from both the hair follicles with lesion and the remaining paraffin tissue block using all three published primer pairs (Fig. 6b). The patient samples, but not the dH20 negative control, generated products of the expected size (Table 1).