Multiple Human Papilloma Virus 16 Infection Presenting as Various Skin Lesions

The 53-year-old woman admitted with multiple persistent, progressive, slightly raised, red, and crusted plague form masses that suddenly occurred on left thumb, both upper and lower extremity about 10 years ago. There was no induration in the lesion or in its surrounding skin. There was no unusual opinion on a radiologic test and family history. And she had no history of working in the business related to any chemical product such as arsenic or tar which was carcinogen. The patient has had total hysterectomy to treat uterine myoma 10 years ago. The wide excision and split thickness skin graft of 2 × 1.5 cm was performed around mass in the size of 1.5 × 1.2 cm on the left thumb and wide excision and local advancement flap was done on the other sites. As a result of biopsy, masses were diagnosed as Bowen disease, actinic keratosis, and Seborrheic keratosis. These specimens were obtained during surgery: broom-type cell sampling devices were used to collect samples from the specimens, and they were placed into PreservCyt solution (Cytyc Corp, Boxborough, MA). Then, the collected samples underwent the Roche Linear Array HPV Genotyping Test (Roche Diagnostics, Branchburg, NJ) that allows for the simultaneous identification of human papilloma virus (HPV) types from liquid-based cell preparations. On histopathological examination of the surgical specimen, atypical squamous cells proliferate through the whole thickness of the epidermis. The entire tumor was confined to the epidermis and did not invade into the dermis. The cells were often highly atypical. That were the irregular shape which the resection margin of masses had a negative tumor component. And HPV 16 genotyping test was positive although vaginal examination of HPV 16 genotyping was negative.