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Case of the month #4

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Case presentation:

8 year old HIV positive boy with a CD4 of 475, who is not yet on HAART, present with significant perianal verrucous lesions for several years. He had a single treatment with podophyllin, approximately 8 months ago, without definitive improvement. His caregiver now feels they may be changing.

Histology:

Histologic sections show acanthosis of the epidermis with clear cell alteration of the keratinocytes and areas of maturation disorder with keratinocytic atypia. The histologic differential diagnosis includes Bowen’s disease (squamous cell carcinoma in situ) or bowenoid papulosis. Given the plaque present clinically, these findings are consistent with squamous cell carcinoma in situ.

Fig. 1a


Fig. 2a	Fig. 2b

This case has been presented by Carrie Kovarik