Case 25

Male 61. Left thumb ?pyogenic granuloma ?SCC

?melanoma. The best diagnosis is:

A. Neutrophilic dermatosis of the dorsal hands

B. Pyogenic granuloma

C.Lymphomatoid papulosis

D.Herpes

E. Orf

Case 25: M 61. Left thumb ?pyogenic granuloma, SCC,melanoma

Cas 25: M 61. Left thumb ?pyogenic granuloma, SCC,melanoma

Case 25: M 61. Left thumb ?pyogenic granuloma, SCC,melanoma

SUSPECTED DIAGNOSIS: PARAPOX VIRUS INFECTION (ORF)

• Further history from dermatologist:

• Patient lives on a farm

• Cut his hand 3 weeks before

• Lesion resolved within two months

• Diagnosis: parapox virus infection (orf)

Human orf and milkers' nodule: a clinicopathologic study. J Am Acad Dermatol. 1991 Oct;25(4):706-11. Groves RW, Wilson-Jones E, MacDonald DM • Males usually

• 12 to 65 years

• history of contact with farm animals

• hands or arms

• 1 to 3 cm • Mean 3 weeks after presumed exposure

Human orf and milkers' nodule: a clinicopathologic study. J Am Acad Dermatol. 1991 Oct;25(4):706-11. Groves RW, Wilson-Jones E, MacDonald DM

• epidermis endophytic strandlike proliferations

• dermal papillae distended by intense edema

• massive capillary proliferation & dilation

• epidermal viral cytopathic changes: inclusion bodies, clumping of keratohyaline granules

Human orf and milkers' nodule: a clinicopathologic study. J Am Acad Dermatol. 1991 Oct;25(4):706-11. Groves RW, Wilson-Jones E, MacDonald DM • cytoplasmic vacuolation with distinctive

"spongiform" appearance within follicular structures • dense inflammatory infiltrate

Case 25 Differential diagnosis?:

Neutrophilic dermatosis of the dorsal hands

Localised site specific form of Sweet’s

syndrome/neutrophilic dermatosis

Can be clinically but not histologically similar

Case 25 Differential diagnosis?:

Pyogenic granuloma (lobular capillary haemangioma)

Often also ulcerated, but typical lobular capillary proliferation

Lymphomatoid papulosis –

histology can be very similar in small biopsy

Case 25: Parapox virus infection (orf)

CD30+ lymphoma simulating orf. González LC, Murua MA, Pérez RG, Río IG, Urra IT, Michelena IA, Oyón NS, Arechavala RS Int J Dermatol. 2010 Jun;49(6):690-2.

Case 25: Parapox virus infection (orf)

CD30+

Case 25 Differential diagnosis?: Herpes pseudolymphoma

Case 25: Parapox virus infection (orf) Herpes pseudolymphoma

Viral infections with reactive CD30 positive lymphoid cells

• Measles

• Hepatitis B & C

• HTLV-1

• HIV

• EBV

• Herpes

• Parapox virus

(orf, milker’s nodule)

• etc. etc.

Infection with parapoxvirus induces CD30-positive cutaneous infiltrates in humans. Rose C, Starostik P, Bröcker EB. J Cutan Pathol. 1999 Nov;26(10):520-2.

Investigation of molluscum contagiosum virus, orf and other parapoxviruses in lymphomatoid papulosis. Fernandez KH, Bream M, Ali MA, Krogmann T, Zhao H, Li Y, Cohen JI, Damon I, Liu V. J Am Acad Dermatol. 2013 Jun;68(6):1046-7

• No evidence of parapox virus in cases of lymphomatoid papulosis

Case 25

Male 61. Left thumb ?pyogenic granuloma ?SCC

?melanoma. The best diagnosis is:

A. Neutrophilic dermatosis of the dorsal hands

B. Pyogenic granuloma

C.Lymphomatoid papulosis

D.Herpes

E. Orf