[Question #10829] A follow up on #5301 - unconfirmed HPV case

19 months ago

Hi, I hope you are doing well.

This a follow up on an old case. I followed your advice and finally did a biopsy test.

Here are the results for the main lesion biopsy:

"Sections of skin with acanthosis, hyper-parakeratosis, basal melanosis; in the minimal rim of present dermis, sclerosis, and a granulomatous inflammatory infiltrate with giant cells.

The morphological finding is suggestive of a reactive-inflammatory process; a possible viral nature should also be considered."

Here is a quick medical history:

1- Lesion is located on the center of the back of the penis shaft, exactly on the circumcision scar line.

2- Lesion is surrounded by multiple super tiny hyper-pigmented growths / dots, they spread out horizontally from the center along the circumcision line in a linear fashion tracking circumcision line. They are confined in the 3cm horizontal distance around the main lesion.

3- Area suffered a chemical burn with ACV after I stupidly applied it 5 years ago.

4- Lesions remained unchanged for about 7-8 years. Main one re-grow after biopsy excision.

5- lesions resemble this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4516113/ .. though not sure this supported by above lab findings.

7- Dermatologists opinions ranged from “Oh, it is nothing”, “Probably a nevus”, “Yeah that’s definitely a wart”.

I would love to hear your opinion on this.

Thanks a lot.

Edward W. Hook M.D.

19 months ago

I'm so sorry you continue to worry about genital HPV. Your focus and level of concern is worrying to me, not because of the possibility that your lesion was a wart but because your response is TOTALLY out of proportion to the problem. Your biopsy results in NO WAY suggest HPV infection. Based on the biopsy it is time for you to put your concerns aside and stop worrying/. EWH

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19 months ago

Hi doctor, thanks for getting back to me.

I just got the test results. The Dr that ordered the biopsy is on a long vacation and I figured you are probably more qualified than anyone else to address the results. So yours in the only medical advise I have on these results :)

The mention of "possible viral nature" kind of worried me. I honestly have no idea on how HPV is diagnosed in histopathologic examination and was wondering if more clear and definitive findings would have been present if the lesion was in fact due to an HPV infection.

BTW, I can only imaging the amount of seemingly anxiety-driver questions you must be bombarded with on daily bases. I have a great respect for you and the team for continuing to attend to these questions with attention and good-will regardless.

Edward W. Hook M.D.

19 months ago

Thank you for the vote of confidence. I am not a pathologist, however, mentioning “possible viral nature” is a non-specific generalization. If the pathologist seen lesions concerning for HPV, they would’ve said so..

You can be confident that the lesions that were biopsied were not due to HPV. I hope that this will allow you to address your anxiety and move forward without continuing concern. EWH.

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