The latter refers to well-differentiated SCC with a papillary architecture. Med Oral Patol Oral Cir Bucal. J Oral Pathol Med. Mod Pathol. Endophytes can extensively colonize plant tissues and competitively exclude other potential pathogens. 2020. https://doi.org/10.1111/odi.13363. [50] Turfgrass seed of Festuca and Lolium perenne infected with fungal inoculants, Acremonium coenophialum and A. lolii, is commercially available for use in growing lawns which might require less pesticide use -the grasses are poisonous to cattle and more resistant to some insect damage. Ten of the 14 tumors that remained classified as SCC had detectable TP53 mutations. The constellation of marked hyperkeratosis, spiky papillae, and convergence of elongated rete ridges allows for distinction of VV from condyloma acuminatum. [32] It has been estimated that there could be approximately 1 million endophytic fungi that exist in the world. The incidence of MT in leukoplakia exhibiting HkNR was 4.9%, compared to 15.3% for ED. volume15,pages 572587 (2021)Cite this article. [39] Non-systemic or transient endophytes on the other hand vary in number and diversity within their plant hosts under changing environmental conditions. 2004;40(4):4403. 2008;58(1):1517. Oral Oncol. Connolly M, Narayan S, Oxley J, de Berker DA. Cancer. [13][14] Some fungal and bacterial endophytes have proven to increase plant growth and improve overall plant hardiness. Keratoacanthoma, committed stem cells and neoplastic aberrant infundibulogenesis integral to formulating a conceptual model for an infundibulocystic pathway to squamous cell carcinoma. Collectively, these feature give rise to a softer appearance compared to VV. have been shown to have a broad range of antimicrobial effects,[32] even against methicillin-resistant Staphylococcus aureus. The ragged tumor base is indicative of stromal invasion. SEBASTIAN, SHELDON; Recipient(s) will receive an email with a link to 'Verruciform and Condyloma-like Squamous Proliferations in the Anogenital Region' and will not need an account to access the content. Oral Dis. Gonzlez-Moles M, Ruiz-vila I, Gonzlez-Ruiz L, et al. Clinically, warty and warty-basaloid HSIL and invasive SCC may mimic condyloma acuminatum when discrete papillomatous papules or plaques are present.44, On histopathology, warty HSIL and SCC mimic condyloma acuminatum by their verruciform architecture, conspicuous fibrovascular cores, and koilocytosis (Figure 4, A). Exophytic verrucous hyperplasia of the oral cavityapplication of standardized criteria for diagnosis from a consensus report. 2011 Mar;37(3):395-8. doi: 10.1111/j.1524-4725.2011.01895.x. [21], Additionally, various reports on endophyte interactions have shown increased photosynthetic capacities of host plants as well as improved water relations. Conclusion: Solitary epidermolytic acanthoma: a clinical and histopathological study, Inherited nonsyndromic ichthyoses: an update on pathophysiology, diagnosis and treatment, Histopathologic varieties of epidermal nevus: a study of 160 cases, Linear epidermolytic verrucous epidermal nevus of the male genitalia, Epidermolytic hyperkeratosis associated with melanocytic nevi: a report of 53 cases, Incidental cutaneous reaction patterns: epidermolytic hyperkeratosis, acantholytic dyskeratosis, and hailey-hailey-like acantholysis: a potential marker of premalignant skin change, Case of isolated epidermolytic acanthoma: Genetic and immunohistochemical analysis, Epidermolytic acanthoma of the genitalia does not show mutations in KRT1 or KRT10, Epidermolytic acanthomas: clinical characteristics and immunohistochemical features, Vegas (verruciform genital-associated) xanthoma: a comprehensive literature review, Vulvar verruciform xanthoma: ten cases associated with lichen sclerosus, lichen planus, or other conditions, Verruciform xanthoma of the penis: a rare benign lesion that simulates carcinoma, Verruciform xanthoma in an immunocompromised patient: a case report and immunohistochemical study, Characterization of verruciform xanthoma by in situ hybridization and immunohistochemistry, Cutaneous verruciform xanthoma: a report of five cases investigating the etiology and nature of xanthomatous cells, Verruciform xanthoma in the setting of cutaneous trauma and chronic inflammation: report of a patient and a brief review of the literature, Verruciform xanthoma: a clinical, light microscopic, and electron microscopic study of two cases, Kristine M. Cornejo, MD, Lloyd Hutchinson, PhD, Patrick O'Donnell, DO, Xiuling Meng, MD, Keith Tomaszewicz, BS, MT(ASCP), Sara C. Shalin, MD, PhD, David S. Cassarino, MD, May P. Chan, MD, Timothy R. Quinn, MD, Paul B. Googe, MD, Rosalynn M. Nazarian, MD, Ridhi Sood, MBBS, MD, Debajyoti Chatterjee, MBBS, MD, DM, Pinaki Dutta, MBBS, MD, DM, Bishan Dass Radotra, MBBS, MD, MAMS, PhD, Gurpal Bisra, MMOR, MSc, BASc, Brigette Rabel, MLT, Nick van der Westhuizen, MB, FRCPC, Jing Wang, MD, PhD, Yan Peng, MD, PhD, Hongxia Sun, MD, PhD, Phyu P. Aung, MD, PhD, Erika Resetkova, MD, PhD, Clinton Yam, MD, MS, Aysegul A. Sahin, MD, Lei Huo, MD, PhD, Qingqing Ding, MD, PhD, Abha Goyal, MD, Christine N. Booth, MD, Rhona J. Souers, MS, Sana O. Tabbara, MD, Janie Roberson, SCT(ASCP), Michael R. Henry, MD, Kaitlin E. Sundling, MD, PhD, Kelly Goodrich, CT(ASCP), Lananh Nguyen, MD, Mohammed Amer Swid, MD, Liping Li, MD, Erin M. Drahnak, BS, Hayden Idom, BS, William Quinones, MD, Jianhong Li, MD, Myra L. Wilkerson, MD, Fang-Ming Deng, MD, Haiyan Liu, MD, Adesola A. Akinyemi, MD, MPH, Ansa Mehreen, MD, Kathy A. Mangold, PhD, MaryAnn Regner, MS, John M. Lee, MD, PhD, Linda M. Ernst, MD, MHS, Si Chen, MMed, Zhigang Mao, MMed, Shuang Wang, MMed, Jiamin Deng, MMed, Hongyan Liao, PhD, Qin Zheng, PhD, Monica Sanchez-Avila, MD, Khalid Amin, MD, Aastha Chauhan, MD, Zhuo Geng, MD, Shawn Mallery, MD, Dale C. Snover, MD, This site uses cookies. Multiple studies have demonstrated the presence of HPV, predominantly type 6, in up to 70% of anogenital SKs.1014 In contrast, HPV was rarely detected in extragenital SK and other nonHPV-mediated lesions on genital skin (such as fibroepithelial polyp, epidermolytic acanthoma, and chronic dermatitis).12,13 These findings suggest that genital SK is at least similar or related to condyloma acuminatum. Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips, Not logged in B, Fibrovascular cores are present. For example, plant chemical signals have been shown to activate gene expression in endophytes. 2018;24(5):74960. They were thought to be plant parasitic fungi and they were later termed as "microzymas" by the French scientist Bchamp. There was less than moderate agreement (kappa<0.60) for lesions in the Bulky hyperkeratotic epithelial proliferation, not reactive category. [1], Endophytes were first described by the German botanist Johann Heinrich Friedrich Link in 1809. Behura SS, Masthan MK, Narayanasamy AB. ( A) Skin punch biopsy of the erythrodermic reaction. Oral Surg Oral Med Oral Pathol Oral Radiol. Woo SB, Lin D. Morsicatio mucosae orisa chronic oral frictional keratosis, not a leukoplakia. These features impart a firm and rigid appearance at low magnification, which contrasts with the soft appearance of giant condyloma acuminatum. WebAtypical squamous proliferation: what lies beneath? These viral cytopathic changes serve as an important diagnostic hallmark (Figure 1, B).9 Binucleated or multinucleated forms may be present. Mignogna MD, Fortuna G, Leuci S, et al. This class of non-clavicipitaceous endophytes has been the most extensively researched and has been shown to enhance fitness benefits of their plant host as a result of habitat-specific stresses such as pH, temperature and salinity. 2018;125(6):591602. Google Scholar. 1995;80(2):18891. 2020;42(3):53955. Potentially malignant disorders of the oral cavity and oral dysplasia: a systematic review and meta-analysis of malignant transformation rate by subtype. J Am Dent Assoc. Head Neck Pathol. There was moderate agreement (>0.41 kappa) for 35 of 48 cases. including secondary metabolite-methyl ether of fusarubin have shown antibacterial activity against Staphylococcus aureus, E. coli, P. aeruginosa, and Bacillus megaterium. Black and brown: non-neoplastic pigmentation of the oral mucosa. PubMed frisingense. No external funding was obtained for this study, with support from institutional review boards and the sponsoring societies. This cancer is classified into three subtypes (superficial, exophytic, and endophytic) based on macroscopic appearance. B, Large spinous keratinocytes contain abundant eosinophilic cytoplasm and bland nuclei. There are occasional dyskeratotic cells, while koilocytes are absent (hematoxylin-eosin, original magnifications 10 [A] and 400 [B]). Histologic distinction between condyloma acuminatum and various benign and malignant condyloma-like lesions in the anogenital area poses a common diagnostic challenge to pathologists across subspecialties. 2014;118(6):71324. Atypical Squamous Proliferation: What Lies Beneath?, Dermatologic Surgery | 10.1111/j.1524-4725.2011.01895.x | DeepDyve DeepDyve Get 20M+ Full-Text Papers For Less Than $1.50/day. The 14 remaining tumors had more prominent cytologic atypia and remained classified as SCC. WebInverted follicular keratosis (IFK) is a rare benign tumor characterized by endophytic growth on the follicular infundibulum. [17], The presence of certain fungal endophytes in host meristems, leaves and reproductive structures has been shown to dramatically enhance the survival of their hosts. Head Neck Pathol. HPV infection and immunochemical detection of cell-cycle markers in verrucous carcinoma of the penis, The association of lichen planus of the penis with squamous cell carcinoma in situ and with verrucous squamous carcinoma, Prevalence of mucosal and cutaneous human papillomaviruses in different histologic subtypes of vulvar carcinoma, Verrucous carcinoma of the skin and mucosa, Surgical treatment for 11 cases of penile verrucous carcinoma, Verrucous carcinoma: clinical and pathologic study of 105 cases involving oral cavity, larynx and genitalia, Diagnostic problems in precancerous lesions and invasive carcinomas of the penis, Primary squamous cell carcinoma of the vagina: human papillomavirus detection, p16(INK4A) overexpression and clinicopathological correlations, Worldwide human papillomavirus genotype attribution in over 2000 cases of intraepithelial and invasive lesions of the vulva, Prevalence and distribution of 15 high-risk human papillomavirus types in squamous cell carcinoma of the scrotum, Histologic classification of penile intraepithelial neoplasia, The 2015 International Society for the Study of Vulvovaginal Disease (ISSVD) terminology of vulvar squamous intraepithelial lesions, The Lower Anogenital Squamous Terminology standardization project for HPV-associated lesions: background and consensus recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology, Distribution and characterization of subtypes of penile intraepithelial neoplasia and their association with invasive carcinomas: a pathological study of 139 lesions in 121 patients, Warty (condylomatous) squamous cell carcinoma of the penis: a report of 11 cases and proposed classification of verruciform' penile tumors, Squamous cell carcinoma of the vulva: a subclassification of 97 cases by clinicopathologic, immunohistochemical, and molecular features (p16, p53, and EGFR), p16 overexpression identifies HPV-positive vulvar squamous cell carcinomas, Distinctive association of p16INK4a overexpression with penile intraepithelial neoplasia depicting warty and/or basaloid features: a study of 141 cases evaluating a new nomenclature, Distinctive immunohistochemical profile of penile intraepithelial lesions: a study of 74 cases, Anal intraepithelial neoplasia: a single centre 19 year review, Papillary squamous cell carcinoma, not otherwise specified (NOS) of the penis: clinicopathologic features, differential diagnosis, and outcome of 35 cases, Bowenoid papulosis: a clinicopathologic study with ultrastructural observations, Bowenoid papulosis: clinical and histological study of eight cases, Bowenoid papulosis: presence of human papillomavirus (HPV) structural antigens and of HPV 16-related DNA sequences, Bowenoid papulosis of the vulva-immunotherapeutical approach with topical imiquimod, Photodynamic therapy for bowenoid papulosis using a novel incoherent light-emitting diode device, Extensive genital bowenoid papulosis responding to imiquimod, Aminolevulinic acid photodynamic therapy for bowenoid papulosis, Bowenoid papulosis: classification as a low-grade in situ carcinoma of the epidermis on the basis of histomorphologic and DNA ploidy studies, Bowenoid papulosis of the male and female genitalia: risk of cervical neoplasia, Heterogeneity of human papillomavirus DNA in a patient with Bowenoid papulosis that progressed to squamous cell carcinoma, Morphometric assessment of nuclei in Bowen's disease and bowenoid papulosis, The presence of HPV types 6/11, 16/18, 31/33/51 in Bowenoid papulosis demonstrated by DNA in situ hybridization, Detection of mucosal human papilloma virus DNA in bowenoid papulosis, Bowen's disease and squamous cell carcinoma of the skin, Expression of p16 and hTERT protein is associated with the presence of high-risk human papillomavirus in Bowenoid papulosis, A genotype distribution of human papillomaviruses detected by polymerase chain reaction and direct sequencing analysis in a large sample of common warts in Japan, Development of a multiplex PCR method for detecting and typing human papillomaviruses in verrucae vulgaris, Verruca vulgaris of the vulva in children and adults: a nonvenereal type of vulvar wart, Human papillomavirus segregation patterns in genital and nongenital warts in prepubertal children and adults, Immunohistochemistry and polymerase chain reaction for detection human papilloma virus in warts: a comparative study, Multiple epidermolytic acanthomas must not be confused with genital human papillomavirus infection, Epidermolytic acanthoma of the scrotum: a rare mimicker of condyloma acuminatum, Multiple localized epidermolytic acanthomas of the vulva associated with vulvar pruritus: a case report, Multiple epidermolytic acanthomas mimicking condyloma: a retrospective study of 8 cases, Epidermolytic acanthoma does not contain human papillomavirus DNA. Class 1 endophytes are all phylogenetically related and proliferate within cool and warm season grasses. Fivenon-PVL histologic mimicswere included as controls. [73], There are several endophytes that have been discovered that exhibit insecticidal properties. 2015;120(4):47482. The eruption was Compared to the spiky papillae in verruca vulgaris (VV), the papillae in condyloma acuminatum have more rounded and undulating contours, with less robust hyperkeratosis (Figure 1, A). [62], Endophytes have been discovered with various anti-tumor properties. The increased growth and resilience is likely caused by the endophytes ability to improve plant nutrition or secondary metabolite production, as in the case of Phoma eupatorii's inhibition of the phytopathogen Phytophthora infestans. 1948;23(4):6708. and transmitted securely. [31], Among the many promising applications of endophytic microbes are those intended to increase agricultural use of endophytes to produce crops that grow faster and are more resistant and hardier than crops lacking endophytes. PubMed Central Epub 2020 Oct 16. Web18.2 Endophytic Fungal Diversity. Demonstration of HPV 2 or other nongenital HPV types in the absence of HPV 6 or 11, either by in situ hybridization or by PCR-DNA sequencing, would support a diagnosis of VV and exclude condyloma acuminatum.6872. [11][12], Endophytes may benefit host plants by preventing other pathogenic or parasitic organisms from colonizing them. Epub 2016 Jun 14. 2012;17(6):e93542. Fleiss JL. Oral mucosal lesions associated with smokers and chewersa casecontrol study in chennai population. Unable to load your collection due to an error, Unable to load your delegates due to an error. The author has no relevant financial interest in the products or companies described in this article. Cheng YS, Gould A, Kurago Z, Fantasia J, Muller S. Diagnosis of oral lichen planus: a position paper of the American Academy of Oral and Maxillofacial Pathology. This supports the hypothesis that plant signaling is required in order to induce expression of endophytic secondary metabolites. J Clin Diagn Res. The keratinocytes are bland and without koilocytic change. [54], Plants are potentially able to break down or sequester, or stimulate micro-organisms in the soil to break down or sequester, certain organic pollutants and inorganic pollutants such as nickel in degraded ecosystems, which is known as phytoremediation. London: Wiley; 1981. Learn more about Institutional subscriptions. Inter-observer variability in the diagnosis of proliferative verrucous leukoplakia: clinical implications for oral and maxillofacial surgeon understanding: a collaborative pilot study. As mentioned above, controversy exists regarding the relationship between verrucous carcinoma and giant condyloma acuminatum. 2013;18(3):e4113. Oral Oncol. Direct immunofluorescence testing results in cases of premalignant and malignant oral lesions. Squamous keratinocytes are more common in this variant compared to basaloid cells. Oral Surg Oral Med Oral Pathol Oral Radiol. Statistical analysis of inter-rater agreement was provided by Sijia Yue, MS at the University of Florida College of Public Health and Health Professions Department of Biostatistics. These findings suggest that some cutaneous squamous proliferations on the legs of women with multiple lesions lack prominent cytologic atypia as well as TP53 mutations and might be more akin to keratoacanthoma than SCC or might represent a reactive phenomenon. Capella DL, Gonalves JM, Abrantes AAA, Grando LJ, Daniel FI. Surgery. Manipulations of a plant's endosymbiots can affect plant development, growth and ultimately the quality and quantity of compounds harvested from the plant. Systemic endophytes are defined as organisms that live within plant tissues for the entirety of its life cycle and participate in a symbiotic relationship without causing disease or harm to the plant at any point. Additionally, systemic endophytes concentrations and diversity do not change in a host with changing environmental conditions. Papillary squamous cell carcinoma. [71] Endophytes accomplish this by increasing the uptake of valuable land limited nutrients from the soil such as phosphorus and making other plant nutrients available to plants such as rock phosphate and atmospheric nitrogen which are normally trapped in forms that are inaccessible to plants. Would you like email updates of new search results? Marginal linear gingival leukoplakia progressing to ring around the collaran ominous sign of proliferative verrucous leukoplakia. The large tumor mass compresses but does not infiltrate normal structures. Mller S. Oral lichenoid lesions: distinguishing the benign from the deadly. This endophytic type has The second method divides fungal endophytes into four groups based on taxonomy and six other criteria: host range, host tissues colonized, in planta colonization, in planta biodiversity, mode of transmission and fitness benefits. May P. Chan; Verruciform and Condyloma-like Squamous Proliferations in the Anogenital Region. Note the convergence of elongated rete ridges at the base. Karabulut A, Reibel J, Therkildsen MH, et al. Akrish S, Eskander-Hashoul L, Rachmiel A, Ben-Izhak O. Clinicopathologic analysis of verrucous hyperplasia, verrucous carcinoma and squamous cell carcinoma as part of the clinicopathologic spectrum of oral proliferative verrucous leukoplakia: a literature review and analysis. D, Patchy p16 immunostaining in a condyloma acuminatum (hematoxylin-eosin, original magnifications 40 [A], 400 [B], and 100 [C]; original magnification 100 [D]). have activity against strains of multi drug-resistant Mycobacterium tuberculosis. [68] Epichlo endophytes are being widely used commercially in turf grasses to enhance the performance of the turf and its resistance to biotic and abiotic stresses. Head and Neck Pathol 15, 572587 (2021). 6 months later, the biopsy showed overlying thickened parakeratin alternating with parakeratin with serum accumulation (b). Interobserver and intraobserver variability in the histologic assessment of oral lichen planus. [59] Three triterpenes were found in the endophyte Xylarialean sp., all three of these compounds displayed mild cytotoxic effects on tumor cells. C, Warty-basaloid HSIL is characterized by a verruciform architecture and basaloid epithelium with full-thickness atypia. which was first harvested from the plant Bontia daphnoides. Given its papillomatous architecture and large size, many regarded giant condyloma acuminatum as a variant of verrucous carcinoma. PubMedGoogle Scholar. [42] These four groups are divided into clavicipitaceous endophytes (Class 1) and non-clavicipitaceous endophytes (Class 2, 3, and 4). The authors declare that they have no conflict of interest. 2007;36(5):25561. 2014;117(4):51120. 2015;19(2):198204. In Search of Nodular Gastric Antral Vascular Ectasia: A Distinct Entity or Simply Hyperplastic Polyps Arising in Gastric Antral Vascular Ectasia. Observer variability in the histologic assessment of oral premalignant lesions. 1985;60(3):28598. The proliferation barely protrudes above the surface Full size image Hyperkeratotic or papillomatous variant is characterized by prominence of papillomatosis, hyperkeratosis, and horn pseudocysts with some acanthosis (Fig. These papillae are surmounted by columns of parakeratosis (church spire parakeratosis), whereas the valleys between the papillae show hypergranulosis (Figure 7, B). [57][58] Endophyte bioprospecting has already yielded compounds with antibacterial,[59][60] antifungal,[61] antiviral,[61] antiparasitic,[62] cytotoxic,[59][63] neuroprotective,[62] antioxidant,[62] insulin-mimetic,[62] -glucosidase inhibitory,[61] and immunosuppressant[62] properties. J Oral Maxillofac Surg. Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, 5601 De Soto Avenue Woodland Hills, CA, 91364, Woodland Hills, USA, Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA, Sarah G. Fitzpatrick,Indraneel Bhattacharyya,Mohammed N. Islam&Donald M. Cohen, Atlanta Oral Pathology, Emory University School of Medicine, Decatur, GA, USA, Oral Health and Diagnostic Sciences, University of Connecticut Health, Farmington, CT, USA, Section of Diagnostic Sciences, Department of Applied Dental Medicine, Southern Illinois University School of Dental Medicine, Alton, IL, USA, Department of Pathology, University of Chicago Medicine, Chicago, IL, USA, Department of Diagnostic and Biomedical Sciences, University of Texas School of Dentistry at Houston, Houston, TX, USA, Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA, Department of Diagnostic Sciences, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA, Centro Clnico de Cabeza y Cuello, Patologa Divisin, Guatemala City, Guatemala, Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA, Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA, Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA, Department of Pathology, Inova Fairfax Hospital, Falls Church, VA, USA, Department of Pathology, University of Ottawa, Ottawa, Ontario, Canada, Department of Pathology, MUSC Health-University Medical Center, Charleston, SC, USA, Department of Pathology, Moffitt Cancer Center, Tampa, FL, USA, You can also search for this author in WebEndophytic type squamous cell papilloma, is continuous with the adjacent hyperplastic epidermis and a crater forms by invagination with no pedicle. [4] Vertically transmitted fungal endophytes are typically considered clonal and transmit via fungal hyphae penetrating the embryo within the host's seeds, while reproduction of the fungi through asexual conidia or sexual spores leads to horizontal transmission, where endophytes may spread between plants in a population or community. Mller S. Frictional keratosis, contact keratosis and smokeless tobacco keratosis: features of reactive white lesions of the oral mucosa. This expert consensus guideline has been developed with support and endorsement from the leadership of the American Academy of Oral and Maxillofacial Pathology and the North American Society of Head and Neck Pathologists to recommend the use of standardized histopathologic criteria and descriptive terminology to indicate three categories of lesions within PVL: (1) corrugated ortho(para)hyperkeratotic lesion, not reactive; (2) bulky hyperkeratotic epithelial proliferation, not reactive; and (3) suspicious for, or squamous cell carcinoma. Classification of PVL lesions based on a combination of clinical findings and these histologic descriptive categories is encouraged in order to standardize reporting, aid in future research and potentially guide clinical management. Learn More Atypical Squamous Proliferation: What Lies Beneath? [20] Specific endophyte species can also stimulate root growth by increasing the flux of auxin to where the endophyte is. Braz J Otorhinolaryngol. [51], A 2008 experiment with an isolate of a fungus called NRRL 50072 found that this strain can produce a small amount of fuel-like hydrocarbon compounds which was promoted as "myco-diesel". C, A defining feature is the presence of xanthomatous (foam) cells in the dermal papillae (hematoxylin-eosin, original magnifications 40 [A], 200 [B], and 400 [C]). [11] Studies have shown endophytic fungi are able to produce secondary metabolites previously thought to be manufactured by their plant hosts. [55], Two strains of the endophytic fungi Pestalotiopsis microspora isolated from stems of plants from the Ecuadorian rainforest were shown in laboratory experiments to be able to digest polyurethane plastic as the fungus's sole carbon source in anaerobic conditions, although many other non-endophytic fungi have demonstrated this ability, and most isolates of endophytic fungi in this experiment could perform this to some degree. Class 4 endophytes are restricted to plant tissues below ground and can colonize much more of the plant tissue. However, in contrast with condyloma acuminatum, which is typically caused by HPV types 6 and 11, VV is most commonly induced by HPV 2, followed by HPV 1, 4, 65, 27, and others.68,69 Distinction of VV and condyloma acuminatum has important clinical implication especially in the pediatric population, as condyloma acuminatum would raise suspicion for sexual abuse, whereas VV is nonsexually transmitted. 1995;24(5):198200. Likewise, Ki-67 positivity is mainly observed in the basal layer.28 Absence of HPV may be confirmed by PCR-DNA sequencing, in situ hybridization, or immunohistochemistry.24,25,28,30, Infection by high-risk HPV, most commonly HPV 16 and less commonly HPV 18, 31, 33, 45, 51, 52, and 59 amongst others, causes undifferentiated intraepithelial neoplasia (-IN) of the vulva, vagina, penis, scrotum, and anus.3842 These HPV-related squamous intraepithelial lesions may be subclassified into warty, basaloid, and warty-basaloid types by histopathologic features.
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