PATHOMORPHOLOGY OF VERRUCAE: A CLINICOPATHOLOGIC STUDY

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I. Emmanuel^1,2, P.O. Akpa^1,2, B.V. Kwaghe¹,C.N. Ibeanu¹, J.B. Atiku,³
I.A. Othman¹, N.Z. Bahaushe¹, J.E. Ben,¹ J.A. Emmanuel¹, C. Amaike⁴, S.J. Winnie5, T. Leslie⁵, T.N. Fadok⁶

1. Department of Anatomic Pathology and Forensic Medicine, Jos University Teaching Hospital, Nigeria, Jos, Plateau State, Nigeria.
2. Department of Pathology, University of Jos, Jos, Plateau State, Nigeria.
3. Department of Public Health Sciences, Adeleke University. Ede, Osun State, Nigeria.
4. Department of Community Medicine, Babcock University and Babcock University Teaching Hospital, Illishan Remo, Ogun State, Nigeria.
5. Department of Nursing Science, Babcock University and Babcock University Teaching Hospital, Illishan Remo, Ogun State, Nigeria.
6. Department of Histopathology, Federal Medical Center Jalingo, Taraba State, Nigeria.

Abstract

Introduction: Verrucae are benign squamous epithelial lesions affecting the skin and mucous membranes, as a result of infection with low-risk Human Papilloma virus, with an estimated 10% of the world’s population affected. This work studies the clinicopathology of all histologically diagnosed warts at the Jos University Teaching Hospital between 1st January 2013 and 31st December 2022.

Methodology: The study was a descriptive study of all histologically diagnosed cases of verrucae during the study period. Patients with histological diagnosis of verrucae were included, while those with inadequate biodata (age and sex), inadequate clinical information, and missing archival slides and tissue blocks were excluded from the study. Patients’ age, gender, clinical characteristics (site and symptoms) and histological diagnosis were obtained from the records.

Results: All 61 cases are of histologically diagnosed verrucae met the criteria for the study. These consisted of males 28 (45.9%), and 33 (54.1%) females. The age range, mean, median and modal age of the study were 1-70 years, 34.81+19.28years, 35.0 years, and 13.0 years, respectively. As much as 28 (45.9%) warts were seen between 30years and 49years of age. According to the anatomical site of occurrence, the lesions were broadly classified into cutaneous warts, 23 (37.7%) and anogenital warts, 38 (62.3%). Specifically, the vulva, penis, and other parts of the perineum were the sites with the highest frequency of wart accounting for 17 (27.9%), 6(9.8%), and 6 (9.8%) cases respectively. Bleeding, pain, itching, and cosmesis as a direct consequence of the lesion were reasons for clinical presentation, with cosmesis predominating (84.4%).

Conclusion: Warts in our environment is commoner in the anogenital region, the third and fourth decade of life, and in the female gender. Bleeding, pain, itching, and cosmesis were reasons for clinical presentation. Vaccination against the etiological agent of the disease is advised on a wide scale to reduce the incidence of this disturbing and distressing pathology.

Keywords: Verrucae, Warts, Cutaneous, Anus, Genital.

Introduction

Verrucae can be defined as benign squamous epithelial nodular eruptive lesions affecting the skin and mucous membranes as a result of infection with low-risk Human Papilloma virus. These lesions are seen in clinical practice on an expanse of anatomical locations from the skin of the head to the distal dorsal aspects of the extremities, and through the mucosa of the oral cavity, the nose and urethra.^1-4 Globally, an estimated 10% of the population are affected.¹ The Human Papilloma Virus, the etiological agent, is the world’s commonest sexually transmitted disease,^1,5 and sexually active individuals in their lifetime will at least be infected once. The symptoms of the disease could be discomforting, with physical or emotional distress^6,7on the heels of a disease with no ideal treatment owing to the lack of standardization,⁸ from the myriad of treatment modalities.^2,8Fortunately, vaccination against the Human Papilloma Virus has shown efficacy of approximately 100% in prevention of the disease caused by this infection. ⁹ It is worthwhile to document the
clinicopathology of this discomforting and distressing disease in our environment to add to the literature, setting the stage for a robust effort towards its prevention and treatment. Herein lies the purpose of this work encompassing all such histologically diagnosed lesions at the Jos University Teaching Hospital between 2013 and 2022 in relation to the clinical presentation.

METHODOLOGY
The study was a descriptive study of all histologically diagnosed cases of verrucae seen at the Jos University Teaching Hospital between 1st January 2003 and December 31st, 2022. The medical records of patients were obtained from the Medical Health Records Department and the Anatomical Pathology and Forensic Medicine Department of the Hospital. The record was the histopathological reports and folders. Patients with histological diagnosis of verrucae were included, while those with inadequate biodata (age and sex), inadequate clinical information, and missing archival slides and tissue blocks were excluded from the study. Patients’ age, gender, clinical characteristics (site and symptoms) and histological diagnosis were obtained from the records. A data extraction form was developed which was used to manually extract the required information from the medical records of the patients.

Using the histologic diagnosis, archival slides were traced, retrieved and reviewed to confirm the histological diagnosis, with concurrence from two anatomic pathology consultant authors in the study. Any observed variation was discussed in a joint session where reviews were made and a decision taken. Cases of missing or broken slides were addressed by making new slides from archival tissue blocks. The protocol of making new slides was as follows: cutting of embedded tissue blocks to a thickness of 3 micrometres and picking on a glass slide after floating in a warm water bath; immersion in xylene and incubation for 15minutes; immersion of slides in equal portions of xylene and ethanol (xylene: ethanol ratio of 1:1) for 5 minutes; immersion in 100% ethanol for 5 minutes, then 95%, 85%, 75%, 65% and 55% ethanol, each for 3 minutes; rinsing in distilled water for 5minutes; and staining with haematoxylin and eosin.

Data obtained was entered into Microsoft Excel, exported into IBM Statistical Package for Social Sciences (SPSS) version 2021, analysed and presented as frequency tables as proportions, simple frequencies, percentages, range, and measures of central tendencies. The limitation of the study was that not all patients in Plateau State with verrucae seek care from the Jos University Teaching Hospital. Many patients visit other tertiary health facilities, while others will opt for traditional medical care, and yet others manage the condition at home. However, this did not affect the findings of this study.