Giant Squamous Cell Papilloma of the Eyelid-Diagnostic and Therapeutic Challenges

Abstract

Squamous cell papilloma (SCP) is generally a human papillomavirus (HPV) induced exophytic or endophytic proliferation on the surface of the skin, oral cavity, larynx, esophagus, cervix, vagina, and anal canal. The endophytic type SCP can cause differential diagnostic difficulties with keratoacanthoma, inverted follicular keratosis, and squamous cell carcinoma; however, these lesions are not associated with HPV infection. The authors present a female patient who noticed an extremely rapidly growing tumor destructing the left lower eyelid. The histological analysis of the biopsy sample revealed a virus-induced squamoproliferative lesion. The eyelid affected was completely removed, and the histological examination resulted in a HPV induced endophytic squamous cell papilloma. The tarsus and the conjunctiva were replaced by a chondromucosal graft harvested from the nasal septum, while the skin defect could be closed directly. Restoration of the eyelid function has been achieved with satisfying functional and cosmetic results.

Figure 1

Giant squamous cell papilloma involving the left lower eyelid (a) and (b).

Figure 2

Clinical appearance of the left lower eyelid 1 week (a) and (b) and 2 months (c) and (d) after tumor removal and surgical reconstruction of the excised area.

Figure 3

Histopathological features. (a) Hyperkeratotic epidermis and endophytic epithelial growth into the dermis with squamous pearl (arrow). There is only mild cytological atypia with intact basement membrane and no increased mitotic activity indicative of the benign nature of the lesion (inset). (b) Diffuse p16 immunopositivity both in the nucleus and in the cytoplasm (see inset) confirms HPV infection. Note the immunonegativity in the adjacent epidermis. (a: Haematoxylin & Eosin, original magnification: x20; inset: x300; b: Immunohistochemistry with DAB chromogen, using monoclonal antibody (clone MX007, Master Diagnostica; x20; inset: x300).