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
