Multibranched acquired periungual fibrokeratomas with confounding histopathologic findings resembling papillomavirus infection: a report of two cases

J Cutan Pathol. 2015 Sep;42(9):652-6. doi: 10.1111/cup.12497. Epub 2015 Jun 1.


Acquired periungual fibrokeratomas are benign fibrous tissue tumors and are considered as the topographical variant of acquired digital fibrokeratoma. They usually present as solitary tumors. In some instance, the entity may appear in multibranched fashion. The main histopathologic features consist of acanthosis, thick collagen bundles mainly oriented in a vertical axis forming a central core, and numerous proliferating fibroblasts. In this article, we present two cases of acquired multibranched periungual fibrokeratoma and depict their varying clinical features over time. Binucleation and perinuclear halos of keratinocytes mimicking human papillomavirus (HPV) infection were detected microscopically, but there was no reactivity with HPV immunostaining. In context, anti-HPV immunostaining may be helpful in the differentiation of fibrokeratomas from HPV infection. On the other hand, it should be kept in mind that these histopathologic findings may be found in acral biopsies independent of viral effects.

Keywords: HPV; fibrous tissue neoplasm; immunohistochemistry; nail disease.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Diagnosis, Differential
  • Female
  • Fibroma / diagnosis
  • Fibroma / pathology*
  • Fingers / pathology*
  • Humans
  • Immunohistochemistry
  • Keratosis / diagnosis
  • Keratosis / pathology*
  • Middle Aged
  • Nail Diseases / diagnosis
  • Nail Diseases / pathology*
  • Neoplasms, Fibrous Tissue / diagnosis
  • Neoplasms, Fibrous Tissue / pathology
  • Papillomavirus Infections / diagnosis
  • Papillomavirus Infections / pathology*
  • Skin Diseases / diagnosis
  • Skin Diseases / pathology
  • Skin Neoplasms / diagnosis
  • Skin Neoplasms / pathology