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Expanding the Morphologic Heterogeneity of Stromal Changes in Molluscum Contagiosum Infection.

To the Editor: Molluscum contagiosum virus, a dsDNA poxvirus of the Molluscipox genus, is the causative agent of a transmissible cutaneous infection, initially described by Dr. Thomas Bateman in 1814, which classically affects young children, immunocompromised individuals and sexually active adults.1,2 The characteristic histologic findings of the infected cells exhibit distinct homogeneous, eosinophilic, globular intracytoplasmic molluscum inclusion bodies that are historically known as Henderson-Patterson bodies. Although the classic pattern does not present any diagnostic difficulty, morphologic heterogeneity can occasionally be encountered, posing a potential pitfall especially if combined with an atypical clinical presentation. Various studies have documented the morphologic variety that can be seen in molluscum contagiosum infection.3–6 Cribier et al4 retrospectively analyzed 578 cases documenting morphologic variations including pseudocystic, giant (1.5–3.0 cm), pedunculated, polypoid, and exophytic patterns, as well as associated dense polymorphonuclear infiltrates and abscesses. Interestingly, they reported that nearly 4% of cases were associated with another process, most commonly epidermal cysts potentially obscuring the molluscum contagiosum infection changes. They suggested that these unusual histologic variants result in atypical clinical phenotypes, particularly when the classic umbilicated pattern is not evident. Ishikawa et al5 expanded the variety of documented stromal changes by examining the histopathologic features other than molluscum contagiosum bodies in 67 cutaneous biopsies. They reported noninflammatory stromal alterations such as fibroedematous and fibromyxoid stromal changes in most of their cases, an observation which was poorly documented in the literature. Most recently, Horiguchi et al6 examined 1 typical and 2 atypical cases of molluscum contagiosum and showed that monoclonal antiCD34 immunohistochemical stain highlighted a tightly enclosing, basket-like capillary network surrounding the lesion in all 3 cases. These vessels were postulated to function nutritionally in support of the rapid growth of molluscum contagiosum and may serve as another histologic clue to the diagnosis when the classic features are absent. We report 2 clinically atypical cases of molluscum contagiosum that we believe further expand the morphologic diversity of surrounding stromal changes that may be encountered in biopsy material. The first case is that of a 17-year-old male who presented to the