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Infrequent human papillomavirus‐associated findings in genital epidermal cysts: A preliminary study

Dear Editor, Human papillomavirus (HPV) is frequently detected in palmoplantar epidermal cysts (PEC) and suggested to contribute to the cyst formation.1 Except for an anecdotal report of HPV6/11associated genital epidermal cyst (GEC),2 there have been few studies regarding HPV with GEC. We retrospectively reviewed medical records of 5950 epidermal cysts (2009– 2018) and selected biopsyproven GEC or PEC. We included cysts located in the anogenital and inguinal area as GEC (located in the scrotum, penile shaft, vulva, buttock, and pubic, perianal, or inguinal area). Finally, 40 GEC of 35 patients and 20 PEC of 20 patients were included. Histopathological findings observed in HPVassociated epidermal cysts were assessed: parakeratotic nuclei within keratinous substances in the cyst cavity (P), vacuolar structures in the keratinous mass in the cyst cavity (VC), and intracytoplasmic eosinophilic bodies in the cells of the cyst wall (IEB).3 Immunohistochemistry (IHC) for HPV was conducted using monoclonal antibody (Clone K1H8; Dako) immunoreactive with major capsid protein epitope of HPV1, broadly expressed among various HPV subtypes. The average age of GEC patients was significantly higher (GEC 44.3 ± 16.8 vs. PEC 26.17 ± 10.5; p < 0.001). There was no significant difference in the femaletomale ratio (GEC 17/18 vs. PEC 11/9; p = 0.646). GEC infrequently demonstrated HPVassociated findings, compared to PEC (P, 9/40 vs. 17/20 [p < 0.001]; VC, 6/40 vs.