DOI: 10.7860/JCDR/2017/24545.

9186
Case Report

Molluscum Contagiosum of
Pathology Section

Cervix – A Case Report

Ankita Bagel1, R Kalyani2, Munikrishna Munisamaiah3, Bachu Narayanaswamy Raghavendra Prasad4

ABSTRACT
Molluscum Contagiosum (MC) is a common viral infection of skin caused by a double stranded DNA Pox virus affecting both adults and
children. MC is primarily an infection of school-going children (one to five years), occasionally it affects adults and immunocompromised
individuals. Transmission of virus occurs by direct contact with infected person or contaminated objects. Most common sites are skin
of face, trunk and extremities in children, genitals in adults and rarely palms, soles and mucous membranes. The occurrence of MC
in genitals is lowest (3%). We present a case report of Molluscum Contagiosum of cervix which is a rare site; only one case has been
reported in medical literature till date.

Keywords: Female genital tract, Viral, Skin

CASE REPORT
A 60-year-old female presented to medicine OPD for Obstructive
Uropathy features since three weeks. Following systemic and local
examination, foul smelling discharge per vagina was observed
for which patient was referred to Department of Obstetrics and
Gynaecology. On per speculum examination, a firm reddish nodule
was seen on the posterior lip of cervix with white discharge over and
around it. A provisional clinical diagnosis of viral infection of cervix was
considered. Cervical biopsy was taken and sent for histopathological
examination. Past history revealed that the patient had undergone 2
rounds for haemodialysis for obstructive Uropathy. No other lesions
were present elsewhere on the body. HIV status was negative.
Grossly, the specimen consisted of a tiny grey-white to grey-brown
soft tissue mass measuring around 0.5 cm across with mucosal
surface on one side. No bullae were identified. Microscopy showed [Table/Fig-2]: Microphotograph showing proliferating keratinocytes consisting of
stratified squamous epithelium with focal hyperplastic changes. intracytoplasmic eosinophilic inclusions (arrow) (H&E, 40X).
Focal area showed a cup shaped lesion consisting of proliferating
keratinocytes having eosinophilic cytoplasmic inclusions with
features of hyperkeratosis [Table/Fig-1,2]. Correlating with case DISCUSSION
history and clinical findings, histopathological diagnosis of Mollus­ Molluscum Contagiosum (MC) is a common skin viral infection
cum Contagiosum (MC) of cervix was given. caused by a double stranded DNA Pox virus affecting both adults
and children. MC is primarily an infection of school-going children
During the patient’s hospital stay, she was catheterized and 2
(1-5 years) and occasionally adults and immunocompromised
cycles of haemodialysis were done. For the cervical lesion only
individuals [1,2]. MC occurs in 2%-10% of worldwide population,
follow up was advised. When patient was symptomatically better,
its incidence increases in immunocompromised individuals like
she was discharged and advised a weekly follow up for which the
HIV infected, increasing upto 5%-18% [3]. In the present case, the
patient did not turn up.
patient was 60-year-old female.
In medical literature, MC was first described in 1817 and its viral
aetiology was determined by Juliusberg. It is known to be of Poxviridae
family [4,5]. The virus is round or rectangular consisting of linear double
stranded DNA [2]. This virus infects epidermal keratinocytes [6]. It
utilizes microtubule cytoskeleton of eukaryotic cells for movement
leading to continuous spread of viral infection [7,8].
There are 4 strains of MC virus (MCV) [1-3]. MCV 1 is most co­
mmon worldwide and also affects young children most commonly.
MCV-2 mainly infects immunocompromised indivi­duals especially
HIV positive individuals. Transmission of virus occurs by direct
contact with infected person or contaminated objects (fomites)
like towels, sponges, swimming pools, tattoo instruments, instru­
ments at beauty salons, etc., [9]. Most common sites are skin
of face, trunk and extremities in children, genitals in adults and
[Table/Fig-1]: Microphotograph showing stratified squamous epithelium with cup rarely palms, soles and mucous membranes [1]. Occurrence of
like lesion (H&E, 10X).
MC in genital areas is lowest, approximately 3% [3]. Molluscum

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 Ankita Bagel et al., Molluscum Contagiosum of Cervix www.jcdr.net

Contagiosum of the cervix is very rare and as far as our knowledge If treatment is required, it should be supportive. Treatment can be
goes, only one case is reported in English scientific literature in the form of curettage, laser, cryotherapy or salicylic acid [10].
till date [10]. In the present case, the risk factors are repeated In our case, the patient underwent biopsy, curative treatment and
haemodialysis, catheterisation and probably immunosuppression. supportive treatment. No follow up was done due to patient’s non-
Clinically, they appear as firm, flesh coloured doughnut or umbilical compliance.
shaped lesion, about 2-5 mm in diameter, centre usually filled with
white curdy type material. It can also present as giant MC (>5 CONCLUSION
mm), eczematous lesions and folliculocentric lesions which can MC in cervix is rare and can present as an incidental finding in a
closely mimic conditions like Condyloma acuminatum, Basal cell host with low immunity. As far as our knowledge goes only one
carcinoma and Lymphangioma. With atypical presentation, it case is reported in English literature till date and the present case
becomes a diagnostic challenge specially in HIV I positive individuals will be the second case.
and immunosuppressed patients [1,10]. In present case, the lesion
presented as reddish nodule with white discharge. References
[1] Diaconu R, Oprea B, Vasilesc MM, Niculescu EC, Ciobanu MO, Diaconu C, et
Usually clinical features are typical and histomorphological al. Inflamed molluscum contagiosum in a 6-year-old boy: a case report. Rom J
features on light microscopy are classical, which confirms the Morphol Embryol. 2015;56(2):843–45.
diagnosis. Hence, other molecular investigations are not done. [2] Zhuang K, Ran Y, Xu F, Lama J. Atypical infantile genital Molluscum contagiosum.
An Bras Dermatol. 2015;90(3):403-05.
The histomorphological features are; the dermis is indented by a [3] Guan H, Nuth M, Zhukovskaya N, Saw YL, Bell E, Isaacs SN, et al. A Novel
sharply delimited and lobulated mass of proliferating epithelium. Target and Approach for Identifying Antivirals against Molluscum Contagiosum
As the cells differentiate within the mass, their cytoplasm gradually Virus. Antimicrobial Agents and Chemotherapy. 2014;58(12):7383–89.
[4] ZurKenntnis JM. Des virus des Molluscum contagiosum. Dtsch Med Wochenschr.
is filled by a faintly granular eosinophilic inclusion that displaces the
1905;31:1598–99.
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immunosuppression including HIV infection and atopic dermatitis.

PARTICULARS OF CONTRIBUTORS:
1. Resident, Department of Pathology, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India.
2. Professor, Department of Pathology, Sri Devaraj Urs Medical College, Kolar, Karnataka, India.
3. Professor and Head, Department of OBG, Sri Devaraj Urs Medical College, Kolar, Karnataka, India.
4. Professor, Department of Medicine, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka. India.

NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR:

Dr. Kalyani Raju,
Professor of Pathology, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research,
Kolar-563102, Karnataka, India. Date of Submission: Oct 12, 2016
E-mail: [email protected] Date of Peer Review: Nov 04, 2016
Date of Acceptance: Nov 12, 2016
Financial OR OTHER COMPETING INTERESTS: None. Date of Publishing: Jan 01, 2017

4 Journal of Clinical and Diagnostic Research. 2017 Jan, Vol-11(1): ED03-ED04