Hyperplastic Squamous Epithelium Research Articles

Rinosporidiose equina: relato de caso no centro-oeste brasileiro

This is the first report of equine nasal rhinosporidiosis in Mineiros, Goiás, diagnosed through the histopathological analysis of granulomatous masses removed from a horse’s nostril of a 12-year-old male horse, through a surgical procedure. Microscopy revealed a papillomatous tissue lesion covered by moderately hyperplastic squamous epithelium, rich, loose fibrocollagenous tissues, well vascularized, accompanied by an accentuated inflammatory reaction constituted by a mixture of macrophages, lymphocytes, plasmocytes, and smaller number of neutrophils, and numerous round to oval structures with a unilamellar wall and a central nucleus surrounded by basophilic granular material, which were morphologically compatible with Rhinosporidium spp. sporangia.

A Rare Case of Granular Cell Tumour of Tongue in a 13-year-old Girl

Granular Cell Tumour (GCT) is a rare benign tumour that usually affects adults in the third to sixth decades, with females being more commonly affected. Here, a rare case of GCT occurring in a 13-year-old child is presented. A young girl presented with a painless swelling on the right-side of her tongue. Her past medical history was unremarkable. Upon examination, a firm, well-defined, non pulsatile, non tender lesion measuring 1×0.8 cm was noted, involving the right lateral border of the tongue. The lesion was excised and sent for histopathological examination. Gross examination revealed a 1×0.8×0.6 cm mass with a grey-white cut surface. Microscopy showed hyperplastic stratified squamous epithelium overlaying a submucosal tumour composed of polygonal cells arranged in sheets. The tumour cells had central small round nuclei with abundant granular eosinophilic cytoplasm and intervening skeletal muscle fibres. No necrosis, atypia, or increased mitosis were observed. Immunohistochemistry showed strong nuclear positivity and bright granular cytoplasmic positivity for S-100, confirming the diagnosis of GCT. The patient was followed-up for 14 months after surgery and reported no recurrences. GCTs typically manifest in older individuals, with the highest prevalence in the fifth and sixth decades of life. However, this case deviates from the norm, being noted in a 13-year-old child. This exceptionally unusual presentation should prompt the inclusion of GCT in the differential diagnosis of tongue neoplasms in paediatric patients as well. Periodic follow-up of these patients is recommended to detect malignant transformations and late recurrences at early stages.

Papillary Variant of Oral Squamous Cell Carcinoma of Alveolar Mucosa- A Case Report and Review

Papillary Squamous Cell Carcinoma (PSCC) is a less frequent subtype of Squamous Cell Carcinoma (SCC) with a more favorable prognosis compared to conventional oral squamous cell carcinoma. PSCC has a distinctive exophytic and papillary projection. The upper aerodigestive tract is the most commonly affected site with a higher incidence of occurrence in the larynx. The papillary variant of oral squamous cell carcinoma involving gingiva or alveolar ridge is relatively uncommon and less reported. Other differential diagnosis of papillary gingival masses is reactive gingival lesions and fungal infections. An accurate diagnosis is vital for both therapeutic and prognostic purposes. This article describes the case of papillary variant oral squamous cell carcinoma in a 75-year-old male in the maxillary alveolar region depicting histopathological features of exophytic growth with hyperplastic stratified squamous epithelium with basaloid cells invading the underlying connective tissue.

Dilated pore of Winer in a dog

A 9-year-old male neutered Goldendoodle was presented to the Animal Medical Center of Seattle with a history of a firm, hairless, cystic mass on the dorsal aspect of the neck. The mass had been present for 2 years and would periodically rupture and discharge moderate quantities of yellow–green, soft, semi-solid, keratinaceous material. As rupture of the mass was reported to cause the patient significant pain and discomfort, it was surgically excised. Histopathology of the mass revealed a bulbous keratin-filled cyst that communicated with the external environment via a small ostium. At the base of the cyst, the cyst lining was characterized by a markedly irregular and hyperplastic stratified squamous epithelium with an overt stratum granulosum and prominent, irregularly sized, shaped and spaced rete ridges. At the superficial aspect of the cyst near the ostium, the cystic lining was characterized by a relatively thinner stratified squamous epithelium with an overt stratum granulosum and regular basal contour. Based on the histomorphological appearance of the mass, a diagnosis of a dilated pore of Winer was made. Dilated pores of Winer are follicular cysts arising from the infundibulum of the hair follicle. They are relatively common in humans and uncommon in cats, and single case reports have been described in a horse and a woodchuck (Marmota monax). To the best of the authors’ knowledge, this is the first description of a dilated pore of Winer in a dog.

EOSINOPHILIC ULCER MIMICKING FLOOR OF MOUTH SQUAMOUS CELL CARCINOMA

A 50-year-old woman sought health care, complaining of a growing lesion below the tongue, with approximately 2 months of evolution, including problems with speech and swallowing. She was a non-smoker and non-alcoholic patient, with a history of breast cancer at age 37, with a cured outcome but without periodic follow-up. Clinical examination revealed an ulcerated lesion (± 3cm) with hard edges and a necrotic center, located on the left floor of the mouth and base of the tongue, asymptomatic on palpation. The clinical diagnostic hypothesis was squamous cell carcinoma. Incisional biopsy was performed. Microscopic analysis revealed hyperparakeratinized and hyperplastic squamous epithelium, with an extensive area of ulceration and granulation tissue with intense eosinophilic infiltrate in the submucosa. The final diagnosis was an eosinophilic ulcer. The 15-day follow-up revealed a spontaneous regression of more than two thirds of the lesion. Final diagnosis was made through the correlation of clinical and microscopic findings, confirming an eosinophilic ulcer lesion. A 50-year-old woman sought health care, complaining of a growing lesion below the tongue, with approximately 2 months of evolution, including problems with speech and swallowing. She was a non-smoker and non-alcoholic patient, with a history of breast cancer at age 37, with a cured outcome but without periodic follow-up. Clinical examination revealed an ulcerated lesion (± 3cm) with hard edges and a necrotic center, located on the left floor of the mouth and base of the tongue, asymptomatic on palpation. The clinical diagnostic hypothesis was squamous cell carcinoma. Incisional biopsy was performed. Microscopic analysis revealed hyperparakeratinized and hyperplastic squamous epithelium, with an extensive area of ulceration and granulation tissue with intense eosinophilic infiltrate in the submucosa. The final diagnosis was an eosinophilic ulcer. The 15-day follow-up revealed a spontaneous regression of more than two thirds of the lesion. Final diagnosis was made through the correlation of clinical and microscopic findings, confirming an eosinophilic ulcer lesion.

ORAL FIBROLIPOMA IN THE BUCCAL MUCOSA

A 71-year-old female patient, totally edentulous, presented an asymptomatic lesion in the right buccal mucosa, close to the mandibular branch. Clinically the lesion showed a pedunculated nodule with a smooth surface, normal coloring, softened consistency, measuring approximately 2cm x 2cm. The patient reported a slow growth, with a 4-year evolution. No ulcerations were observed in the region. According to these characteristics, the clinical diagnostic hypotheses were inflammatory fibrous hyperplasia, fibroma, or lipoma. Therefore, the tumor was excised under local anesthesia, and the specimen was submitted to histopathological analysis. Microscopically, we observed a nodular limited lesion with dispersed mature adipocyte proliferation in a dense collagenous fibrous stroma, and lined with hyperplastic and hyperkeratotic squamous epithelium. Given these characteristics, the lesion was diagnosed as fibrolipoma, a histopathological variant of lipoma that is rare in the buccal mucosa. The treatment was concluded with surgical excision and, currently, the patient has shown no recurrence. A 71-year-old female patient, totally edentulous, presented an asymptomatic lesion in the right buccal mucosa, close to the mandibular branch. Clinically the lesion showed a pedunculated nodule with a smooth surface, normal coloring, softened consistency, measuring approximately 2cm x 2cm. The patient reported a slow growth, with a 4-year evolution. No ulcerations were observed in the region. According to these characteristics, the clinical diagnostic hypotheses were inflammatory fibrous hyperplasia, fibroma, or lipoma. Therefore, the tumor was excised under local anesthesia, and the specimen was submitted to histopathological analysis. Microscopically, we observed a nodular limited lesion with dispersed mature adipocyte proliferation in a dense collagenous fibrous stroma, and lined with hyperplastic and hyperkeratotic squamous epithelium. Given these characteristics, the lesion was diagnosed as fibrolipoma, a histopathological variant of lipoma that is rare in the buccal mucosa. The treatment was concluded with surgical excision and, currently, the patient has shown no recurrence.

Concurrent Occurrence of Nasopharyngeal and Disseminated Cutaneous Rhinosporidiosis: A Rare Presentation.

Concurrent Occurrence of Nasopharyngeal and Disseminated Cutaneous Rhinosporidiosis: A Rare Presentation.

Anterior segment optical coherence tomography features of ocular surface squamous epithelial hyperplasia: A report of four cases.

Herein, we report the clinico-tomographic and histopathological features of four patients with biopsy-proven ocular surface squamous epithelial hyperplasia (OSSEH), a close mimicker of ocular surface squamous neoplasia (OSSN). The mean age at diagnosis was 58 years (median, 60 years; range, 35-77 years). All lesions were unilateral. Isolated corneal plaque was seen in 50% (n = 2) and nodular lesion at the nasal limbus in 50% (n = 2). Keratinization was seen in 75% (n = 3) of lesions and intrinsic vessels in 75% (n = 3). A clinical diagnosis of OSSN was made in all cases. Anterior segment optical coherence tomography (ASOCT) revealed mild epithelial hyperreflectivity in 100% (n = 4). The epithelium was normal in thickness in 75% (n = 3) and showed mild thickening in 25% (n = 1). Only 25% (n = 1) showed abrupt transition in epithelial thickness from the contiguous corneal epithelium. Histopathological examination revealed hyperplastic squamous epithelium and no cellular atypia in all cases. Stable ocular surface and no recurrences were noted at a mean follow-up of 17 months (median, 11 months; range, 2-43 months). Although OSSEH can mimic OSSN clinically, the presence of mild epithelial hyperreflectivity, lack of epithelial thickening, absence of abrupt transition from normal epithelium, and presence of subepithelial hyperreflectivity on ASOCT favor the diagnosis of OSSEH.

P268 Laryngeal Mucormycosis: does mucor take the voice away?

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjectiveThis case aims to highlight a unique presentation of Mucormycosis.Methods and ResultsA 57-year-old retired office supervisor, presented to the ENT department with complaints of hoarseness of voice ending with almost complete dysphonia over 6 months. There were no complaints of stridor, dyspnea or dysphagia. He had no history of prior surgery or tracheal intubation. On examination, a lesion over his right vocal cord was noted (Fig. 1) and underwent surgical excision of the lesion.HPE of the lesion (Fig. 2) showed hyperplastic stratified squamous epithelium which was partly ulcerated and covered by thick bands of necro-inflammatory material. Within the necrotic material were seen broad aseptate fungal hyphae. Beneath the necrotic material was inflamed granulation tissue with fibrosis. No tissue or vascular invasion was noted as per the report, however there was a recurrence of the lesion after 15 days.ID team opinion was sought in view of need for antifungals. Owing to financial constraints, CT chest could not be done, but his chest X-ray was normal. His HbA1c was 7.5%, which was suggestive of newly detected diabetes mellitus (DM).In this case, even though no angioinvasion or tissue invasion was reported, the presence of hyphae in the area of necrosis, the presence of inflammatory local tissue reaction, coupled with newly detected DM, prompted the ID team to advise treatment with amphotericin B followed by suspension posaconazole (GR was not available at the that time). The patient was not willing for treatment at the time. However, local recurrence of the lesion occurred 2 weeks later. Surgical resection along with posaconazole, TDM and close follow-up was advised. However, the patient was lost to follow-up, possibly due to loss of confidence in us?ConclusionThe importance of sending every surgically excised tissue for histopathology and culture has been highlighted by this case. Early ID opinion and AF therapy could have averted recurrence and loss of patient confidence. Chronic Granulomatous form of mucormycosis though rare, needs timely diagnosis and treatment in the form of surgical resection as well as systemic antifungal therapy.

Morphological Assessment Of Epithelium and Nucleus in Oral Submucous Fibrosis Individuals

Aim: To evaluate histomorphological alterations present within nucleus and epithelium in oral submucous fibrosis subjects Methods: This study recruited 50 clinically diagnosed cases of oral submucous fibrosis which were active chewers of areca nut and associated products. Oral mucosa tissue blocks were prepared and processed followed by staining with Hematoxylin & Eosin to observe morphological features. The findings were statistically analyzed through SPSS version 23 Results: Amongst the sample size of 50, 33(66%) of cases had pleomorphic nuclear structure out of which 21(91.3%) had prominent nucleoli. High statistical significance was appreciated relating to involvement of nuclear and nucleoli structure. In addition, epithelial demarcation was appreciated within epithelium present in disease. 37(74%) cases were histologically identified cases of fibrosed structure out of which 31(83.8%) of the subjects had hyperplasia in epithelial lining. Hyperplastic epithelium was significantly correlated with OSMF. However, strength of association was weak with a p value of 0.04 Conclusion: The results revealed pleomorphism in nuclei underlining a strong association of structural alteration with disease initiation and progression. Hyperplastic stratified squamous epithelium was found in abundance which could be attributed to adaptive response of epithelium to inflammatory alkaloids present in areca nut products. Such findings could serve as trigger factor for oral submucous fibrosis and should be considered significant for early diagnosis and treatment management. Keywords: Oral submucous fibrosis,epithelium, nuclei, nucleoli, histology.

Odontogenic hamartomas in cultured angelfish (Pterophyllum scalare)

Odontogenic tumors present diverse clinical and histopathological behaviors that range from benign odontoma or hamartoma lesions to malignant tumors. In angelfish Pterophyllum scalare , findings of tumorous masses have been reported in the frontal region of the mouth, encompassing both the maxilla and mandible. Histologically, oral tumors have been characterized as angelfish lip fibroma or ameloblastoma. In this report, we describe the occurrence of a compound odontoma/hamartoma in 60 angelfish from a population of 300, all of which were collected from a Mexican ornamental fish farm. All fish presented a tumor-like mass on the rostral part of the mouth. Histological analyses revealed the tumor-like mass was covered by a hyperplastic stratified squamous epithelium, with fully differentiated denticles in various states of organization, immersed among normal dental tissues and showing a mild disorganized pattern. Radiograph analysis revealed radiopaque denticles in a radiolucent protuberance. Bacterial and viral isolation procedures and electron microscopy analysis revealed no presence of these microorganisms. Although findings of odontogenic tumors in the mouth of angelfish are reported as sporadic, our study detected odontogenic mouth tumors in 60 angelfish, but the possible cause of alteration is not yet clarified. Further research is needed to clarify pathogenesis and to identify possible genetic abnormalities.

CLINICAL AND HISTOPATHOLOGIC CHARACTERISTICS OF HEREDITARY BENIGN INTRAEPITHELIAL DYSKERATOSIS

A 55-year-old male with leukoderma, retired, had a main complaint of having a white spot on the tongue, unknown evolution time. The patient had no systemic history and was an ex-smoker (35 years). Clinically, he had a white plaque on the right lateral border of the tongue, asymptomatic, 5.0 × 1.5 cm in diameter, resilient, smooth surface, homogeneous, and well delimited. In addition, he had whitish plaques in the eyes. Incisional biopsy revealed oral mucosa consisting of hyperplastic stratified squamous epithelium, with areas of acanthosis, and cells of the middle and superficial layers were vacuolized with clear cytoplasm (basket weave aspect). Underlying, fibrous connective tissue with an extensive area of skeletal muscle fibers interspersed with adipose cells was noted. Due to clinical and histopathologic findings, the diagnosis was hereditary benign intraepithelial dyskeratosis. The patient reported not knowing if anyone in the family showed the same lesion. The conduct was clinical preservation and periodic controls.

BENIGN NONODONTOGENIC NEOPLASM LESION ON THE PALATE

A 60-year-old woman with leukoderma, retired, presented with a main complaint of “ball in the roof of the mouth,” evolution of 10 years, without change of size, and she had used a partial removable prosthesis for 20 years. However, in the last month she began to feel pain. She was a smoker for 10 years (1 pack/d). Clinical examination showed a nodule on the palate, normocorate, in the tooth region 24/25, 1 cm in diameter, hard to palpation, smooth surface, with defined and regular borders. An excisional biopsy was performed, which revealed gingival mucosa with hyperplastic parakeratinized squamous epithelium, and submucosa with fascicular arrangements of young fibroblast cells in dense bundles of collagen fibers. In the depth connective tissue, salivary glands with acinar atrophy and mononuclear inflammatory infiltrate and ductal dilation were noted. The diagnosis was fibroma, benign neoplasm uncommon in the oral mucosa. In the postoperative period, good healing was observed without recurrences.

ATYPICAL MANIFESTATION OF ORAL LICHEN PLANUS

White plaques on oral mucosa associated with patient habits often receive clinical diagnosis of leukoplakia. A 55-year-old woman, ex-smoker and ex-alcoholic, sought dental care for oral rehabilitation. On intraoral examination, an asymptomatic white plaque in the tongue margin measuring approximately 2.5 × 2.0 cm of indeterminate time was observed. The diagnostic hypothesis was leukoplakia. Incisional biopsy was performed, and microscopic analysis revealed hyperplastic hyperparakeratinized stratified squamous epithelium, sawtooth-shaped rete ridges, mitotic figures, Civatte bodies, and an underlying lymphocytic inflammatory infiltrate in the band and juxta-epithelial invading and disorganizing the basal layer of the epithelium, cleft at the epithelial-connective interface, with final diagnosis of lichen planus. This report shows an atypical and rare presentation of oral lichen planus and shows that the diagnosis of white lesions becomes challenging when there are overlapping clinical features. The patient was referred for treatment and is followed up. Acknowledgments: CNPq.

Esophageal-Crop Capillariasis and Proventriculus Ventriculus Hystrichisiasis in a Migratory Duck (Anas crecca)

The aim of the present study was to study pathological and parasitological characteristics of simultaneous capillariasis and hystrichiasis in a diseased Anas crecca captured in Mazandaran Province of Iran on Oct 2016. Parasitology and histopathology techniques were used to detect the parasites of the carcass of the captive common teal. Macroscopically, severe chronic inflammatory reactions and nodular or granuloma formation and irregular thickening of the affected wall of the esophagus, crop, proventrculus and ventriculus were observed. Microscopically, apart from the chronic inflammatory reactions and granuloma formation, in the paraffin sections stained with Harris Hematoxyline and Eosin technique, the characteristics of the mature female and male Capillaria spp. and their barrel-shaped operculated embryonated eggs were found within the tunnels burrowed by the nematode in the hyperplastic stratified squamous epithelium of the inflamed crop and distal portion of the esophagus. The mature female Hystrichis spp. containing oval-shaped, embryonated non-operculated eggs and male parasite were found within the labyrinthus spaces formed in the submucosa granulomas of the ventriculus and proventriculus. Based on the parasitological and pathological studies, the species of the nematode parasites were identified as Capillaria (Thominx) contorta and Hystrichis. tricolor.

Esophageal Parakeratosis: Not All White Plaques Are Candida

Endoscopic appearance and clinical significance of esophageal parakeratosis have not been well described. We report a case of esophageal parakeratosis which presented as whitish plaques mimicking candidiasis. A 67-year-old male presented to our clinic for evaluation of progressive solid food dysphagia of one-month duration. His medical history was significant for active tobacco use, congestive heart failure and coronary artery disease. Physical examination of mouth, oropharynx and head and neck region did not disclose any abnormal findings. Upper endoscopy showed friable mid to distal esophageal mucosa. Biopsies showed severe active fungal esophagitis consistent with candida species. PAS-D stain was also positive for fungal organisms. Patient was prescribed fluconazole 400mg loading dose followed by 200mg daily for 2 weeks. A repeat upper endoscopy in 4 weeks again showed diffuse white plaques in mid and distal esophagus (Figure 1). Mucosal biopsies were obtained and patient was prescribed voriconazole for suspected resistant candida species. Interestingly the microscopic examination showed hyperplastic squamous epithelium with marked parakeratosis. PAS-D stain was negative for fungus. Antifungal treatment was discontinued and a repeat upper endoscopy in 4 weeks showed similar whitish plaques throughout mid to distal esophagus consistent with parakeratosis. Patient's dysphagia resolved after initial antifungal treatment and was discharged from clinic. Endoscopic findings of esophageal parakeratosis have not been well described. It can present as linear plaques, mucosal thickenings with rings and furrows or as a discrete flat elevated lesion. These findings can easily mimic endoscopic appearance of eosinophilic esophagitis, candida esophagitis and even neoplastic lesions like squamous cell cancer or dysplasia. Parakeratosis had been found to be associated with alcoholic cirrhosis, tylosis and zinc deficiency. In one reported case series involving 100 esophagectomies for esophageal cancer, parakeratosis was present in non-cancerous portion of mucosa in 90% of the specimens. However, there are no reports of progression of parakeratosis to dysplasia or cancer. We could not find any recommendations in literature regarding treatment or surveillance of this condition. Our case highlights the importance of considering all the possible differential diagnosis for whitish plaques in esophagus before resorting to prolonged courses of antifungal drugs.1740 Figure 1. Whitish Plaques of parakeratosis

Glycogenic acanthosis on mouth clinically present as white plaque

ABSTRACT Glycogenic acanthosis is a benign condition, commonly observed during endoscopic procedures in older patients, which present as slightly elevated whitish plaques often on the lower third of the oesophagus. Microscopically, glycogenic acanthosis is composed of hyperplastic squamous epithelium with intracytoplasmic glycogen deposits. The extraoesophageal glycogenic acanthosis is extremely rare, with only three case reports in the English-language literature. We report a white lesion showing glycogenic acanthosis-like features located on the left posterolateral border of the tongue, affecting a 56-year-old male patient. The medical history was non-contributory and the patient did not show any lesions during endoscopic examination of the oesophagus, stomach, and upper duodenum. Glycogenic acanthosis is a benign condition, which should be included in the differential diagnosis when assessing oral white lesions. It is important also to recognize this benign condition early and rule out the possibility of other more severe diseases, but further studies were necessary for better define their potential for persistence or recurrence, as observed in the current case.

Re-Irradiation of Recurrent Buccal Mucosa Cancer Utilizing Customized Intraoral Mold-Based HDR Brachytherapy

Feasibility of re-irradiation in recurrent buccal mucosa squamous cell carcinoma after definitive external beam radiation therapy utilizing customized intraoral mold HDR brachytherapy, An 82-year-old male with a 3-year history of right buccal mucosal lesions, diagnosed as moderate dysplasia with inability to rule out invasion, was referred to radiation oncology as he was not a surgical candidate. Examination demonstrated extensive erythematous lesions involving the right oral commissure, gingivobuccal sulcus, right anterior tonsillar pillar, and soft and hard palate. He received 70 Gy in 35 fractions with a complete treatment response; however, 6 months later, he presented with stomatalgia and oral mucosa bleeding. Physical examination revealed new ulcerations of the right lower vermillion lip and exophytic plaque-like lesions along the posterior right maxillary alveolar ridge extending to the gingivobuccal sulcus and along the buccal mucosa and hard and soft palate. Biopsy of the tumor demonstrated hyperplastic squamous epithelium with mild to moderate dysplasia. Initially, the patient declined surgical treatment but returned as the tumors became more symptomatic. Subsequently, decision was made to treat with intraoral HDR brachytherapy as this was a previously irradiated field. Impressions were made and a customized mold was embedded with UV exposed low-Z shielding, which allowed for kV CT treatment planning. Eight 6-French catheters were inserted into the mold and a CT scan was obtained to determine the mold composition and needle placement. Modifications were made and a fitting test was conducted to assess reproducibility and comfort. A neck brace was constructed to secure the mold placement. Two CT simulations were obtained: one with contrast to delineate the extent of the tumor, and the other without contrast but with addition of radiopaque markers inside catheters to digitally reconstruct the source path. Rigid registration fused the two CT scans and the clinical target volume (CTV) and mandible were delineated. We prescribed 30 Gy in 10 fractions using the following criteria: CTV target, V90% ≥90% (28.6 Gy2/2) and mandible, D0.1cc < 28.6 Gy2/2 was a hard constraint. HDR plan produced a CTV V90%= 90.7%, V200% = 2.4 cc. Mandible D0.1cc received 25.9 Gy2/2. Prior to fraction 6 of 10, the plan was modified to address medial soft palate contours as a result of tumor shrinkage. Adaptive planning on new image data sets used the same criteria as the original plan. Soft palate D0.1cc was reduced by 9%. Patient completed treatment without complications or interruptions. Four months after treatment, he had no evidence of disease recurrence. This report demonstrates the design and use of non-invasive intraoral mold brachytherapy as a promising treatment modality for complex tumor recurrences within the oral cavity.

Contiguous verrucous proliferations in syringocystadenoma papilliferum: A retrospective analysis with additional evaluation via mutation-specific BRAFV600E immunohistochemistry.

Syringocystadenoma papilliferum (SCAP) is an uncommon cutaneous adnexal proliferation. There have been several reports describing collision lesions of SCAP and verruca, although little is known about the frequency of this association. Molecular testing has revealed the BRAFV600E mutation in a large proportion of SCAP cases, although its expression pattern has not been previously evaluated. In this retrospective analysis, we explored the potential histopathological association between verruca and SCAP. We also evaluated mutation-specific BRAFV600E expression in these lesions by immunohistochemistry. Cases of SCAP diagnosed over a 7-year period were closely reviewed for the presence of contiguous verrucous proliferations. Additional sections were cut and stained using the BRAFV600E-specific clone VE1 antibody. Contiguous verrucous proliferations were identified in 9 out of 12 identified cases. Furthermore, expression of the BRAFV600E mutation was identified in 7 out of 12 cases. Interestingly, in SCAP associated with endophytic verrucous proliferations (n = 4), expression of BRAFV600E was found in both the glandular and the contiguous hyperplastic squamous epithelium. Overall, these findings suggest that contiguous verrucous proliferations in SCAP are common. Both components of the neoplasm may express the BRAFV600E mutation, which is suggestive of a common origin.

Pyogenic Granuloma of the Esophagus

A 59-year-old man had a 1-month history of intermittent dysphagia for solid food. There was no odynophagia, heartburn, regurgitation, or weight loss. Esophagogastroduodenoscopy showed a pedunculated red polyp measuring approximately 15 mm in diameter in the esophagus 25 cm from the incisor teeth and an adherent white deposit on the head (Figure A). Thus, he was referred for management. The physical examination and laboratory testing revealed no remarkable abnormalities. The tumor markers, including carcinoembryonic antigen, carbohydrate antigen 19-9, and alpha fetoprotein, were within normal limits. Endoscopic ultrasonography revealed a homogenous, hyperechoic lesion; the lesion was primarily confined to the mucosal layer and had clear borders (Figure B). A computed tomography scan demonstrated a well-defined, expansive mass in the middle esophagus (Figure C). The lesion was entirely removed without complications by using endoscopic submucosal dissection. Pathologic examination of the resected specimen revealed a surface covered by hyperplastic squamous epithelium and inflamed and edematous stroma containing numerous capillaries with a lobular arrangement (Figure D; hematoxylin-eosin; original magnification, ×40). A diagnosis of pyogenic granuloma (PG) was made. A PG is a lobular capillary hemangioma that presents as a polypoid red mass several millimeters to centimeters in size. PGs commonly occur on the skin and oral mucosa; however, a gastrointestinal PG is extremely rare. Only 21 cases of esophageal PGs have been published since esophageal PG was first described in 1983 by Okumura et al.1Okumura T. Tanoue S. Chiba K. et al.Lobular capillary hemangioma of the esophagus: a case report and review of the literature.Acta Pathol Jpn. 1983; 33: 1303-1308PubMed Google Scholar Nearly one-half of the reported esophageal PGs (10 of 21) have occurred in patients >60 years of age. The symptoms described in these patients included dysphagia, retrosternal pain, weight loss, and bleeding; however, some patients were asymptomatic. On the basis of endoscopy, PG is a pedunculated polyp that is mostly red in color with a white coating and occasional ulcerations, which can mimic esophageal cancer. The rapid growth and metamorphic nature of esophageal PG can serve as diagnostic clues.2Iwamuro M. Okada H. Tanaka T. et al.Morphological changes in a pyogenic granuloma of the esophagus observed over three years.Intern Med. 2015; 54: 1737-1740Crossref PubMed Scopus (2) Google Scholar Endoscopic ultrasonography showed that the lesions are homogeneously hyperechogenic, which reflects the proliferation of blood vessels in lesions like hemangiomas. Because PGs are highly vascular lesions, massive bleeding is expected after biopsy. We should avoid endoscopic biopsy for histologic diagnosis. The differential diagnosis for esophageal PGs includes inflammatory polyps, bacillary angiomatosis, angiosarcomas, reactive angioendotheliomatosis, and angiomatous variants of Kaposi sarcoma. The definitive diagnosis that is based on histopathologic evaluation is characterized by proliferating capillaries surrounded by inflammatory cells in a loose connective tissue stroma. Endoscopic mucosal resection and endoscopic snare polypectomy are the preferred treatment options for esophageal PGs3Seoung H.G. Kim G.H. Song G.A. et al.Esophageal pyogenic granuloma: endosonographic findings and endoscopic treatments.Clin Endosc. 2013; 46: 81-84Crossref PubMed Scopus (6) Google Scholar; however, it should be noted that incomplete excision can result in local recurrence.2Iwamuro M. Okada H. Tanaka T. et al.Morphological changes in a pyogenic granuloma of the esophagus observed over three years.Intern Med. 2015; 54: 1737-1740Crossref PubMed Scopus (2) Google Scholar In the current case, carcinosarcoma was also considered in the differential diagnosis, so endoscopic submucosal dissection was performed to completely remove the lesion. PGs are benign tumors, and no cases of malignant transformation have been reported; however, a case of PG co-occurring with esophageal squamous cell carcinoma has been reported.4Yu J.H. Seo K.J. Cho Y.S. Unusual esophageal mass as a cause of dysphagia.Gastroenterology. 2016; 150: e1-e2Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar In conclusion, PG is a polypoid capillary hemangioma. Because of its unusual appearance, PG can be misdiagnosed and treated as esophageal carcinoma with extensive surgery. Familiarity with this infrequent benign lesion facilitates the diagnosis and proper treatment.