Pseudoepitheliomatous Hyperplasia Research Articles

PARACOCCIDIOIDOMYCOSIS OF THE CHEEK: CASE REPORT

Paracoccidioidomycosis (PCM) is a disease caused by the fungus Paracoccidioides brasiliensis, which is common in Brazil and some other areas in Latin America. We report a case of a 50-year-old male patient, a farm worker and smoker, presenting an asymptomatic ulcerated lesion with moriform appearance in the left buccal mucosa and uncertain time of evolution. The presumptive diagnosis was PCM. The patient underwent incisional biopsy, and histopathologic analysis revealed pseudoepitheliomatous hyperplasia and granulomatous inflammatory reaction. Ovoid yeasts with birefringent membrane were also evidenced. Grocott-stained slices demonstrated the presence of microorganisms exhibiting multiple buddings (ship´s wheel appearances) and double buddings (Mickey Mouse ears). The diagnosis was PCM. The patient was referred to the infectious diseases specialist for treatment of the lesion. Although PCM affects lungs primarily, it is often diagnosed through oral manifestation. Thus, dentists play a fundamental role in the identification of these lesions and referral for appropriate treatment. Paracoccidioidomycosis (PCM) is a disease caused by the fungus Paracoccidioides brasiliensis, which is common in Brazil and some other areas in Latin America. We report a case of a 50-year-old male patient, a farm worker and smoker, presenting an asymptomatic ulcerated lesion with moriform appearance in the left buccal mucosa and uncertain time of evolution. The presumptive diagnosis was PCM. The patient underwent incisional biopsy, and histopathologic analysis revealed pseudoepitheliomatous hyperplasia and granulomatous inflammatory reaction. Ovoid yeasts with birefringent membrane were also evidenced. Grocott-stained slices demonstrated the presence of microorganisms exhibiting multiple buddings (ship´s wheel appearances) and double buddings (Mickey Mouse ears). The diagnosis was PCM. The patient was referred to the infectious diseases specialist for treatment of the lesion. Although PCM affects lungs primarily, it is often diagnosed through oral manifestation. Thus, dentists play a fundamental role in the identification of these lesions and referral for appropriate treatment.

1799 A Rare Cause of Dysphagia-Mucosal Leishmaniasis

INTRODUCTION: Leishmaniasis is a parasitic disease spread by the bite of infected sand flies. Depending on the location of tissue or organ involvement, it may be described as cutaneous, mucosal or visceral. We present a case of mucosal leishmaniasis, exclusively involving the upper aerodigestive tract with primary symptom of dysphagia. This pattern of anatomical involvement is uncommon, and tissue biopsies may be non-specific, leading to delays in diagnosis and treatment. In our case immunohistochemical staining, molecular studies and clinical suspicion were required for the diagnosis. CASE DESCRIPTION/METHODS: A 42-year-old Hispanic man presented to the clinic with a 4-month history of progressive dysphagia. He denied sinonasal or respiratory symptoms. He had normal vital signs. Oral examination revealed a large painless exophytic mass replacing the soft and hard palates, extending to the hypopharynx (Figure 1). A CT scan of the neck with contrast showed a severe infiltrative process throughout the upper aerodigestive tract extending from the oral cavity to the subglottic airway (Figure 2). Repeat biopsies were non-diagnostic initially, showing pseudoepitheliomatous hyperplasia without evidence of dysplasia or neoplasia. Work up for endemic fungal, tuberculous and non-infectious granulomatous etiologies were negative. Further histopathologic review led to immunohistochemical staining of biopsies and assays which were positive for Leishmania panamensis. He was treated with oral miltefosine. At a 3-month follow up, oropharyngeal lesions had substantially regressed (Figure 3) and his dysphagia resolved. Sustained improvement was noted at a 1-year follow up. DISCUSSION: Mucosal leishmaniasis may be caused by different species, including Leishmania braziliensis and panamensis. It results from lymphangitic or hematogenous spread of leishmania parasites, usually from a pre-existing skin lesion. Symptoms of dysphagia or odynophagia may be the primary manifestation. Lesions are mostly exophytic and commonly involve the tongue, palate, oropharynx or larynx. Diagnosis requires demonstration of leishmania amastigotes or positive immunohistochemical staining in biopsy samples. Different treatment modalities may be used. Miltefosine is the latest drug treatment approved by the FDA for mucosal leishmaniasis. A high index of suspicion is required for the diagnosis of mucosal leishmaniasis as it potentially mimics other granulomatous, neoplastic and infectious etiologies of the upper aerodigestive tract.

Lichenoid granulomatous dermatitis revisited: A retrospective case series

Lichenoid granulomatous dermatitis (LGD) is an uncommon reaction pattern for which clinical correlates can be difficult to establish. LGD combines vacuolar degeneration with variable types of granulomas. To determine clinical correlates of LGD. The laboratory information systems at the University of Florida, the Medical College of Wisconsin, and Inform Diagnostics Research Institute were queried to identify 56 cases of LGD. Cases were reviewed for information regarding eosinophils, plasma cells, deep perivascular infiltrates, granuloma subtype, parakeratosis, epidermal atrophy, psoriasiform epidermal changes, pseudoepitheliomatous hyperplasia, periadnexal inflammation, vasculitis, and red blood cell extravasation. The most common clinical correlates were drug eruption (39.3%, n=22) and lichenoid keratosis (19.6%, n=11). Tattoo reaction, postherpetic dermatitis, and scabies or postscabietic dermatitis each accounted for 7.1% (n=4) of cases. Pigmented purpuric dermatosis and lichen striatus each accounted for 5.4% (n=3) of cases. Dermal eosinophils (P=.005) and psoriasiform epidermal changes (P=.055) were associated with drug hypersensitivity. Perineural (P=.049) and perifollicular (P=.003) inflammation were associated with tattoo reaction and postherpetic dermatitis. Red blood cell extravasation was helpful in cases of pigmented purpuric dermatosis (P=.049). This study is limited by its retrospective nature and statistical power. Dermal eosinophilia, psoriasiform epidermal changes, periadnexal inflammation, and red blood cell extravasation might aid in the clinical diagnosis of patients with LGD.

Laryngeal Extranodal Nasal-type Natural Killer/T-cell Lymphoma: A Clinicopathologic Study of 31 Cases in China.

Extranodal natural killer/T-cell lymphoma, nasal-type (ENKTL-N) initially presented in larynx is a rare condition without distinctive clinicopathologic features, with a challenging pathologic diagnosis. This study aimed to evaluate the clinicopathologic features and diagnosis of laryngeal ENKTL-N and spread awareness regarding ENKTL-N. A series of 31 cases of laryngeal ENKTL in one Chinese institution over a 9-year interval was retrospectively analyzed. Median age was 50 years (range, 13 to 77 y) with a male/female ratio of 5.2:1 (26/5). All patients initially presented with hoarseness and/or laryngalgia, and 10 patients (32.3%) experienced B symptoms. The supraglottic region was the most common site of occurrence (58.1%), the glottic area being the rarest site (6.5%). The mucosal squamous epithelium was detected in 26 specimens and pseudoepitheliomatous hyperplasia was observed in 8 cases (8/26, 30.8%). "Keratin-pearls" and a "pseudoinvasive" pattern were observed in 2 cases. Follow-up data were available for 26 patients (83.9%), the median survival duration was 9 months, and the overall survival rate at 5 years was 29.6%. Univariate analysis revealed that patients experiencing B symptoms (P=0.019) and age above 60 years had a significantly low survival (P=0.049) and that combined radiotherapy and chemotherapy prolongs overall survival (P<0.001). Laryngeal ENKTL-N is a rare entity with high aggressiveness and a poor prognosis. Multiple biopsies are usually required owing to secondary infection and massive necrosis. Laryngeal EKTL-N may mimic inflammatory lesions or well-differentiated squamous cell carcinoma. Therefore, clinical vigilance is essential to prevent misdiagnosis or a delayed diagnosis.

GRANULAR CELL TUMOR S-100 NEGATIVE VARIANT

Granular cell tumor is a benign mesenchymal lesion that occurs more often in the oral cavity and skin. Its cell origin is controversial, including muscle, fibroblasts, neural crest, neural sheath and histiocytes. Granular cell tumors composed of larger and polygonal cells with abundant eosinophilic granular cytoplasm. Classic granular cell tumor shows positive immunostaining for S-100 and vimentin, and in some cases, positive CD68 staining is also reported positive. However, three cases of S100 negative granular cell tumor in oral mucosa and several cases in skin have also been reported in the literature recently. Therefore, the purpose of this study is to report a case of oral S100 negative granular cell tumor to increase the awareness of this entity. A 79-year-old female patient presented with a small asymptomatic, circumscribed mass lesion in the posterior lateral aspect of the palatal torus. Histologically, the specimen was covered by keratinized stratified squamous epithelium showing no pseudoepitheliomatous hyperplasia. The lamina propria consisted of fibrous connective tissue with chronic inflammation and cluster or sheet of large polygonal cells with granular cytoplasm. Immunohistochemistry showed that the granular cells stain positive for CD68 but negative for S100. Currently there is no difference in recommended treatment or in prognosis of S100 negative from S100 positive granular cell tumor. However, it is important to be aware of this rare variant of granular cell tumor for stablishing correct diagnosis.

First report of Straelensia cynotis Fain and Le Net, 2000 (Trombidiformes: Leeuwenhoekiidae) parasitizing Capra pyrenaica (Artiodactyla: Bovidae) with histopathological analysis

ABSTRACTThe chigger mite Straelensia cynotis Fain and Le Net, 2000 is the etiological agent of a trombiculiasis characterized by nodular dermatitis known as “straelensiosis”. Until now, dogs and cats were the known hosts of this mite. This study is the first record of S. cynotis parasitizing an Artiodactylan host, Capra pyrenaica Schinz. Additionally, this case report describes the lesions caused by this mite and observes a focally extensive, hyperpigmented and lichenified skin lesion in the left hind leg. Histologically, the lesion was characterized by pseudoepitheliomatous hyperplasia with perifollicular mucinosis. In the margins, each dilated follicle contained a larval mite.

Late-onset pseudoepitheliomatous hyperplasia developing within a red ink tattoo

The popularity of tattoos has increased dramatically worldwide particularly in the last three decades, giving rise to the frequent occurrence of a wide spectrum of secondary cutaneous and systemic complications. Pseudoepitheliomatous hyperplasia (PEH) is a benign irregular hyperplasia of the epidermis occurring in response to various stimuli, that clinically and histopathologically resembles cutaneous neoplasms such as squamous cell carcinoma and keratoacanthoma. In an attempt to improve the awareness of the possible occurrence of PEH in tattoos and of its diagnostic and therapeutic aspects, we present herein the case of a 30-year-old woman with histologically confirmed PEH related to a red-ink tattoo. She revealed two important features: the longest interval reported so far between tattooing and onset of PEH (two years) and the lack of the otherwise very common lichenoid tissue reaction to red ink. In view of the serious toxicological potential of tattoo inks, implementation of updated and standardized regulations worldwide regarding their use in the tattooing process is now urgently warranted and continuous efforts should be undertaken in order to enhance the awareness among tattoo artists and the public with regard to the possible serious health risks associated with the use of tattoo ink pigments.

A case of malignant melanoma with pseudoepitheliomatous hyperplasia wherein the differential diagnosis included squamous cell carcinoma

A case of malignant melanoma with pseudoepitheliomatous hyperplasia wherein the differential diagnosis included squamous cell carcinoma

Histological analysis of 41 dentigerous cysts in a paediatric population.

Dentigerous cysts are usually of developmental nature but may be of inflammatory origin especially in paediatric populations. It is important to understand the histological features of dentigerous cysts to enable accurate diagnosis. The aim of this study is to present epidemiological, clinical features and histopathological features of dentigerous cysts seen in a paediatric tertiary referral hospital. The medical, radiographic and histopathology records of the Department of Pathology, Women's and Children's Hospital, Adelaide, Australia, during January 1998 to December 2013 were reviewed for patients with dentigerous cysts. All cases were re-examined by a specialist oral pathologist, consultant paediatric pathologist and paediatric dentistry registrar. Forty-one cases of dentigerous cysts were found. Patients in the permanent dentition were most frequently affected. Male predilection was observed (male:female 2.42:1). The posterior mandible was the most frequently affected region (63.42%) although maxillary canines were the teeth most commonly associated with dentigerous cysts (29.27%). The majority of cases were incidental findings. Squamous epithelium showing pseudoepitheliomatous hyperplasia (46%) was frequently observed and was significantly present with thicker epithelium (P<0.0001) and an acute and chronic inflammatory infiltrate (P<0.001). Inflammatory infiltrate was seen in 75.6% of cases. The current study provides increased knowledge of the histological features of dentigerous cysts in a large retrospective series of paediatric patients and provides further evidence regarding the frequency of inflammatory dentigerous cysts.

Palatal Lesion Leading to the Diagnosis of Syphilis

A 30-year-old woman presented with a painful lesion in the hard and soft palates with 3 months of evolution. Extraoral examination revealed painless brownish nodules in the nose, legs, back, palms of hands, and soles of feet. Incisional biopsy was performed under local anesthesia on the hard palate, and serology for syphilis (Venereal Disease Research Laboratory and fluorescent treponemal antibody absorption) yielded positive results. The histopathologic report was descriptive, containing the following: pseudoepitheliomatous hyperplasia and underlying inflammatory infiltrate containing neutrophils, histiocytes, and plasma cells, demonstrating foci of granulomatous inflammation with well-circumscribed collections of histiocytes and multinucleated giant cells; the findings were considered compatible with the clinical hypothesis of syphilis. The patient was referred for medical treatment, and follow-up visit within a short period demonstrated complete regression of the lesion in the palate. The patient is still undergoing medical treatment and follow-up.

Synchronous Lipoma and Epithelial Dysplasia on Both Sides of Tongue: Report of a Case

Synchronous lesions (SLs) are primary diseases that arise in the same patient with a maximum interval of 6 months. We report the case of a 69-year-old man, presenting with an asymptomatic yellowish nodular lesion of resilient consistency on the right side of the border of the tongue; an asymptomatic polypoid lesion with ulcerated areas was observed on the left side. Provisional diagnoses of lipoma and epidermoid carcinoma were established, for which excisional and incisional biopsies were performed, respectively. Pathologic analysis of the first lesion revealed proliferation of mature adipocytes in a lobular arrangement, and the second lesion showed deep and irregular hyperplasia of oral squamous epithelium with focal areas of atypia. The diagnosis was lipoma and mild epithelial dysplasia with pseudoepitheliomatous hyperplasia. A discussion on the relevance of SL of the oral mucosa will be provided, particularly the rarity of unrelated lesions with distinct biologic nature.

Analysis of laser therapy effects in Sporothrix schenckii inactivation in vivo

Abstract Introduction Sporotrichosis is a common disease in tropical regions, caused by the fungus Sporothrix schenckii, affecting mainly rural workers and in direct contact with animals. Although treatment by indiscriminate use of oral antifungal drugs gives rise resistant isolates, leading to therapeutic failures and no remission of the disease. To evaluate the effectiveness of red low-power laser photobiomodulation in inactivation of S. schenckii infection induced in rodents. Methods Subcutaneously inoculation (2x103 S. schenckii/ml, 0.2 ml suspension) in the left footpad, in 27 mice divided into: control (n = 6, inoculated, without irradiation): early stage (not inoculated) = 1th biopsy; intermediate (9 weeks of evolution) = 2nd biopsy; final (21 weeks of evolution) = 3th biopsy. Treated (n = 21, inoculated and irradiated): early (13 weeks of evolution, 4 weeks after first irradiation) = 4th biopsy, intermediate (17 weeks of evolution, 8 weeks after first irradiation) = 5th biopsy, final (21 weeks of evolution, 12 weeks after first irradiation) = 6th biopsy. Serial irradiation with biopsies occurred every 30 days during each month, for three months. At the end of testing, the mice were euthanized, and histological analyzes of biopsies were performed. Results Each laser treatment session showed an inactivation of S. schenckii in treated animals compared to controls, with a regression of pseudoepitheliomatous hyperplasia, chronic inflammation, neutrophils, granulomas, giant mononuclear cells and steroid corpuscles. Conclusion The laser photobiomodulation was effective on S. schenckii inactivation, appearing to be an interesting therapeutic option in infections caused by this organism.

A Case of Oral Florid Papillomatosis (Verrucous Carcinoma) With Lack of Evidence for Human Papillomavirus Involvement

To the Editor: Oral florid papillomatosis is best defined as a type of verrucous carcinoma, although some consider it a separate entity.1 It is characterized histopathologically by local invasion with minimal dysplasia, and biologically it is characterized by a low incidence of metastases.1 In contrast to the anogenital and plantar types of verrucous carcinoma which have shown a strong correlation with human papillomavirus (HPV) infection,2,3 there is conflicting evidence for HPV involvement in oral florid papillomatosis. Some studies have demonstrated a low presence of HPV in oral verrucous carcinoma,3–11 whereas others did not find evidence for its involvement in the pathogenesis of the oncogenic process.12–16 We report a case of oral florid papillomatosis (verrucous carcinoma) which failed to demonstrate HPV involvement altogether, using several techniques. An 83-year-old woman was referred to our clinic for verrucous lesion that appeared 5 years ago on the right buccal mucosa and then spread to the right lip. There was no history of smoking or oral lichen planus. The lesions were painful and caused functional impairment. On physical examination, she demonstrated confluent, verrucous, keratotic plaques in the entire right buccal mucosa, right oral commissures, and lips (Fig. 1). Three biopsies which were taken 4, 2, and 1 year before were reported to show: “pseudoepitheliomatous hyperplasia with inflammation,” “hyperkeratosis with lichenified features,” and “hyperplastic epithelium with mild atypia,” respectively. None of them showed clinicopathological features suggestive of HPV infection. The biopsy, which was performed in our clinic, demonstrated histopathological findings compatible with verrucous carcinoma (Fig. 2). Immunohistochemical staining for P16 was negative. In situ hybridization for HPV DNA 16 & 18 and polymerase chain reaction for HPV DNA extracted from the paraffin-embedded biopsy as previously described17,18 were all negative. Immunohistochemical staining using anti-HPV antibody [BPV-1/1H8 + CAMVIR] (ab 2417, Abcam), which identifies HPV 1,6,11,16-16, 18, and 31, was negative in the initial biopsy (4 years before) and in the current biopsy.FIGURE 1.: Verrucous hyperkeratotic plaques on the right buccal mucosa (A) extending to the right commissure and lateral upper and lower lips (B).FIGURE 2.: Histopathology of the lesion in Fig 1. A, Marked papillomatosis and downgrowth of the epithelium into the dermis. B, Higher magnification showing irregular crowding of keratinocytes with atypical nuclei and scant cytoplasm in the basal cell layer and above it. There is also “horn pearl” and several dyskeratotic keratinocytes. C, Downgrowth of the epithelium into the upper dermis surrounded by a dense inflammatory cell infiltrate. D, Higher magnification showing exocytosis of lymphocytes and dyskeratotic keratinocytes. There are also interface vacuolar changes in the basal cell layer.Positron emission tomography–computed tomography did not show involvement beyond the primary site and the patient was treated palliatively by local radiotherapy. In conclusion, our case study did not provide evidence for the role of HPV in the pathogenesis of oral florid papillomatosis (verrucous carcinoma).

Evaluation of Safe Systemic Immunosuppression Created with Dexamethasone in Prevention of Capsular Contracture: A Glance to Distinct Perspectives with Toll-Like Receptors.

The toll-like receptors (TLRs) stand at the interface of innate immune activation. We hypothesize to decrease the response of innate immunity activated by TLR4 by a safe, short-term, systemic immunosuppression. Two silicone block implants were placed into two dorsal subcutaneous pockets in 32 rats that were subdivided into four groups: The two study groups were the IV DEX group (single intravenous injection of dexamethasone 1h before surgery) and the IV DEX + IP DEX group (in addition to a single intravenous injection of dexamethasone 1h before surgery, intraperitoneal dexamethasone was administered for 10days after surgery), and the two control groups were the untreated control group and the saline-treated control group. After 10weeks, all animals were killed to determine capsular thickness, inflammatory cell density, presence of pseudoepitheliomatous hyperplasia, edema, necrosis, vascularization, TLR4 expression and myofibroblast proliferation. No significant difference was observed in any parameter between the untreated and saline-treated control groups (p > 0.05). Capsular thickness, myofibroblast proliferation, TLR4 expression density were statistically different amongstudy groupscompared to control (p < 0.05). This study demonstrates the relationship between toll-like receptors and fibrous capsule after implant surgery. Decreasing the innate immunity by a safe, short-term perioperative systemic immunosuppression resulted in decreased TLR4 expression and myofibroblast differentiation which could be a new research field in profibrotic pathophysiology underlying breast capsule formation. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

ULTRASTRUCTURAL FEATURES OF THE MAIN CLINICAL VARIANTS OF BASAL CELL CARCINOMA, AS A FACTOR DETERMINING THE BIOLOGICAL BEHAVIOR OF THE TUMOR

Histological variants of basal cell carcinoma (BСС) are characterized by a variety of structures depending on the location of the original tumor cells, their differentiation, the reaction of the surrounding tissue, the age of the patient, which causes a large number of histological classifications of the tumor. To evaluate the prognosis of the effectiveness of different treatment methods and the biological behavior of the ВCC, the clinical form and the corresponding histomorphological type of tumor are of great importance. Most of the primary foci of the ВCC are surface and micronodular (syn.: nodular) forms, rarely there is a scleroderm-like variant and extremely rarely fibroepithelioma of Pincus. Surface and micronodular forms of ВCC corresponding to the T1N0M0 characteristic (up to 2 cm in diameter) with a simple histological type of structure (multicentric, solidly compact) are regarded as tumors with a low risk of recurrence and progression. Materials and methods. Studying the features of the pathomorphological characteristics of the tumor and the frequency of various variants on the basis of an analysis of 223 ВCC biopsy specimens, we found that most often (54.7%) there was a solid type of tumor, less often -- superficial (12.7%), morphea (4.9% ), adenoid (10.9%), as well as ВCC with a piloidal (3.1%) and sebaceous (4.4%) differentiation. Among the biopsies analyzed in 6.8% of cases metatypic cancer was found. Conclusions: The histological structure of the tumor can determine its biological behavior and have prognostic significance. Thus, pronounced primitive angiogenesis, infiltrating growth and active stroma formation testify to tumor aggressiveness and clinically most correspond to the recurring macronodular and infiltrative clinical forms of BCC. The tumor is most aggressive in its basosquamous transformation, manifested in the emergence of two components of the tumor complex in the area of dyskeratosis and pseudoepitheliomatous hyperplasia of the epidermis: basal cell carcinoma and highly differentiated cancer, which corresponds to the formation of metatype skin cancer.

Histopathologic spectrum of reactions to black tattoo pigment: a report of five cases from India

There is an increasing prevalence of cutaneous adverse reactions to tattoos. The reactions range from inflammatory, infectious, to neoplastic conditions. Colored tattoo inks are most commonly implicated in such cases. Black tattoo pigment is generally considered inert. We describe a series of five cases of adverse reactions to black tattoo pigment, a rare feature. The age of these patients ranged from 17 to 24 years. There were four men and one woman. The patterns observed were lichenoid, tuberculoid granulomatous, granuloma annulare-like, pseudoepitheliomatous hyperplasia, and minimal dermal infiltrate.

Disseminated cutaneous sporotrichosis: an unusual case

Sporotrichosis is a subcutaneous mycosis caused by Sporothrix schenckii with endemic regions in the American continent. Clinical features depend on the immunological patient state and some characteristics of the fungus. Disseminated cutaneous sporotrichosis is a rare variant usually described in immunocompromised patients. A 42-year-old man was admitted with multiple verrucous and erythematous papules and plaques of the face and limbs. Many lesions showed an ulcerated and crusted component, some papules displayed linear arrangement, and some verrucous plaques exhibited black spots. Skin biopsy revealed pseudoepitheliomatous hyperplasia and granulomas in the papillary dermis. Culture of a skin sample grew Sporothrix schenkii. We report an unusual presentation of disseminated cutaneous sporotrichosis, which was a diagnostic challenge owing to polymorphism and spread of the lesions in a patient without an immunosuppressive state.

A RARE CASE OF PSEUDOEPITHELIOMATOUS HYPERPLASIA OF THE SKIN ARISING IN A TATTOO SITE

Literature analysis on prevalence and clinical manifestations of adverse reactions to tattoo inks has been performed. A clinical case of a rare tattoo complication, i.e., pseudoepitheliomatous hyperplasia caused by red tattoo ink, has been describe. Key words:tattoo, complications, pseudoepitheliomatous hyperplasia. Cite this article: Kuklin I.A., Volkova N.V., Kokhan M.M., Kungurov N.V., Zilberberg N.V., Safonova G.D., Kuklina M.K. A rare case of pseudoepitheliomatous hyperplasia of the skin arising in a tattoo site. RoJCED 2017;4(4):210-212 https://doi.org/10.26574/rojced.2017.4.4.210

Pseudoepitheliomatous Hyperplasia in the Setting of CD30+ Lymphoproliferative Disease: A Histologic Mimic of Squamous Cell Carcinoma that Exhibits Indolent Clinical Behavior

Pseudoepitheliomatous Hyperplasia in the Setting of CD30+ Lymphoproliferative Disease: A Histologic Mimic of Squamous Cell Carcinoma that Exhibits Indolent Clinical Behavior

Hypertrophic Lichen Planus versus Well-Differentiated Squamous Cell Carcinoma: A Histological Challenge

Differentiating hypertrophic lichen planus (LP) from well-differentiated squamous cell carcinoma (SCC) is a histological challenge given the numerous histopathologic similarities between SCC and pseudoepitheliomatous hyperplasia (PEH) arising in the setting of hypertrophic LP. Multiple reports have shown that SCC can arise from hypertrophic LP not infrequently, but that the LP-to-SCC sequence is poorly understood, and many cases defy diagnosis due to histologic similarities. However, there are several clinical clues and histopathologic details that have shown to have some value when trying to ascertain the correct diagnosis. To the contrary, immunohistochemical tests have shown little promise in differentiating hypertrophic LP from SCC. Although multiplex PCR has shown some potential in differentiating PEH from SCC, this has only been in the setting of patients diagnosed with prurigo and lichen simplex chronicus, but not necessarily in the case hypertrophic LP.