Pseudoepitheliomatous Hyperplasia Research Articles

Comparative study of histopathological diagnostic criteria in cutaneous lesions of lichen planus and discoid lupus erythematosus

Background and aims: Lichen planus (LP) and discoid lupus erythematosus (DLE) are two relatively common mucocutaneous lesions whose clinical and histopathological features overlap in some cases. The present study aimed to distinguish between these two lesions histopathologically in order to treat them more accurately. Methods: In a cross-sectional descriptive-analytical study, 29 and 48 microscopic slides of skin samples of DLE and LP, respectively, were examined in the pathology archive of Al-Zahra hospital of Isfahan from 2008 to 2018. The slides prepared by hematoxylin-eosin staining were examined simultaneously and blindly by three pathologists with a light microscope and compared according to certain histopathological criteria. Then obtained data were analyzed by SPSS version 24 using chi-square, Fisher’s exact, Mann-Whitney, and t tests (P<0.05). Results: Based on the findings, the presence of hyperparakeratosis with superficial hyperorthokeratosis, epithelial atrophy, deep perivascular infiltration, presence of edema in the papillary dermis, presence of plasma cells with lymphohistiocytes in inflammatory infiltration, and presence of mucin in the dermis were significantly higher in DLE than in LP (P<0.05). On the other hand, the intensity of lichenoid infiltration, presence of saw tooth hyperplasia of rete ridges, presence of cleft between the epithelium and connective tissue, spongiosis, hyperorthokeratosis alone, and wedge-shaped hypergranulosis were significantly higher in LP than in DLE (P<0.05). Conclusion: Perieccrine and perifollicular inflammation, presence of Civatte bodies (CBs), abundance of fibrosis, presence of pale keratinocytes, and presence of pseudoepitheliomatous hyperplasia were not the criteria for differential diagnosis of LP and DLE.

Granulomatosis with polyangiitis in gingiva: A rare case of isolated presentation.

Granulomatosis with polyangiitis (GPA) is a rare autoimmune disease characterized by necrotising granulomatous inflammation of upper and lower respiratory tract, vasculitis and glomerulonephritis. This ailment may present with cough, haemoptysis, sinusitis, nasal deformity, skin lesions, malaise, fever, anorexia, and weight loss. Oral manifestation includes strawberry gingivitis, which is a pathognomonic clinical presentation. Here, we present a case of GPA in gingiva as the first manifestation. Clinical examination of the oral cavity revealed granular, erythematous gingival enlargement in the lower anterior teeth region involving papilla, marginal and attached gingiva with shiny and pebbled surface. Histopathological examination showed pseudoepitheliomatous hyperplasia with vasculitis and inflammation in the connective tissue, neutrophilic infiltration and abscess formation with haemorrhage were noted. Laboratory investigations revealed Proteinase 3 (PR3) antigen and Glomerular basement membrane (GBM) antigen were positive. Clinical, histopathological and laboratory investigations enabled the diagnosis of Granulomatosis with Polyangiitis. We present this rare case report of GPA with primary manifestation in gingiva.

Disoriented collagen fibers and disorganized, fibrotic orbicularis oris muscle fiber with mitochondrial myopathy in non-syndromic cleft lip

ObjectiveThis study aims to explore and compare the histopathology of upper cleft lip tissue in order to identify the abnormalities and orientation of muscle and collagen fibers in patients affected with non-syndromic cleft lip with or without cleft palate (NSCL±P) and normal controls. Materials and methodsEight fresh lip tissues of consented patients with NSCL±P and two controls were fixed and stained with hematoxylin and eosin (H&E), Masson’s trichrome (MT), and modified Gomori trichrome techniques. The images were captured and examined using imaging cellSens software (Olympus, Tokyo, Japan) and Mirax Scan (Carl Zeiss, Germany). The H&E stained tissues were analysed for muscle fiber size using image processing program (imageJ, USA). Histopathological appearance of epidermal and dermal layers including collagen orientation, as well as muscle fibers abnormalities were observed. ResultsTissues stained with H&E exhibit pseudoepitheliomatous hyperplasia, epidermal and sebaceous glands hyperplasia. Morphometric analysis of muscle fibers showed the diameter was between 6.912 and 10.246 µm. Collagen fibers were densely packed in cleft tissue, but muscle fibers were sparse in MT stain. Modified Gomori trichrome stain revealed hypoplastic muscle with fibrosis, including ragged red fibers. ConclusionDisoriented collagen fibers, significant sparse and disorganized orbicularis oris muscle fibers with classical myopathic appearances proved that cleft tissue had abnormal histology findings. These findings further support the mechanism of collagen and muscle fibers during embryonic development that causing cleft formation.

Gingival Squamous Cell Carcinoma Masquerading as Localized Periodontal Disease in the Maxilla: A Case Report

Objectives: Squamous cell carcinoma is a malignant neoplasm of epithelium. In the U.S., carcinoma of the gingiva constitutes 4% to 16% of all oral carcinomas. This case report highlights such a case in maxillary gingiva and emphasizes the vital role of dental professionals, especially periodontists and endodontists, in being cognizant that an inflammatory lesion can mimic a serious condition like squamous cell carcinoma. Case Presentation: A patient who visited the screening clinic for an ulcerated lesion in the gingiva was otherwise healthy with no associated history of tobacco or any traumatic/persistent traumatic events. The patient was treated for pseudoepitheliomatous hyperplasia based on the current condition and negative history of malignancy. On three months of follow-up, computed tomography radiographic evaluation and a biopsy were done, which were positive for the malignancy. Follow-up after six months includes PET, Head MRI, and chest X-ray examinations to rule out any metastatic entity. Results: A six-month follow-up radiographic examination revealed metastasis of the entity. Additional findings include pleural effusion and underlying infections. Conclusion: Early diagnosis is the key to the treatment plan. It further highlights the role of advanced imaging as a vital tool in determining the extent of the disease. Therefore, any persistent lesion exhibiting features that are not responding to conventional gingival and periodontal treatment options for more than two weeks should be referred for further evaluation to rule out cancer.

Pseudoepitheliomatous hyperplasia: The link between sporotrichosis and squamous cell carcinoma

The pseudoepitheliomatous hyperplasia (PEH) is a benign condition. It is a reactive histological pattern characterized by hyperplasia of the epidermis and adnexal epithelium. Therefore, it can be found in several clinically heterogeneous diseases: Infections, neoplasms, dermatoses with inflammation/chronic irritation, and miscellaneous processes. Among the infections group, deep mycoses stand out, and squamous cell carcinoma (SCC) for the neoplasm. As these two lesions can be observed in the same body regions and present visually similar features, it is also natural that they can be mistaken, as seen in previous works. Thus, we propose an individually based, cross-sectional retrospective review of patients with confirmed sporotrichosis (from a total of 86 cutaneous sporotrichosis cases) in which squamous cell carcinoma was also suspected as a clinical hypothesis. Considering the small sample, a qualitative analysis of the results was made. This paper presents an explanation with a microscopic basis for this diagnostic error. We also recommend examining several histological sections, detailed clinical information, and the use of special stains to avoid misdiagnosis.

Multiple ulcerated lesions in a patient from Amazon, Brazil

Multiple ulcerated lesions in a patient from Amazon, Brazil

Immune Disregulation in Cutaneous Squamous Cell Carcinoma of Patients with Recessive Dystrophic Epidermolysis Bullosa: A Single Pilot Study.

Background: Cutaneous squamous cell carcinoma (cSCC) is one of the most devastating complications of recessive dystrophic epidermolysis bullosa (RDEB). We recently demonstrated a reduction in immune cell peritumoral infiltration in RDEB patients with cSCC, together with a reduction in CD3+, CD4+, CD68+ and CD20 lymphocytes as compared to primary and secondary cSCC in patients without RDEB. Recently, new molecules, such as high mobility group box 1 (HMGB1), T cell immunoglobulin, mucin domain 3 (TIM-3) and Heme oxygenase-1 (HO-1), have been shown to play a role in antitumoral immunity. Objective: Patients with RDEB are known to be at increased risk of developing skin cancers, including the dreaded squamous cell carcinoma of the. Tendentially, cSCCs that arise in the context of EBDR are more aggressive and lead to statistically significant bad outcomes compared to cSCCs developed on the skin of patients without EBDR. In an attempt to study the microenvironment of these lesions, we conducted an immunohistochemical analysis study of proteins that could be actively involved in the genesis of this type of malignant neoplasms. Methods: In this retrospective study, the OH1-HMGB1-TIM3 activation axis, as correlated to the T lymphocytes cell count, was assessed in biopsy samples from 31 consecutive cases consisting of 12 RDEB patients with cSCC, 12 patients with primary cSCC and 7 RDEB patients with pseudoepitheliomatous cutaneous hyperplasia. Parametric Student’s t-test was applied for normally distributed values, such as CD4+ and CD8+, and non-parametric Mann–Whitney test for non-normally distributed values, such as HMGB-1, TIM-3 and HO-1. Results: In RDEB patients with cSCC and with pseudoepitheliomatous hyperplasia, the expression of CD4 T helper lymphocytes was lower than in the peritumoral infiltrate found in primary cSCC. CD8 cytotoxic T lymphocytes were increased in primary cSCC compared to the other two groups. An increased HMGB1 expression was evident in both primary and RDEB cSCC. TIM3 expression was higher in RDEB patients with cSCC compared to the other two groups. A significantly reduced immunohistochemical expression of HO-1 was evident in the tumoral microenvironment of cSCC-RDEB as compared to primary cSCC. Conclusions: These data suggest that a reduced immune cell peritumoral infiltration in RDEB patients could be responsible, in the complexity of the mechanisms of carcinogenesis and host response, of the particular aggressiveness of the cSCC of RDEB patients, creating a substrate for greater local immunosuppression, which, potentially, can “open the doors” to development and eventual metastasis by this malignant neoplasm.

Histoplasmosis of the Head and Neck Region Mimicking Malignancy: A Clinic-Pathological Predicament.

Histoplasmosis is a systemic, deep mycotic infection caused by Histoplasma capsulatum. Disseminated histoplasmosis (DH) is synonymous with HIV seropositive immunocompromised individuals; however, isolated histoplasmosis involving the head and neck mucosal sites mimicking malignancy is a clinical predicament. The result, in a superficial biopsy with marked pseudoepitheliomatous hyperplasia (PEH), in a tertiary care cancer center where the number of squamous carcinomas far outnumber the infectious diseases, could be catastrophic. The archives of a tertiary care cancer hospital were searched (2010-2019) for cases of histoplasmosis involving the head and neck mucosal sites in HIV non-reactive patients. Six cases of isolated head and neck histoplasmosis were seen in biopsies from 4 men and 2 women, with an age range of 46-72 years. Three of these patients suffered from chronic illnesses. The most common site involved was the larynx (vocal cords) in three cases, two cases were involving lips, and one involving the tongue. The biopsies were reviewed in-house with a clinical diagnoses of malignancy in all and an outside biopsy diagnosis of "squamous cell carcinoma" in 2 cases. The important histological findings in the biopsy were PEH (3 cases), granulomas (2 cases), lymphoplasmacytic inflammation (all cases). Eosinophils were conspicuous by their absence. Intracellular histoplasma was seen in all cases, albeit to varying density, which was confirmed with GMS stain. A high index of suspicion, meticulous history taking by oncologists, and appropriate distinction of PEH from neoplastic squamous proliferation by pathologists in superficial biopsies and an apropos deeper wedge biopsy are essential to clinch the correct diagnosis.

An Observational Study of Head and Neck Squamous Carcinomas from a Tertiary Cancer Centre of Marathwada Region, Maharashtra, India

Introduction: Head and neck cancer constitutes about one third of all the cancers in India. Head and neck squamous carcinoma is an important cause of morbidity and mortality with variability in geographical location, age, gender, habits, socio-economic status. Aim: To identify changing trends in age, gender, sites involved and histopathological grades of malignant and analyse potentially malignant lesions in head and neck region in Marathwada region of Maharashtra, India. Materials and Methods: This observational retrospective descriptive study was carried out in tertiary cancer hospital in Marathwada region of Maharashtra, India, over a period of two years which included 1008 cases. All the biopsy cases and biopsies obtained under ultrasound and also to computed tomography guidance showing invasive squamous carcinoma and potentially malignant lesions of head and neck region with their histological analysis were studied. Relevant clinical and demographic details were noted and statistical analysis was done and results were explained in tables and percentage. Results: Total 1008 cases were studied. The maximum number of cases were in the age group of 51-60 years. Males were more affected than females. The buccal mucosa (29.5%) was most common site affected and maxilla (0.8%) the least. Histologically invasive tumour were well differentiated (17.65%), moderately differentiated (79.93%) and poorly differentiated (2.42%). Rest lesions were distributed in following categories: carcinoma- in-situ, verrucous neoplasm, dysplasia, atypical squamous proliferation, leukoplakia, pseudoepitheliomatous hyperplasia. Age wise, site wise, gender wise distribution of cases and association between site of lesions and gender and grade of tumour were studied. Conclusion: The associated risk factors, lifestyle patterns, habits, addictions and geographic and demographic factors, socio-economic status and evolving Human Papilloma Virus (HPV) association and pathogenesis are still topic of debate where much progress is still to be made. It deserves closer study. Apart from invasive squamous malignancies, precursor lesions if investigated at an earliest along with increasing awareness among population in relation to healthy lifestyle changes, habits followed by thorough clinical examination and histopathology and HPV association, possibility of planning specific strategies of prevention, diagnosis and treatment help reduce morbidity and mortality.

Clinico-histopathological Features of Pyoderma Gangrenosum: A Case Series

Pyoderma Gangrenosum (PG) is a rare, ulcerative, non infectious neutrophilic inflammatory dermatosis and often associated with underlying systemic disorder. The incidence of PG is estimated to be 0.63 per 1,00,000 with the median age at presentation of 59 years. Among its clinical variants, classical PG is the most common. The diagnosis of PG can be difficult. This case series was an attempt to review the new trends for the diagnosis of PG and also to compare them with previous diagnostic criteria. Previously histopathological criteria were included as minor criteria in Su WP et al., classification. More recently proposed diagnostic criteria by Maverkis E et al., include histopathology of skin biopsy from edge of ulcer showing neutrophilic infiltration as a major criteria. Aim of the study is to correlate and stamp the clinically suspected cases of PG with help of histopathology. This retrospective observational case series study was conducted in a tertiary care hospital from May 2018 to April 2020 consisting of 19 cases (15 years to 68 years of age range; 13 males and 6 females). Detailed history, clinical examination and blood investigations were done in all suspected cases of PG followed by histopathological examination of skin biopsy. In 17 cases, lesions were located in lower limb, one case each in buttocks and lower abdomen. The classical, ulcerative form found in 12 cases (63.15%), vegetative form in 3 cases (15.78%), plaque and bullae form were in 2 cases each (10.52%). Pathergy test was positive in 11 cases (57.89%). Histopathological examination showed neutrophilic infiltration in all 19 cases (100%), vasculitis in 11 patients (57.89%), lymphoplasmacytic infiltrate in 6 patients (31.57%), pseudoepitheliomatous hyperplasia in 5 patients (26.31%), mixed inflammatory infiltrate in 4 patients (21%), Epidermal ulceration in 4 patients (21%) and mitosis is seen in 3 patients (15.78%). Histopathology is considered as a main tool which helps clinicians to stamp suspected cases of PG.

Histopathological analysis of soft tissue changes in gingival biopsied specimen from patients with underlying corona virus disease associated mucormycosis (CAM).

Background Corona Virus Disease-2019 (COVID-19) is perhaps the disastrous medical emergencies that has ever hit globally with multiple strains. Amongst various sequelae, mucormycosis may be considered as the most debilitating one. Post COVID-19 mucormycosis is formally regarded as corona virus disease associated mucormycosis (CAM). The aim of the current paper is to present twelve cases of CAM with unique clinical presentation with a detailed histopathological correlation of the gingival biopsied material.Material and Methods Twelve cases of CAM were included in the study who presented initially with non-purulent swelling of the gingiva. The clinic-demographic data pertaining to age, gender, location, laterality and presence of co-morbidities was collected along with histopathological examination of biopsied specimen.Results The patients ranged from 31-65 years (mean age 47.33 years). There was a male predominance. Clearly, maxillary right gingiva was mostly affected and all cases presented with non purulent, non tender swelling of the gingiva. The incisional biopsy from the gingiva consistently showed pseudoepitheliomatous hyperplasia of the surface epithelium along with vacuolar degeneration, extensive stromal edema, massive mixed inflammatory reaction, congested blood vessels, hemorrhage and abundant multinucleated giant cells. Potassium hydroxide (10% KOH) mount served no additional diagnostic advantage. After two initial biopsies any suspected case of CAM with these features was treated with appropriate antifungal therapy and conservative excision.Conclusions Gingival swelling with aforementioned histopathological features resembling post COVID-19 histological alterations could be alarming early signs of CAM and are candidate of prompt antifungal therapy rather than repeat biopsy for confirmation. Key words:CAM, COVID-19, giant cells, gingiva, mucormycosis.

P53/CK17 Dual Stain Improves Accuracy of Distinction Between Differentiated Vulvar Intraepithelial Neoplasia and Its Mimics.

Accurate diagnosis of differentiated vulvar intraepithelial neoplasia (dVIN) is challenging, in part due to the sometimes subtle nature of its atypia. Many dVIN lesions demonstrate aberrant p53 staining; however, staining patterns overlap between dVIN and benign/reactive entities. We evaluate a p53/CK17 dual stain in an initial cohort of dVIN (n=30), benign vulvar skin (n=5), lichen sclerosus (LS, n=10), lichen simplex chronicus (LSC, n=10), and pseudoepitheliomatous hyperplasia (PEH, n=10). In the initial cohort, aberrant p53 staining was seen only in dVIN (50%, 15/30). Equivocal p53 staining patterns were seen in dVIN (37%, 11/30), LS (50%, 5/10), LSC (40%, 4/10), and PEH (40%, 4/10). All 30 dVIN cases were positive for CK17 (strong partial-thickness or full-thickness staining), but positive CK17 staining was also seen in LS (70%, 7/10), LSC (50%, 5/10), and PEH (100%, 10/10). In the initial cohort, the combination of aberrant p53 and positive CK17 was seen only for dVIN (50%, 15/30). Forty cases of LS with known follow-up (20 with progression to dVIN, 20 without) were stained to assess prognostic value. Three LS cases showed aberrant p53 staining with CK17 positivity; all progressed to dVIN. Equivocal p53 staining and CK17 positivity were seen in cases with and without progression. The p53/CK17 dual stain is more diagnostically useful than either stain alone. Negative/focal staining for CK17 argues against a diagnosis of dVIN, while aberrant p53 staining with CK17 positivity strongly supports the diagnosis.

Giant Squamous Cell Carcinoma on The Scalp of A Young African American Male

Abstract Introduction/Objective Skin cancer comprises 1-2% of all cancers in African American (AA) patients. Among all skin cancers, squamous cell carcinoma (SCC) is the most common one in AA, with an incidence of approximately 3 per 100,000. It mainly affects patients over 50-year-old. The most common locations of SCC (60-70% of cases) in AA were the sun-protected areas such as the lower limbs and anogenital region, rather than sun-exposed areas. Methods/Case Report We report a case of a 40-year-old AA male with longstanding folliculitis decalvans presenting with giant SCC. In 2016, the patient noted the enlargement of the atrophic hyperpigmented plaques on the right posterior scalp. They grew into a 10.5 x 10 x 4.5 cm exophytic, verrucous-like mass when the patient presented to the clinic in 2021. A skin biopsy of the giant mass showed pseudoepitheliomatous hyperplasia with cytologic atypia. CT scan ruled out underlying bone invasion. After that, the mass was resected with minimal 3-cm negative margins. Histological evaluation reveals a moderately differentiated keratinizing SCC with clear cell changes in a background of severe acute and chronic inflammation, folliculitis, and scar. No lymphovascular invasion is noted. An over 10-cm SCC arising within folliculitis decalvans on the scalp of a young AA patient is rare. To our knowledge, this the first report of such a case. Despite the limited data available, chronic scarring process and inflammation, instead of sun damage, are believed to be the most important risk factors for SCC development in the AA population. SCC greater than 4cm in chronic inflammation/scar is strongly associated with a poor prognosis. Therefore, early diagnosis, treatment, and close follow-up are critical. Results (if a Case Study enter NA) NA Conclusion Our report emphasizes (1) biopsy has limitations in diagnosing giant cutaneous neoplasms due to inadequate sampling; (2) the need for growing awareness, earlier diagnosis, and skin cancer treatment in people of color.

Usage of Negative Pressure Wound Therapy in Pseudoepitheliomatous Hyperplasia Secondary to Burn Injury: A Case Series.

Pseudoepitheliomatous hyperplasia (PEH) is a reactive epithelial proliferation secondary to a wide range of stimuli, including traumatic injury, inflammation, infection, and tumors of the skin. PEH secondary to burn injury is rarely reported. We report three cases of PEH patients after burn injury. All three cases were confirmed with the existence of bacterial infection, and all these cases were second- or third-degree burns. All three patients were treated with negative pressure wound therapy after wound debridement or tangential excision. All the wounds healed without split-thickness skin grafting and recurrence.

Cauliflower Outgrowths on an Amputation Stump

Pseudo-epitheliomatous hyperplasia (PEH) is a histopathological reaction due to various stimuli, which includes trauma, infection, inflammation, neoplasia. We report a case of a patient with cauliflower outgrowths on an amputation stump simulating a squamous cell carcinoma.

27910 A sporotrichoid rash in a landscaper and fish owner

A 63-year-old male presented with nonhealing tender nodules in lymphocutaneous pattern to the right hand and forearm for two months. Patient had significant risk factors for both Sporotrichosis and Mycobacterium marinum: he works as a landscaper with recent thorn injury to his right second finger, and raises freshwater fish. Patient was initially evaluated in the emergency department, where itraconazole was started for presumed sporotrichosis. He reported no improvement on itraconazole, with development of new nodules ascending his right arm despite five weeks of therapy. He then presented to dermatology for further evaluation. Exam showed erythematous papulonodules to the right forearm and distal upper arm in a lymphocutaneous pattern. Histopathology revealed suppurative granulomatous inflammation with pseudoepitheliomatous hyperplasia, and mixed lymphohistiocytic infiltrate. PAS-F, GMS, and Warthin-Starry stains were negative, and no organisms were identified. Itraconazole therapy was discontinued and patient was started on saturated solution of potassium iodide (SSKI) drops. Clinical improvement was noted after four weeks of SSKI therapy. Wound cultures grew no fungi, possibly due to itraconazole use prior to obtaining cultures. After 8 weeks of incubation, cultures were positive for Mycobacterium marinum. SSKI was discontinued, and patient was transitioned to azithromycin and rifampin. He continues to improve on these antibiotics. Both Sporothrix schenckii and Mycobacterium marinum infections can present in a sporotrichoid pattern. In cases refractory to itraconazole therapy, SSKI has been an effective treatment for sporotrichosis. Treatment of M marinum typically includes a combination of antibiotics. This case highlights a possible coinfection with two distinct organisms.

The role of α-smooth muscle actin in confirming the microinvasion of laryngeal squamous cell carcinoma

BackgroundThe diagnosis of microinvasive laryngeal squamous cell carcinoma (LSCC) is not always straightforward and sometimes can be very challenge in daily clinical practice. The focus lies in the confirmation of microinvasion. Cancer-associated fibroblasts (CAFs), as the major element of reactive tumor stroma, are believed to participate actively in the growth and invasion of tumor cells. ObjectivesTo evaluate the diagnostic role of α-smooth muscle actin (α-SMA) labelling CAFs in microinvasive LSCC. MethodsA total of 81 laryngeal biopsy specimens were retrieved, including 41 cases of microinvasive LSCC with depth of invasion no more than 3 mm, 20 laryngeal squamous intraepithelial lesion (SIL), and 20 benign pseudoepitheliomatous hyperplasia (PEH). All cases were stained for immunohistochemistry, using antibody against the α-SMA antigen. The correlation between the presence of CAFs in microinvasive LSCC and tumor histological characteristics was investigated. ResultsImmunoreactivity of α-SMA was detected in twenty-nine microinvasive LSCC (29/41, 71%), while no reactivity was observed in laryngeal SIL (0/20, 0%), and rarely in PEH (2/20, 10%). The α-SMA expression pattern in stroma of microinvasive LSCC was significantly different from that of SIL (χ2 = 26.966, p = 0.000) and PEH (χ2 = 19.838, p = 0.000). In addition, there seemed to be a certain correlation between the histological characteristics of microinvasive LSCC and the presence of interstitial CAFs. ConclusionsThis study highlights the practical role of utilizing α-SMA in the pathological diagnosis of microinvasive LSCC, with emphasis on variable histomorphologic features of microinvasive LSCC.

CUTANEOUS AND PULMONARY BLASTOMYCOSIS INFECTION: A CASE REPORT

<h3>Introduction</h3> Blastomycosis is a chronic granulomatous disease caused by <i>Blastomyces dermatitidis</i>. More frequently, it presents as a respiratory disease. However, extrapulmonary disease occurs in 25% to 30% of patients after hematogenous dissemination from the lungs. The most common site is the skin; bone, the genitourinary system, and the central nervous system can also be affected. <h3>Case Report</h3> A 34-year-old female patient from Oaxaca, México, presented with an asymptomatic ulcer, verrucous and eroded plaques, and scab areas of unknown evolution on the low and medium third of the face and the nose. The histopathologic staining with hematoxylin and eosin revealed a squamous epithelium with a pseudoepitheliomatous hyperplasia and granulomatous inflammation, containing numerous Langhans multinucleated giant cells and spherical microorganisms of approximately 12 µm characterized by a double-contoured yeast and thick birefringent wall. Periodic acid-Schiff and Grocott's methenamine silver special staining showed positive results for fungal organisms. The thoracic imaging revealed lung involvement. The histopathologic final diagnosis was blastomycosis. <h3>Discussion</h3> In Mexico from 1898 to 2017, only 6 cases were reported. Blastomycosis infections can clinically be easily mistaken for malignant neoplasms or other cutaneous infections more prevalent in Mexico, such as leishmaniasis, coccidioidomycosis, leprosy, or adiaspiromycosis. <h3>Conclusions</h3> The treatment of choice for all forms of the disease includes itraconazole 600 mg, oral 3 days, followed by 200 to 400 mg every day for 6 to 12 months. Spontaneous remissions have been reported in patients with a mild form of blastomycosis. Our patient had 6 months of follow-up with remission of the lesion

Herpes vegetans of the vulva

A 40-year-old woman sought a consultation for a 3-month history of a vulvar tumor. She had a history of HIV infection with unregular therapeutic compliance. Physical examination revealed an exophytic, fleshy yet hard, ulcerated mass located in the inferior third of the left labia majora (Figure 1). Adjacent condyloma were observed. Histologic examination depicted a pseudoepitheliomatous hyperplasia next to an ulcerated epidermis, associated with an inflammatory infiltrate (including plasma cells, neutrophils, and eosinophils) and cytopathic changes (Figures 2 and 3).

Unusual location of tuberculosis: laryngeal form

Introduction: Tuberculosis is a specific infectious disease caused by a mycobacterium: Koch's bacillus. In Morocco, the lung’s lesion is the most common site 52%, however lymph node tuberculosis is the most frequent extrapulmonary form. Laryngeal tuberculosis is rare. We present the case of a young man with a laryngeal location. Presentation of case: A 25-years-old young man, with 10-years history of alcohol and smoking consumption, was presented to our ENT department with a permanent dysphonia and dyspnea on exertion, the patient had fever and weight loss estimated to 15 kg. Clinical examination found a cachectic patient with a 38.5 ° C of temperature, without any palpable cervical mass or lymphadenopathy. A nasofibroscopy was performed showing a right vocal cord’s lesion. We performed a cervical CT scan revealing a process of the glottic and supraglottic level. Direct laryngoscopy was performed, objectifying ulcerative mass budding from the right vocal cord. Histopathological examination revealed a tuberculoid granuloma without caseating necrosis. Discussion and conclusion: Laryngeal tuberculosis is a rare and frequently under-recognized disease. It typically affects adults in the fifth decade. Literature reports dysphonia to be the most common symptom, followed by weight loss, cough, dysphagia, and odynophagia. Direct laryngoscopy allows direct visualization of the endolaryngeal lesions and performing multiple biopsies. Histopathological examination may identify granulomatous inflammation, caseating granulomas, and acid fast bacillus. However, the presence of pseudoepitheliomatous hyperplasia, which mimics squamous cell carcinoma, can make the diagnosis difficult. The pharmacologic treatment is the same as for the pulmonary forms, and results are generally excellent. Surgical intervention is reserved for those cases of airway compromise.