Pseudoepitheliomatous Hyperplasia Research Articles

Ultrastructural and immunohistochemical evaluation of hyperplastic soft tissues surrounding dental implants in fibular jaws

In reconstructive surgery, complications post-fibula free flap (FFF) reconstruction, notably peri-implant hyperplasia, are significant yet understudied. This study analyzed peri-implant hyperplastic tissue surrounding FFF, alongside peri-implantitis and foreign body granulation (FBG) tissues from patients treated at the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital. Using light microscopy, pseudoepitheliomatous hyperplasia, anucleate and pyknotic prickle cells, and excessive collagen deposition were observed in FFF hyperplastic tissue. Ultrastructural analyses revealed abnormal structures, including hemidesmosome dilation, bacterial invasion, and endoplasmic reticulum (ER) swelling. In immunohistochemical analysis, unfolded protein-response markers ATF6, PERK, XBP1, inflammatory marker NFκB, necroptosis marker MLKL, apoptosis marker GADD153, autophagy marker LC3, epithelial–mesenchymal transition, and angiogenesis markers were expressed variably in hyperplastic tissue surrounding FFF implants, peri-implantitis, and FBG tissues. NFκB expression was higher in peri-implantitis and FBG tissues compared to hyperplastic tissue surrounding FFF implants. PERK expression exceeded XBP1 significantly in FFF hyperplastic tissue, while expression levels of PERK, XBP1, and ATF6 were not significantly different in peri-implantitis and FBG tissues. These findings provide valuable insights into the interconnected roles of ER stress, necroptosis, apoptosis, and angiogenesis in the pathogenesis of oral pathologies, offering a foundation for innovative strategies in dental implant rehabilitation management and prevention.

PLANTAR CARCINOMA CUNICULATUM: A RARE PRESENTATION IN THE FOOT REGION

Carcinoma cuniculatum is a rare variant of squamous cell carcinoma. The clinical presentation is usually a non-verrucous exophytic plaque or tumor of the plantar region with a penetration in the deep tissues. Histological examination shows a proliferation of well-differentiated keratinocytes. We describe a patient affected by a slowly enlarging tumoral lesion overlying the fifth metatarsum of the left foot. Clinical examination and radiological investigations suggested a chronic osteomyelitis and a first histological examination of a punch biopsy was suggestive of a pseudo-epitheliomatous hyperplasia. The patient underwent several cycles with systemic antibiotics without improvement. Finally, the fifth metatarso was amputated and the skin lesion was completely removed. The histological examination of the whole operatory mass allowed a diagnosis of carcinoma cuniculatum invading the bone.

Three cases of pseudoepitheliomatous hyperplasia mimicking squamous cell carcinoma of the foot: A case series

Three cases of pseudoepitheliomatous hyperplasia mimicking squamous cell carcinoma of the foot: A case series

Tattoos: risks and complications, clinical and histopathological approach

BackgroundSkin modification through tattoos is as old as humanity itself. However, this trend is on the rise, and with the use of different types of pigments and application practices, both cutaneous and systemic complications can arise. Adverse reactions can be grouped into five classes: inflammatory, infectious, neoplastic, aesthetic, and miscellaneous. On histopathology, inflammatory reactions can exhibit a lichenoid pattern or present as spongiotic dermatitis, granulomatous reactions, pseudolymphoma, pseudoepitheliomatous hyperplasia, or scleroderma/morphea-like changes. This article reviews tattoo complications, including their clinical and histopathological characteristics. MethodsAn open search was conducted on PubMed using the terms “tattoo”, “complications”, and “skin”. No limits were set for period, language, or publication type of the articles. ResultsReactions to tattoos are reported in up to 67% of people who get tattooed, with papulonodular and granulomatous reactions being the most common. Some neoplastic complications have been described, but their causality is still debated. Any pigment can cause adverse reactions, although red ink is more frequently associated with them. Patients with pre-existing dermatoses may experience exacerbation or complications of their diseases when getting tattoos; therefore, this procedure is not recommended for this patient group. ConclusionsDermatological consultation is recommended before getting a tattoo, as well as a histopathological examination in case of complications. In patients who develop cutaneous inflammatory reactions following tattooing, additional studies are recommended to investigate systemic diseases such as sarcoidosis, pyoderma gangrenosum, atopic dermatitis, and neoplasms. It is important for physicians to be trained in providing appropriate care in case of complications.

Diagnosis of verruciform acanthotic vulvar intra-epithelial neoplasia (vaVIN) using CK17, SOX2 and GATA3 immunohistochemistry.

Verruciform acanthotic vulvar intra-epithelial neoplasia (vaVIN) is an HPV-independent, p53 wild-type lesion with distinct morphology and documented risk of recurrence and cancer progression. vaVIN is rare, and prospective distinction from non-neoplastic hyperplastic lesions can be difficult. CK17, SOX2 and GATA3 immunohistochemistry has emerging value in the diagnosis of HPV-independent lesions, particularly differentiated VIN. We aimed to test the combined value of these markers in the diagnosis of vaVIN versus its non-neoplastic differentials in the vulva. CK17, SOX2 and GATA3 immunohistochemistry was evaluated on 16 vaVINs and 34 mimickers (verruciform xanthoma, lichen simplex chronicus, lichen sclerosus, psoriasis, pseudo-epitheliomatous hyperplasia). CK17 was scored as 3+ = full-thickness, 2+ = partial-thickness, 1+ = patchy, 0 = absent; SOX2 as 3+ = strong staining ≥ 10% cells, 2+ = moderate, 1 + =weak, 0 = staining in < 10% cells; and GATA3 as pattern 0 = loss in < 25% basal cells, 1 = loss in 25-75% basal cells, 2 = loss in > 75% basal cells. For analysis, results were recorded as positive (CK17 = 3+, SOX2 = 3+, GATA3 = patterns 1/2) or negative (CK17 = 2+/1+/0, SOX2 = 2+/1+/0, GATA3 = pattern 0). CK17, SOX2 and GATA3 positivity was documented in 81, 75 and 58% vaVINs, respectively, versus 32, 17 and 22% of non-neoplastic mimickers, respectively; ≥ 2 marker positivity conferred 83 sensitivity, 88 specificity and 86% accuracy in vaVIN diagnosis. Compared to vaVIN, SOX2 and GATA3 were differentially expressed in lichen sclerosus, lichen simplex chronicus and pseudo-epitheliomatous hyperplasia, whereas CK17 was differentially expressed in verruciform xanthoma and adjacent normal mucosa. CK17, SOX2 and GATA3 can be useful in the diagnosis of vaVIN and its distinction from hyperplastic non-neoplastic vulvar lesions. Although CK17 has higher sensitivity, SOX2 and GATA3 are more specific, and the combination of all markers shows optimal diagnostic accuracy.

Ocular surface pseudoepitheliomatous hyperplasia secondary to allergic eye disease: clinical features and management.

To study the clinical characteristics and treatment outcomes of ocular surface pseudoepitheliomatous hyperplasia (PEH) associated with chronic vernal keratoconjunctivitis (VKC). This retrospective study includes 39 eyes of 32 patients with VKC induced PEH who presented from 2016-2022. A database search was conducted for diagnosis of PEH, and data on clinical features, imaging characteristics, and treatment were analyzed. Of the 32 patients, 11 (34%) were children and adolescents, 21 (66%) were adults. PEH was common in males (72%) and ocular surface squamous neoplasia (OSSN) was the commonest referral diagnosis (43.7%). Mean age at presentation was 26.62 ± 10.18 (range: 6-52) years. While history of VKC was present in 21 patients, 11 were diagnosed with VKC at the time of diagnosis of PEH. The mean base/largest diameter was 5.2 ± 1.67 mm. Anterior segment optical coherence tomography (AS-OCT) showed irregular hyper-reflective epithelium, epithelial dipping, and sub-epithelial hyper-reflective lesion with shadowing in all lesions. Of the 31 eyes that received medical therapy, 21 (67%) and 10 (32%) eyes showed complete and partial resolution respectively with median time to resolution of 3(IQR:2-4) months. Eight eyes that underwent surgical excision showed complete resolution and one developed partial limbal stem cell deficiency. Ocular surface PEH is a manifestation of chronic VKC which closely mimics OSSN. Detailed history-taking, examination for signs of allergy, and AS-OCT imaging can distinguish it from OSSN. It responds well to medical therapy and should be considered first-line therapy before planning any surgical intervention.

Gottron’s Carcinoid Papillomatosis: Case Report

Introduction. Gottron’s papillomatosis is a rare benign type of dermatosis with pseudoepitheliomatous hyperplasia of the epidermis, first described as an independent disease by the German dermatologist H.A. Gottron. Invasive epidermal growth and hyperkeratosis reveal no signs of malignancy. Chronic venous insufficiency and lymphedema can be associated with various secondary skin lesions: the formation of ulcers, hyperkeratosis and skin papillomatosis, as well as infectious complications. Skin papillomatosis may be a manifestation of paraneoplastic syndrome, which requires a careful differential diagnosis. Timely treatment of complications in a patient with concomitant somatic pathology performed by a multidisciplinary team of specialists is necessary to improve the prognosis. Considering the relative rarity of Gottron’s papillomatosis and the lack of awareness among practicing physicians regarding the differential diagnosis of this disease, we present this clinical analysis.Description of a clinical case. Patient L., 42 years old (body mass index — 76.5 kg/m2) with chronic lymphovenous insufficiency, lymphedema, erysipelas of the right lower limb associated with unspecified skin papillomatosis, was urgently hospitalized in a health care institution “City Clinical Hospital No. 3” of Grodno (Republic of Belarus), consulted by a multidisciplinary team of clinicians including a therapist, a cardiologist, a dermatologist, an endocrinologist, an infectious disease specialist, and a surgeon. Taking into account the clinical status of the patient and the retrospective analysis of archival records of previous examinations performed on the patient in the health care institution “Grodno University Clinic”, the type of dermatosis was determined as Gottron’s papillomatosis of both lower extremities. In terms of the clinical diagnosis of the patient, complex therapy was initiated in a hospital setting, which was then continued at the outpatient stage.Conclusion. Adequate long-term treatment of morbid obesity and chronic lymphovenous insufficiency is necessary to prevent serious complications. According to the academic literature, timely diagnosis of such a rare dermatosis as Gottron’s papillomatosis, as well as the prescription of adequate therapy determine the possibility of regression in the early stages of the disease.

Extranodal NK/T-Cell Lymphoma Predominantly Composed of Anaplastic Cells: A Frequently Misdiagnosed and Highly Aggressive Variant.

Extranodal NK/T-cell lymphoma (ENKTL) is a non-Hodgkin lymphoma associated with the Epstein-Barr virus that primarily affects individuals in East Asia and indigenous populations in Central and South America. Morphologically, ENKTL typically consists of medium-sized cells or a combination of small and large cells. This report presents 10 cases characterized by predominantly anaplastic cells with diffuse expression of CD30, resembling anaplastic lymphoma kinase-negative anaplastic large cell lymphoma (ALK-negative ALCL) and demonstrating highly aggressive behavior. The cohort included 9 males and 1 female, ranging in age from 29 to 65 years (median age: 47y). Eight patients presented with nasal disease, while 2 had non-nasal disease. Five patients had stage I/II disease, and the remaining 5 had stage III/IV disease. Morphologically, necrosis was observed in 9 cases, angiocentric-angiodestructive growth in 3 cases, and pseudoepitheliomatous hyperplasia in 2 cases. Anaplastic cells predominated in all cases, with some displaying eccentric, horseshoe-shaped, or kidney-shaped nuclei (referred to as "Hallmark" cells). The morphology profile was monomorphic in 3 cases and polymorphic in 7 cases. Immunohistochemically, all cases tested positive for cytotoxic granule markers (TIA1 and granzymeB) and Epstein-Barr virus-encoded RNA. Cytoplasmic expression of CD3ε and CD56 was observed in 9 of 10 cases. Interestingly, most cases (7 of 8) exhibited variable expression of MuM1, ranging from 10% to 90%. All cases showed diffuse positivity for CD30 but were negative for ALK, resulting in 3 cases being initially misdiagnosed as ALK-negative ALCL. Compared with nonanaplastic cases, anaplastic cells predominant ENKTL had a significantly higher frequency of "B" symptoms, bone marrow involvement, hemophagocytic lymphohistiocytosis, and higher Ki67 proliferative index. These findings provide valuable information for pathologists, expanding their understanding of the cytologic spectrum of ENKTL. This rare variant of ENKTL, characterized by the predominance of anaplastic cells and diffuse CD30 expression, exhibits high aggressiveness and should be differentiated from ALK-negative ALCL. Awareness of this uncommon variant is crucial in preventing misdiagnosis and ensuring the timely initiation of therapy.

Squamous Cell Carcinoma Arising in a Nevus Sebaceus in a 10-Year-Old Male

The patient is a 10-year-old male who presented to a dermatologist regarding a bleeding plaque on the right scalp. The initial pathology report demonstrated an atypical endophytic squamous proliferation with an infiltrative pattern, raising concern for squamous cell carcinoma versus pseudoepitheliomatous hyperplasia. Physical exam showed a painless 4.4 x 1.2 cm elliptical, rough, orange-to-pink plaque with waxy superficial scale on the left forehead. Wide local excision was performed, and pathology confirmed no residual carcinoma. Squamous cell carcinoma arising in a nevus sebaceous in a pediatric patient is exceedingly rare, but as demonstrated by this case, does occur, emphasizing the need for improved guidelines for management to optimize treatment in the pediatric population.

Intraoral epithelioid and spindle cell hemangioma associated with pseudoepitheliomatous hyperplasia: An immunohistochemical study.

Intraoral epithelioid and spindle cell hemangioma associated with pseudoepitheliomatous hyperplasia: An immunohistochemical study.

Case Report : Chromoblastomycosis

Background: Chromoblastomycosis is a recurring deep mycosis of the skin and subcutaneous towel. Clinical features are characterized by verrucous shrine lesions, especially in the lower extremities. This disease is usually preceded by trauma in the form of a wound which is the initial implantation of the fungus. The fungus will be implanted in the dermis and will infect the skin with the subcutaneous towel. Chromoblastomycosis is caused by a fungus from the Dematiaceae family. Although Chromoblastomycosis occurs worldwide, it is most common (&gt;70%) in tropical and subtropical regions. Case Presentation: We present a case in which a 72-year-old man came to the dermatovenereology polyclinic with the main complaint of thickening of the skin in the plantar of the right leg, the surface is rough, the skin looks dry, it doesn't itch and it doesn't hurt, it gets worse over time, widened. Based on the histopathology, the appearance of the epidermis in the form of pseudoepitheliomatous hyperplasia, hyperkeratosis, acanthosis, microabscesses with neutrophil inflammatory cells, lymphocytes, multinucleated giant cells, and spores. In the dermis, microabscesses were found, and no necrosis was seen. Conclusion: The diagnosis was chromoblastomycosis. This patient was given oral antimycotic Itraconazole 2 x 200 mg/day. There was a clinical improvement.

Chromoblastomycosis successfully treated with the combination of itraconazole and 5-flucytosine

Chromoblastomycosis (CBM) is a fungal disease, distributed in tropical and subtropical regions, affecting mainly rural workers. It is characterized by chronic skin lesions that may vary from nodular, tumorous, verrucous or plaque type. Associated constitutional symptoms are rarely found. The histological presentation may yield a pathognomonic feature, the Medlar (sclerotic) bodies, in which a typical brown to black pigment is depicted, explaining “copper pennies” as its alias. In this article, the case of a 56-year-old woman in the countryside of Brazil is reported; whose main complaint was a chronic leg ulcer for the past 8 years. On the left leg, a large, partially ulcerated plaque lesion was found. Microbiological cultures were positive for the pathogen. Histological analysis demonstrated pseudoepitheliomatous hyperplasia, lymphohistiocytic infiltrate and sclerotic bodies (“copper pennies”). CBM’s epidemiological panorama, once established uniquely by geographical distribution, is transitioning to a global health issue, influenced by immunosuppressive conditions, global warming and migration. This scenario demands CBM to be widely considered as a differential diagnosis and may represent a clinical challenge in regions whose professionals have little expertise in infectious tropical diseases.

Clinico-pathological Spectrum of Pyogenic Granuloma in Patients Presenting at Ayub Teaching Hospital, Abbottabad

Background: Oral Pyogenic Granuloma (OPG) is a type of oral mucosal lesion that is distinguished by its rapid development, friable nature, and vascular proliferation. Aim: To examine the demographic and histopathological features of patients diagnosed with oral pyogenic granuloma. Study design: The cross-sectional study. Methodology: This study was conducted in the Dentistry Department of Ayub Medical College, Abbottabad following the acquisition of a comprehensive medical history through a pre-established form, pertinent clinical information pertaining to the patients, including age and lesion location, was collected. All excisional biopsy specimens were collected. Following preservation in 10% neutral buffered formalin, the gathered specimens underwent preparation for paraffin embedding. The histopathological findings that were assessed and documented included the observation of ulceration, inflammatory cell infiltration, vascular proliferation, fibrosis, and epithelial alterations. Data was analyzed in SPSS. Results: The 51 patients who were a part of the research had a mean age of 31.14+SD and were all female. The bulk of the patients were between the ages of 26 and 35. Lesion diameters varied from 0.5 to 3 cm, with 1.1 to 2 cm being the most common size range. 78% of the cases involved pregnant females. The most common site was the gum mucosa, lips, tongue, and palate were the next most typical locations for OPG. The majority of patients had pseudoepitheliomatous hyperplasia, mild chronic inflammation, and fibrosis, in addition to lobules of capillary sized blood vessels according to histopathological examination. Conclusion: Oral Pyogenic Granuloma is predominantly seen in young females, and is mostly associated with pregnancy and most common site is gum mucosa. The histopathological findings demonstrate characteristic features such as pseudoepitheliomatous hyperplasia, chronic inflammation, and fibrosis. Understanding these features contributes to accurate diagnosis and management of this lesion. Keywords: Oral Pyogenic Granuloma, lobular capillary hemangioma, pseudoepitheliomatous hyperplasia.

GRANULAR CELL TUMOR IN AN UNUSUAL LOCATION AFFECTING A PEDIATRIC PATIENT: CASE REPORT

Granular cell tumor (GCT) is a rare benign soft-tissue neoplasm of Schwann-cell origin. It most often affects the tongue, followed by floor of the mouth and buccal mucosa, mainly in adult women. A 13-year-old male patient was referred for evaluation of a lesion on the upper lip. Intraoral examination showed a painless sessile nodule, normal color, measuring 1.0 × 0.5 cm, with several months of evolution. Diagnostic hypotheses included neurofibroma, pleomorphic adenoma, and canalicular adenoma. An excisional biopsy was performed, and histopathologic analysis revealed a well-defined proliferation of eosinophilic granular cells, with no typical pseudo-epitheliomatous hyperplasia, and perineural involvement. Immunohistochemistry showed positivity for vimentin, S100, CD56, and CD68. The diagnosis was GCT. After one year of follow-up, the patient showed no signs of recurrence or alterations. GCT is extremely rare, affecting the upper lip in pediatric patients; therefore, it should be considered in the differential diagnosis of lip nodular lesions. Granular cell tumor (GCT) is a rare benign soft-tissue neoplasm of Schwann-cell origin. It most often affects the tongue, followed by floor of the mouth and buccal mucosa, mainly in adult women. A 13-year-old male patient was referred for evaluation of a lesion on the upper lip. Intraoral examination showed a painless sessile nodule, normal color, measuring 1.0 × 0.5 cm, with several months of evolution. Diagnostic hypotheses included neurofibroma, pleomorphic adenoma, and canalicular adenoma. An excisional biopsy was performed, and histopathologic analysis revealed a well-defined proliferation of eosinophilic granular cells, with no typical pseudo-epitheliomatous hyperplasia, and perineural involvement. Immunohistochemistry showed positivity for vimentin, S100, CD56, and CD68. The diagnosis was GCT. After one year of follow-up, the patient showed no signs of recurrence or alterations. GCT is extremely rare, affecting the upper lip in pediatric patients; therefore, it should be considered in the differential diagnosis of lip nodular lesions.

HISTOPLASMOSIS IN A MAN WITH AIDS: CASE REPORT

Histoplasmosis is a systemic infectious disease caused by Histoplasma capsulatum. Patient, male, 40 years old, melanoderma, with AIDS, referred from a Reference Center for Tropical Diseases for stomatological care, complaining of a "tongue lesion". Nothing noteworthy was seen in the extra-oral examination. Intra-oral, a nodular lesion disseminated in a red tongue, papillary and ulcerated surface with sessile base. The clinical diagnosis was Histoplasmosis and Paracoccidioidomycosis. An incisional biopsy was performed and the histopathological sections were stained with hematoxylin and eosin (HE) revealing a granulomatous inflammatory process associated with pseudoepitheliomatous hyperplasia compatible with histoplasmosis. Positive PAS reaction and Grocott staining; and negative in the Ziehl-Neelsen staining. The patient died before starting the treatment. This case reinforces the importance of the stomatologist and oral pathologist in the elucidation of cases of systemic diseases when it is shown exclusively in the mouth and the diagnostic challenge. Histoplasmosis is a systemic infectious disease caused by Histoplasma capsulatum. Patient, male, 40 years old, melanoderma, with AIDS, referred from a Reference Center for Tropical Diseases for stomatological care, complaining of a "tongue lesion". Nothing noteworthy was seen in the extra-oral examination. Intra-oral, a nodular lesion disseminated in a red tongue, papillary and ulcerated surface with sessile base. The clinical diagnosis was Histoplasmosis and Paracoccidioidomycosis. An incisional biopsy was performed and the histopathological sections were stained with hematoxylin and eosin (HE) revealing a granulomatous inflammatory process associated with pseudoepitheliomatous hyperplasia compatible with histoplasmosis. Positive PAS reaction and Grocott staining; and negative in the Ziehl-Neelsen staining. The patient died before starting the treatment. This case reinforces the importance of the stomatologist and oral pathologist in the elucidation of cases of systemic diseases when it is shown exclusively in the mouth and the diagnostic challenge.

Histopathological Analysis of Tongue Lesions and Distribution by Age Groups

Aim: To retrospectively evaluate the histopathological characteristics of biopsies taken from tongue lesions and compare the results with current literature. Material and Methods: Histopathological results of biopsies taken from 163 patients with suspected tongue lesions between January 2017 and January 2022 were retrospectively reviewed. The results were evaluated in different age groups. Results: Seventy-two (44.2%) of the patients were male and 91 (55.8%) were female. The mean age of the patients was 47.76±17.33 years. The lesion was benign in 135 (82.8%) patients, precancerous in 4 (2.5%), and malignant in 24 (14.7%). Of the 135 patients with benign findings, squamous papilloma was detected in 33 (24.4%) patients and irritation fibroma in 19 (14.1%). Ulcer/inflammatory granulation tissue was detected in 18 (13.3%) patients, parakeratosis/acanthosis in 14 (10.4%), fibroepithelial polyp in 14 (10.4%), and pseudoepitheliomatous hyperplasia in 9 (6.7%). Less frequently, lymphoid hyperplasia, neurofibroma, mucocele, and verruca vulgaris were detected in 1 (0.7%) patient each. Squamous cell carcinoma was detected in all patients with malignancy. When evaluated according to age groups, it was found that the patients were most commonly in the 50–59 (27.6%) age group, followed by the 40–49 (19.6%) age group. Conclusion: The results show that most tongue lesions are benign. It should be noted that not every mass in the tongue is cancerous, but leukoplakic and ulcerated areas can be malignant. Due to the rapid metastasis of tongue lesions, early diagnosis and treatment may contribute significantly to the prognosis of patients.

Pathogenesis, Diagnosis and Management of Squamous Cell Carcinoma and Pseudoepithelial Hyperplasia Secondary to Red Ink Tattoo: A Case Series and Review.

The increasing popularity of tattooing has paralleled an increase in associated cutaneous reactions. Red ink is notorious for eliciting cutaneous reactions. A common reaction is pseudoepitheliomatous hyperplasia (PEH), which is a benign condition closely simulating squamous cell carcinoma (SCC). Differentiating PEH from SCC is challenging for pathologists and clinicians alike. The exact pathogenesis of these lesions secondary to red ink is not known, and there are no sources outlining diagnostic and treatment options and their efficacy. We present four study cases with different pathologies associated to red ink tattoos including lichenoid reaction, granulomatous reaction, PEH, and an SCC. Additionally, an extensive review of 63 articles was performed to investigate pathogenesis, diagnostic approaches, and treatment options. Hypotheses surrounding pathogenesis include but are not limited to the carcinogenic components of pigments, their reaction with UV and the traumatic process of tattooing. Pathogenesis seems to be multifactorial. Full-thickness biopsies with follow-up is the recommended diagnostic approach. There is no evidence of a single universally successful treatment for PEH. Low-dose steroids are usually tried following a step up in lack of clinical response. For SCC lesions, full surgical excision is widely used. A focus on clinicians' awareness of adverse reactions is key for prevention. Regulation of the unmonitored tattoo industry remains an ongoing problem.

Paracoccidioidomycosis: an Australian case

A 33-year-old HIV negative Brazilian engineer who had been living in Australia for three years presented to his dentist with an eight week history of a progressively enlarging maxillary gingival ulcer, suspicious for malignancy. Biopsy of the lesion showed pseudoepitheliomatous hyperplasia with round structures present in periodic acid-schiff and grocott stains suggestive of a fungal organism. A second biopsy revealed fungal organisms with a pathognomonic appearance on microscopy. The organism grew on Brain Heart Infusion agar and Sabouraud agar at 30 and 35 degrees celsius. An identification of Paracoccidioides brasiliensis was made. To our knowledge, we present the first Australian case of P. brasiliensis infection, a highly pathogenic dimorphic fungus, in order to highlight some of the key diagnostic features of this unusual infection.

Case report: A case of Pseudoepitheliomatous hyperplasia of vulva, a differential diagnosis for squamous cell carcinoma of external genitalia in women

A woman presenting with vulval lesions is to be examined and evaluated further before giving her the definitive diagnosis and proposing treatment. As the differential diagnosis may vary from benign lesions like lichen sclerosus, vulval intraepithelial neoplasia or malignant lesions like squamous cell carcinoma. We are presenting a case report wherein 70 year woman presented with features similar to squamous cell carcinoma but was diagnosed as pseudoepitheliomatous hyperplasia of vulva which is a benign lesion.Pseudoepitheliomatous hyperplasia (PEH) is a benign condition, characterized by hyperplasia of the epidermis and adnexal epithelium, closely similar to squamous cell carcinoma. PEH may be present in a number of conditions characterized by prolonged inflammation and/or chronic infection, as well as in association with many cutaneous neoplasms.

Pseudoepitheliomatous Hyperplasia: Harbinger of Underlying Squamous Cell Carcinoma - Lessons Learnt

Pseudoepitheliomatous hyperplasia (PEH) is a benign condition marked by reactive epithelial proliferation seen in response to various insults like trauma, infection, persistent inflammation and neoplasia. In this report, we discuss a case of a 35-year-old man who presented with a perineal swelling, later turned into a non-healing ulcer, first diagnosed as PEH. Still, after clinical suspicion, a deeper biopsy was conducted, confirming the diagnosis of squamous cell carcinoma and directing treatment appropriately. Non-healing perineal lesions are not uncommon. Most of the lesions turn out to be Squamous Cell Carcinoma. But, if the histopathological picture suggests Pseudoepitheliomatous Hyperplasia, it is vital to consider the limitations of the biopsy, and a solid clinicopathological correlation is required to look aggressively for underlying Squamous Cell Carcinoma. Due to the benign nature of PEH, most cases are treated via excision biopsy, while grafts or flaps are occasionally required to restore severe tissue defects. It is therefore crucial to rule out and distinguish this condition from other benign and malignant conditions, as the treatment and prognosis differ widely. It is of utmost importance to sample the base of the lesion, analyze multiple sections, and consider clinical data to ensure an accurate diagnosis.