Pseudohorn Cysts Research Articles

Dermoscopy-pathology relationship in seborrheic keratosis.

Making a definitive diagnosis of seborrheic keratosis (SK) can be challenging for the naked eye due to its wide variation in clinical features. Fortunately, however, most cases of SK exhibit the typical dermoscopic findings of fissures and ridges, hairpin vessels with white halo, comedo-like openings, and milia-like cysts, all of which are helpful to distinguish SK from melanoma, melanocytic nevus, squamous cell carcinoma, basal cell carcinoma (BCC) and other skin tumors. Histopathologically, these dermoscopic characteristics correspond to papillomatous surface of the epidermis, enlarged capillaries of the dermal papillae, pseudohorn cysts in the epidermis opened to the surface of the lesion and intraepidermal cysts, respectively. Clinicians should bear in mind that the clonal type of SK dermoscopically mimics melanoma and BCC by the presence of globule-like structures, while regressing SK exhibits a granular pattern that is similar to the peppering found in melanoma. Furthermore, milia-like cysts alone are insufficient for a conclusive diagnosis of SK because melanoma in rare cases displays cysts along with other SK-like dermoscopic findings.

The role of immunosuppression in squamous cell carcinomas arising in seborrheic keratosis

Seborrheic keratoses (SK) are common skin neoplasms considered to be benign. Reports of associated squamous cell carcinoma arising within seborrheic keratosis (SCC-SK) have been described. To describe the histopathologic characteristics of SCC-SK and identify predisposing factors in formation of these rare lesions. There were 162 cases of SCC-SK in a span of a decade (2003-2014). All of the histopathologic specimens and medical records were reviewed. Data from these patients were compared to a control group with seborrheic keratosis who were matched by age, sex, and location of lesion from the same time period (n=162). SCC-SK has the classic histopathologic features of SK, such as hyperkeratosis, parakeratosis, papillomatosis, and pseudohorn cysts. The areas of squamous cell carcinoma were characterized by areas of squamous dysplasia (100%), hypogranulosis (79.6%), squamous eddies (79.6%), solar elastosis (80.9%), and brown pigmentation (59.9%). Patients with a history of immunosuppression had an increased risk for developing SCC-SK (19% vs 3%; P<.01), particularly when inhibition was transplant-associated (10% vs 0%; P<.01). This was a single center, retrospective study. SCC-SK occurs more often in elderly men with a history of immunosuppression associated with organ transplants.

A Rare Report of Verrucouse Carcinoma of Right Leg - A Clinical Image

The patient is a 70 year-old-man. He is a farmer; he had multiple eruptive lesions in right leg from late childhood. The similar lesion has seen in his maternal family. These lesions have been spread and growth and from six months ago. He had no history of cigarette smoking, alcohol consumption and substance use. Clinical Data Vast congenital lesions on the shin, suspected of malignancy such as Kaposi sarcoma and others. The Macroscopic Description A single piece of gray-white, skin- covered, soft, solid tissue, measuring The Pathology Report after Excision and Biopsy The microscopic description The specimen shows part of skin with severe hyperkeratosis. Papillomatosis, acanthotic epidermis, some squamous horn cysts and pseudo-horn cysts, and lymphocytic infiltration in upper dermis. The pathologist reported that she hasn’t found margin of free of tumor.

Decreased Srcasm expression in hyperproliferative cutaneous lesions

Src-family tyrosine kinases (SFKs) are signaling proteins that regulate keratinocyte proliferation and differentiation. Src-activating and signaling molecule (Srcasm) is a recently identified molecule that downregulates SFK activity and promotes keratinocyte differentiation. To determine if Srcasm expression correlates with keratinocyte differentiation, we characterized the level of Srcasm expression in some cutaneous lesions that exhibit increased keratinocyte proliferation. Formalin-fixed sections of randomly selected seborrheic keratoses (SKs) and basal cell carcinomas (BCCs) were analyzed for Srcasm and Ki-67 immunohistochemical staining. Anti-Srcasm and anti-Ki-67 stainings were performed in parallel. All SKs displayed decreased Srcasm staining in areas comprised of basaloid keratinocytes that exhibited an increased Ki-67 index. Higher Srcasm staining levels were detected near pseudohorn cysts where keratinocytes exhibited a lower Ki-67 index. All multicentric and nodular BCCs displayed a prominent loss of Srcasm staining in association with a marked increase in Ki-67 staining. Our results support the hypothesis that Srcasm protein levels are decreased in the hyperproliferative keratinocytes found in SKs and BCCs. Increased Srcasm protein levels are detected in keratinocytes undergoing differentiation. Decreased Srcasm levels may be part of the pathophysiologic mechanism in cutaneous lesions, exhibiting keratinocyte hyperproliferation.

Seborrheic Keratosis of the Conjunctiva: A Case Report

Seborrheic keratosis is a benign epithelial neoplasia that occurs mainly in the skin of the eyelids and face. We describe a case of seborrheic keratosis of the conjunctiva confirmed by histopathology. A 72-year-old man presented with a recurrent conjunctival mass involving the nasal side of his right eye. Clinically, a diagnosis of conjunctival papilloma was made, and a mass excision was performed. The histopathological analysis evidenced a conjunctival-covering epithelium with papillomatous changes and irregular acanthosis, at the expense of a proliferation of basaloid cells. In addition, the lesion exhibited multiple pseudohorn cysts containing keratin. With the above findings, a diagnosis of conjunctival seborrheic keratosis was established. The occurrence of seborrheic keratosis on the conjunctiva is rare. In this case, seborrheic keratosis was confirmed by pathologic report despite its similar appearance with papilloma. Seborrheic keratosis should be considered in the differential diagnosis of conjunctival lesions.

Collision of Pigmented Benign Tumours: A Possible Simulator of Melanoma

The coexistence of more than one neoplasm in a single cutaneous specimen is relatively uncommon and has been defined as a collision or compound tumour (1, 2). Although some of these collision tumours may arise from the involvement of related cell types, most occur by chance (1). Melanocytic naevus has been reported as occurring associated with several different tumour types (1, 3). The association of a melanocytic naevus arising contiguously with or adjacent to seborrhoeic keratosis is, however, uncommon (1, 4–7). We report here a patient who presented with a pigmented macule that she had had for a long time, and which had recently increased in size and darkened. Histopathological examination showed a pigmented seborrhoeic keratosis that developed contigu-ously with a melanocytic naevus.CASE REPORTA 39-year-old woman had had a brown, asymptomatic cutaneous lesion on her back since childhood. She re-ported that the lesion had increased in size and became darker in the last year. Clinical examination disclosed an asymmetric, pigmented tumour measuring 13 mm in diameter on the right scapular region. The lesion exhibited 2 well-differentiated areas of pigmentation: one part was light brown in colour, 4 mm in diameter and the other was black, 9 mm in diameter, with fol-licular prominence (Fig. 1a). Dermoscopic evaluation of the whole lesion revealed a sharp demarcation, with pseudo-horn cysts, comedo-like openings and fissures in the bigger area. The other part of the tumour showed the presence of a pigmented network with small hy-popigmented areas. Clinical and dermoscopic findings suggested a collision tumour: seborrhoeic keratosis and melanocytic naevus. The lesion was surgically excised. Histopathological examination showed a symmetrical intradermal melanocytic proliferation composed of nests of melanocytes without atypia, consistent with a melanocytic intradermal naevus. Adjacent to the mela-nocytic naevus we observed a proliferation of pigmen-ted small basaloid cells with uniform appearance with hyperkeratosis, acanthosis and pseudohorn cysts (Fig. 1b). The latter features were consistent with pigmented seborrhoeic keratosis.DISCUSSIONThe combination of a melanocytic naevus with other tumours of epidermal or adnexal origin has often been described (1, 3). Common epidermoid cyst and melano-cytic nevus is the association reported most frequently (8). Melanocytic naevus has also been associated with a trichilemmal cyst(9), steatocystoma, hidrocystoma and dermoid cyst(8), syringoma(10), trichoepithelioma (3), trichoadenoma (11) and basal cell carcinoma (1). Despite the fact that melanocytic lesions and seborr-hoeic keratosis are among the skin lesions from which biopsies are more commonly taken, the association of a melanocytic naevus with a seborrhoeic keratosis is uncommon. Boyd & Rapini (1), in a retrospective study of 40,000 cutaneous biopsies, found 14 cases of melanocytic naevus juxtaposed with a seborrhoeic keratosis. Only another 4 cases of melanocytic naevus

Verruciform xanthoma‐like phenomenon in seborrheic keratosis

Verruciform xanthoma is xanthomatous dermal infiltrate in a proliferating epidermal lesion and is an uncommon phenomenon. It has been reported in various neoplastic or inflammatory conditions. We report a 72-year-old man who had an asymptomatic 1-cm black nodule on his abdomen. Histopathology showed a typical acanthotic type of seborrheic keratosis characterized by basaloid keratinocyte proliferation and pseudohorn cysts. Many aggregated xanthomatized cells were seen in dermal papillae within the acanthotic epithelium. Papillomatosis, parakeratosis, and neutrophil infiltrates, the histologic features of typical verruciform xanthoma, were not seen. The foamy cells were positive for CD-68 and vimentin and negative for cytokeratin and S-100. No human papillomavirus DNA was found by nested polymerase chain reaction. The blood lipid profile was normal. The presence of verruciform xanthomatous change in seborrheic keratosis provides further evidence that verruciform xanthoma may be a reactive phenomenon occurring in common skin disorders.

Florid eruption of seborrheic keratoses associated with elevated insulin‐like growth factor, hypoglycemia, and solitary fibrous tumor of the pleura

A 66‐year‐old man with a past medical history of hypertension and arthritis was hospitalized and treated for bacterial pneumonia. Chest X‐ray revealed a left‐sided chest mass. Computed tomography (CT) scan of the chest demonstrated a large heterogeneously enhancing mass occupying most of the left lower lobe and extending to the inferior aspect of the hilum. It measured 16.6 × 12 cm and caused a mild shift of the mediastinum to the right. The patient declined further work‐up or surgical resection of the mass. Dermatologic examination was unremarkable at that time.Over the next 5 months, numerous skin lesions erupted on the patient's trunk. He then experienced several syncopal episodes, at which time he was found to be profoundly hypoglycemic. It was suspected that the chest tumor was producing high serum levels of insulin‐like growth factor (IGF) resulting in hypoglycemia and syncope. Serum laboratory investigations were significant for glucose of 20 mg/dL (normal, 60–120 mg/dL), IGF‐1 of 39 ng/mL (normal, 152–494 ng/mL), IGF‐2 of 927 ng/mL (normal, 210–750 ng/mL), and insulin of &lt; 5.0 microunits (MCU)/mL (normal, 0–30 MCU/mL). Surgical extirpation of the chest tumor was recommended.The dermatology service was consulted to evaluate whether the numerous skin lesions in the area of planned surgery would pose an increased risk of infection. Cutaneous examination revealed a dense aggregation of pigmented hyperkeratotic plaques with a “stuck‐on” appearance, predominantly localized on the trunk. Many were unusually large or darkly pigmented. A particularly dense distribution was apparent on the left side of the chest (Fig. 1a). Numerous large acrochordons were evident on the lower eyelids and in the axillary vaults. Acanthosis nigricans was not present. A biopsy specimen from a hyperkeratotic lesion on the left upper back revealed an acanthotic, hyperpigmented epidermis with a lamellar horn, anastomosing rete, and pseudohorn cysts (Fig. 1b).(a) Dense aggregation of pigmented hyperkeratotic papules and plaques with a “stuck‐on” appearance predominantly localized on the left side of the trunk. Many are unusually large or darkly pigmented. (b) Photomicrograph of a biopsy specimen from a hyperkeratotic lesion on the left upper back. An acanthotic, hyperpigmented epidermis with a lamellar horn, anastomosing rete, and pseudohorn cysts is demonstrated (hematoxylin and eosin stain; original magnification, × 4)imageLeft thoracotomy and left lower lobectomy were performed, and surgeons extirpated an 18 × 17 × 10 cm cystic, multilobular, hard tumor (Fig. 2a) adhering to the left diaphragm, left lower lobe, and left parietal pleura. Pathologic examination revealed a highly cellular spindle cell tumor (Fig. 2b). The nuclei were relatively monotonous with few mitoses. No areas of necrosis were identified. These pathologic findings were diagnostic for solitary fibrous tumor of the pleura.(a) Gross specimen of solitary fibrous tumor of the pleura measuring 18 × 17 × 10 cm. The mass was a cystic, multilobular, hard tumor adhering to the left diaphragm, left lower lobe, and left parietal pleura. (b) Histopathology demonstrates a highly cellular spindle cell tumor. The nuclei are relatively monotonous with few mitoses. Necrosis is not present (hematoxylin and eosin stain; original magnification, × 20)imageAfter surgery, the patient experienced no further syncopal episodes. The truncal seborrheic keratoses decreased substantially in number, size, and density over the following 6 months. Post‐operative laboratory data revealed normalization of the blood glucose, insulin, IGF‐1 (191 ng/mL; normal, 71–290 ng/mL), and IGF‐2 (515 ng/mL; normal, 358–854 ng/mL).

Seborrheic Keratosis: A Rare Clinical Appearance

A variety of clinical appearance of Seborrheic Keratosis have been already reported. We report the case of a 16-year-old woman who presented with itchy brownish papules on the right side of her chest with dermatomal distribution for 2 years. Diagnosis of the dermatosis was histologically evident. It seems that linear and dermatomal Seborrheic Keratosis is a new clinical variant. CASE REPORT A 16-year-old woman presented with a 2 -year history of itchy brownish papules localized on the right side of chest. (Fig. 1, 2) It began whit dark brownish macules and patches on the right side of lower chest near to midline and gradually change to brownish papules and spread to the outer side of chest. The lesions became itchy. There was no underline disease. Figure 1 Figures 1, 2: Papules on the right side of the chest Figure 2 The initial diagnosis was epidermal nevus , wart , localized Darier,s Disease. A biopsy was performed and the histology showed hyperkeratosis and achantosis with basaloid appearance and true and pseudo horn cysts in the epidermis and chronic inflammatory reaction in dermis (Fig. 3,4). Seborrheic Keratosis: A Rare Clinical Appearance 2 of 4 Figure 3 Figure 3: Hyperkeratosis , achantosis, horn cysts Figure 4 Figure 4: True and psudo cysts

Immunohistochemical demonstration of carcinoembryonic antigen and related antigens in various cutaneous keratinous neoplasms and verruca vulgaris.

Carcinoembryonic antigen (CEA), which is a well-known marker for the normal sweat gland apparatus and its neoplasms in the skin, was recently demonstrated in sebaceous neoplasms. The aim of this study was to examine the expression of CEA and related antigens in the other cutaneous keratinous neoplasms and verruca vulgaris. Normal adult skin, squamous cell carcinoma (SCC), senile keratosis, Bowen's disease, basal cell carcinoma (BCC), seborrhoeic keratosis and verruca vulgaris were stained immunohistochemically with a panel of monoclonal and polyclonal antibodies that recognize different epitopes of CEA and related molecules. Localization of the antigens was compared with that of involucrin and proliferating cell nuclear antigen. The strongest expression of CEA-related antigens, other than non-specific cross-reacting antigen (NCA) -50/90, was seen in SCC and verruca vulgaris, while no detectable expression was seen in BCC. Senile keratosis, Bowen's disease and seborrhoeic keratosis showed the predominance of the CEA-related antigens over CEA weakly expressed. Strong expression of both CEA and NCA-50/90 was seen only in SCC. All the expressions were limited to the cells situated in the upper epidermal cell layers of the tumours, at the centre of tumour islands in SCC and along the pseudohorn cysts in seborrhoeic keratosis, where involucrin was coexpressed. We suggest that CEA and related antigens are not only markers for sweat gland differentiation in the skin, as currently accepted, but are also expressed in various cutaneous keratinous neoplasms and verruca vulgaris. The expression may correlate with the terminal differentiation of the tumour cells, the strong coexpression of CEA and NCA-50/90 may correlate with the malignant potential of the tumour types, and the mechanisms that control the expression of CEA and related antigens in the neoplasms may be similar to those operative in verruca vulgaris.