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LETTER TO THE EDITOR
Year : 2019  |  Volume : 10  |  Issue : 3  |  Page : 343-345  

A case of warty dyskeratoma on an unusual location


Department of Dermatology, HBT Medical College and Dr. RN Cooper Hospital, Juhu, Mumbai, Maharashtra, India

Date of Web Publication17-May-2019

Correspondence Address:
Kinjal D Rambhia
B-105 Kalpataru Classic, Chincholi Bunder Road, Malad West, Mumbai - 400 064, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/idoj.IDOJ_473_18

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How to cite this article:
Rambhia KD, Makhecha MB. A case of warty dyskeratoma on an unusual location. Indian Dermatol Online J 2019;10:343-5

How to cite this URL:
Rambhia KD, Makhecha MB. A case of warty dyskeratoma on an unusual location. Indian Dermatol Online J [serial online] 2019 [cited 2019 Jun 16];10:343-5. Available from: http://www.idoj.in/text.asp?2019/10/3/343/258610



Sir,

A 72-year-old female presented to our dermatology outpatient department with complaints of a single asymptomatic skin lesion over the left lower leg since 5 years. There was no history of any oozing, discharge or bleeding from the lesion. She denied any rapid or sudden increase in the size of the lesion; although she did admit to have applied home remedies like turmeric powder to treat the lesion. Cutaneous examination revealed a solitary, firm, skin colored to yellowish nodule with central crusting over the extensor aspect of the left lower extremity [Figure 1]. The nodule was non-tender and did not bleed on touching. Clinical differential diagnosis of keratoacanthoma (KA) and appendiceal appendageal neoplasm were considered. Histopathology of the excised nodule revealed a large cup-shaped invagination which was connected to the surface by a channel filled with keratinous material. There were several acantholytic and dyskeratotic cells in the upper epidermis. At the base of the lesion, basal cell hyperplasia, villi formation, papillomatosis, lacunae filled with acantholytic and dyskeratotic cells (corps ronds and grains) were seen [Figure 2]. The histological pattern of acantholytic dyskeratosis was seen in all the adjoining hair follicles [Figure 3] and [Figure 4]. Thus, the case was diagnosed as warty dyskeratoma. Since complete surgical excision of the nodule was performed, no further treatment was advised to the patient.
Figure 1: Skin colored to yellowish nodule with central crusting over left lower extremity

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Figure 2: Cup-shaped invagination with villi formation, papillomatosis and foci of acantholytic dyskeratosis [Hematoxylin and Eosin ×4]

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Figure 3: Another focus depicting acantholysis dyskeratosis at base of the invagination [Hematoxylin and Eosin ×4]

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Figure 4: Suprabasal lacuna with corps ronds and grains [Hematoxylin and Eosin ×10]

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Warty dyskeratoma (WD) is regarded as a benign follicular adnexal neoplasm.[1] It is characterized by solitary papule or nodule arising from the scalp, face or neck in middle-aged persons or elderly. Szymanski was the first to describe a rare tumour presenting as a solitary papule or nodule most commonly affecting the scalp, face and neck and called it a 'warty dyskeratoma'[2] However, rare cases of multiple lesions [3] and involvement oral mucosa [4] and vulva [5] have been described.

Histologically, these lesions are characterized by 3 architectural patterns including cup-shaped, cystic and nodular variants. Sometimes combination of any of these two patterns may be seen.[1]

The striking histological features of Warty dyskeratoma (WD) are a cup-shaped epidermal invagination filled with keratotic debris, grains, corps ronds and villi formation with supra basal acantholytic cells. The differential diagnosis of acantholytic dyskeratosis similar to that seen in warty dyskeratoma are Darier's disease, acantholytic dyskeratotic acanthoma, acantholytic dyskeratotic epidermal nevus, focal acantholytic dyskeratosis and squamous cell carcinoma of acantholytic type, relapsing linear acanhtolytic dermatosis and acantholytic dermatosis of genitocrural area [6] [Table 1].
Table 1: Clinicopathological correlation in conditions characterized by acantholytic dyskeratosis

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This case is described for the rarity of warty dyskeratoma occurring on the lower extremity. In this case, histopathology proved to be valuable in confirming the diagnosis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Kaddu S, Dong H, Mayer G, Kerl H, Cerroni L. Warty dyskeratoma--”follicular dyskeratoma”: Analysis of clinicopathologic features of a distinctive follicular adnexal neoplasm. J Am Acad Dermatol 2002;47:423-8.  Back to cited text no. 1
    
2.
Szymanski FJ. Warty dyskeratoma; a benign cutaneous tumor resembling Darier's disease microscopically. AMA Arch Derm 1957;75:567-72.  Back to cited text no. 2
    
3.
Ugras N, Adim SB, Kilicoglu M and Baskan EB. Multiple warty dyskeratomas: Case report. Iran J Public Health 2014;43:1145-7.  Back to cited text no. 3
    
4.
Kaugars GE, Lieb RJ, Abbey LM. Focal oral warty dyskeratoma. Int J Dermatol 1984;23:123-30.  Back to cited text no. 4
    
5.
Torres KM, Junkins-Hopkins JM. Cystic acantholytic dyskeratosis of the vulva: An unusual presentation of a follicular adnexal neoplasm. Indian Dermatol Online J 2016;7:272-4.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Ho J, Bhawan J. Mimickers of classic acantholytic diseases. J Dermatol 2017;44:232-42.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1]



 

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