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Knapp C, Masters R, Ruhoy SM. Pagetoid Dyskeratosis of the Hand With Parallel Ridge Pattern on Dermoscopy and Expression of Bcl-10 by Immunohistochemistry. Am J Dermatopathol 2022; 44:840-842. [PMID: 36066116 DOI: 10.1097/dad.0000000000002277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Calvin Knapp
- Department of Dermatology, Oregon Health and Science Center, Portland Oregon
| | - Reid Masters
- Department of Dermatology, Valley Medical Center, Renton Washington; and
| | - Steven M Ruhoy
- Department of Dermatology, Oregon Health and Science Center, Portland Oregon
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Falay Gür T, Savaş Erdoğan S, Sade AG. Pagetoid dyskeratosis with a palmar localization: Rapid resolution following biopsy. J Cosmet Dermatol 2021; 21:1749-1752. [PMID: 34213809 DOI: 10.1111/jocd.14321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/15/2021] [Accepted: 06/28/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Pagetoid dyskeratosis (PD), which is found in more than 2% of skin biopsy specimens, is accepted as a histopathological finding reflecting the abnormal keratinization process. However, to date, only a limited number of cases have been described to have brown pigmentation on the hands, triggered by friction, and present with pagetoid dyskeratosis as the only sign on histopathology and a parallel ridge pattern on dermoscopy. AIM To present and discuss the typical clinical, histopathological, and dermoscopic features of pagetoid dyskeratosis, and to draw attention to the spontaneous resolution following biopsy. PATIENT We present a case of pagetoid dyskeratosis with a palmar localization, which rapidly resolved following biopsy, in a patient with no history of friction. RESULTS PD is the only important histopathological finding in typical irregular pigmented lesions located in the hand. PD should also be considered in the differential diagnosis of lesions that show parallel ridge pattern on the hand. Two weeks after the biopsy, disappearance of the lesion may be due to the effect of inflammatory response revealed by biopsy. CONCLUSIONS Although the cause of this condition is not yet fully understood, most cases being associated with friction or rapid spontaneous resolution following biopsy, as in the current case, may indicate the reactive nature of the lesion. Further researches are required to be clarify etiology of PD.
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Affiliation(s)
- Tuğba Falay Gür
- Department of Dermatology, University of Health Sciences, Sultan 2. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Sevil Savaş Erdoğan
- Department of Dermatology, University of Health Sciences, Sultan 2. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Ayşe Gökçen Sade
- Department of Pathology, University of Health Sciences, Sultan 2. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
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Rocha TOCD, Moya FG, Vilella VM, Lellis RF. Pagetoid dyskeratosis in dermatopathology. An Bras Dermatol 2021; 96:454-457. [PMID: 34083117 PMCID: PMC8245710 DOI: 10.1016/j.abd.2020.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/08/2020] [Indexed: 11/15/2022] Open
Abstract
Currently, pagetoid dyskeratosis is believed to involve an accelerated keratinization process, possibly induced by mechanical trauma. It represents, in almost its totality, incidental histological findings of specific cells, except when it occurs in the hands, where it usually occurs simultaneously with skin lesions and local dyschromia. These are large, rounded keratinocytes, with pale cytoplasm and a pyknotic nucleus surrounded by a clear halo, which can be easily mistaken by other skin diseases. Its etiology is not completely elucidated, and the correct identification of this entity can be of great importance in the differential diagnosis of skin disorders and the understanding of the keratinization process of the epidermis.
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Affiliation(s)
| | - Fernanda Gonçalves Moya
- Department of Pathology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Rute Facchini Lellis
- Department of Pathology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil; Department of Pathology, AC Camargo Câncer Center, São Paulo, SP, Brazil
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Konstantinova AM, Kazakov DV. Extramammary Paget disease of the vulva. Semin Diagn Pathol 2020; 38:50687. [PMID: 32921571 DOI: 10.1053/j.semdp.2020.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 02/03/2023]
Abstract
Extramammary Paget disease (EMPD) is a rare neoplasm with uncertain histogenesis, usually presenting in the anogenital area, most commonly in the vulva. The disease is characterized by slow grow and high recurrence rates. This article reviews the epidemiological, clinical, morphological, genetic and treatment features of EMPD of the vulva reported in recent years.
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Affiliation(s)
- Anastasia M Konstantinova
- Department of Pathology, Clinical Research and Practical Center for Specialized Oncological care, Saint-Petersburg, Russian Federation; Department of Pathology, Medical Faculty, Saint-Petersburg State University, Russian Federation; Department of Pathology, Saint-Petersburg Medico-Social Institute, St.-Petersburg, Russian Federation
| | - Dmitry V Kazakov
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic; Bioptical Laboratory, Pilsen, Czech Republic.
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Werbel T, Cohen PR. Pagetoid Dyskeratosis of the Male Genitalia: Case Report and Review. Cureus 2018; 10:e2727. [PMID: 30083488 PMCID: PMC6070057 DOI: 10.7759/cureus.2727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Pagetoid dyskeratosis is a benign incidental pathologic finding that has been reported in many distinct skin lesions on various locations of the body. A man who had pagetoid dyskeratosis within lesions of the penile shaft is described and similar cases of pagetoid dyskeratosis in lesions of the male genitalia are reviewed. The patient was a 26-year-old healthy man who developed several asymptomatic penile papules that were refractory to topical imiquimod 5% cream and cryotherapy. Snip biopsies were performed and microscopic examination revealed pagetoid dyskeratosis. PubMed was searched for the following terms: cell, clear, dyskeratosis, genitalia, pagetoid, penile, penis, prepuce, scrotum, and shaft. The papers containing these terms and their references were reviewed. Pagetoid dyskeratosis has been observed in lesions on the prepuce and scrotum; this case report now expands the distribution of this finding to the penile shaft. Clinicians and pathologists should be aware of this intriguing potential incidental finding within skin lesions of the male genitalia.
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Affiliation(s)
- Tyler Werbel
- School of Medicine, University of California, San Diego, San Diego, USA
| | - Philip R Cohen
- Dermatologist, San Diego Family Dermatology, National City, USA
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Abstract
Pagetoid dyskeratosis (PD) is an incidental pathologic finding that appears in several skin conditions. In an attempt to better understand PD and its incidence in dermatopathology, the authors have analyzed all skin biopsies performed over the period of 1 year in our Department of Dermatology and examined their clinical and dermatopathological variables. The criteria used for a keratinocyte to be considered a PD cell were: (1) a size larger than normal, (2) the presence of pycnotic nucleus, (3) a clear halo surrounding the nucleus, and (4) a pale eosinophilic cytoplasm. A total of 3565 biopsies were analyzed, PD cells being found in 80 cases (2.24%). Melanocytic nevi were the commonest skin lesions in which PD was observed, followed by soft fibromas, angiofibromas, and acrochordons. Most lesions were located on the head, neck, and trunk. Most cases displayed fewer than 15 PD cells per field. PD cells were normally located in the mid epidermis (frequently in clusters). The biopsies usually revealed indirect signs of rubbing, although PD cells were also found in places where rubbing was unlikely. Here, the authors report the largest series of PD analyzed to date, expanding our understanding of this striking pathological observation.
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Affiliation(s)
- Pankaj Salphale
- Department of Dermatology, Venereology and Leprosy, Christian Medical College and Hospital, Vellore, India
| | - Meera Thomas
- Department of Pathology, Christian Medical College and Hospital, Vellore, India
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Proliferating pagetoid dyskeratosis: a new variant of pagetoid dyskeratosis associated with Bowen disease. Am J Dermatopathol 2014; 36:e97-9. [PMID: 24805260 DOI: 10.1097/dad.0000000000000002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pagetoid dyskeratosis refers to a characteristic pathologic aspect of keratinocytes of the epidermis and other stratified epithelia, that have a size larger than normal, a pale cytoplasm and a pycnotic nucleus surrounded by a clear halo. This aspect has been reported, often as an incidental finding, in benign conditions. We observed a case of Bowen disease featuring pagetoid dyskeratosis remarkable because the cells concerned were in mitosis, a finding so far unreported. We call this aspect "proliferating pagetoid dyskeratosis" to differentiate it from the usual pagetoid dyskeratosis and to highlight its association with mitotic nuclei. The significance of this rare finding warrants further study.
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Al-Mohammedi F, de Gannes GC, Crawford RI. Friction-induced pagetoid dyskeratosis. J Cutan Med Surg 2013; 17:250-2. [PMID: 23815957 DOI: 10.2310/7750.2012.12071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pagetoid dyskeratosis (PD) is characterized by pale cells within the epidermis resembling those of Paget disease. These cells have been seen as an incidental finding in a variety of benign papules most commonly located in intertriginous areas. The lesion is considered a reactive process in which a small proportion of the normal population of keratinocytes is altered. Among the triggers for this lesion, friction has been suggested; however, a direct cause-and-effect relationship has not yet been reported. RESULTS We confirmed the relationship between PD and friction in a biopsy taken from a 19-year-old woman who presented with clinical features indicating exogenously induced bullae and erosions and consented to a biopsy of a lesion immediately after its induction, demonstrating combined features of PD and friction bulla.
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Affiliation(s)
- Faisal Al-Mohammedi
- Department pf Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC
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Pagetoid dyskeratosis of the scrotum: histologic findings resembling extramammary Paget's disease. Am J Dermatopathol 2011; 33:755-7. [PMID: 21915037 DOI: 10.1097/dad.0b013e31820a264f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Long considered to be ectopic breast tissue representing the caudal remnants of the milk ridges, anogenital mammary-like glands are nowadays thought to represent a normal constituent of the anogenital area. Lesions involving these glands, benign or malignant, epithelial or stromal manifest a striking similarity to their mammary counterparts. This review addresses the recent literature on lesions of anogenital mammary-like glands and our personal experience with various lesions related to these structures. Discussed are the normal anatomy and histology of these glands as well as the clinical presentation, histopathological and immunohistochemical features, molecular biological aspects, and differential diagnosis of various lesions involving anogenital mammary-like glands, including lactating adenoma, hidradenoma papilliferum, hidradenocarcinoma papilliferum, fibroadenomas, phyllodes tumor, pseudoangiomatous stromal hyperplasia, extramammary Paget disease, and other carcinomas. In addition, "nonspecific" epithelial or stromal changes some of which can be likened to similar changes occurring in a range of benign breast disease, including sclerosing adenosis, columnar cell lesions, ductal lesions and various metaplastic changes affecting epithelium and myoepithelium are discussed. Although lesions of anogenital mammary-like glands are often discussed in many dermatopathology textbooks in the context of cutaneous adnexal neoplasms we advocate that the best approach to the diagnosis of these lesions is to relate them to analogous well recognized lesions occurring in the breast, that is, through the eyes of a breast pathologist. This will enable their recognition, precise classification and should introduce greater uniformity in how they are reported in the literature so that more meaningful clinicopathological comparisons and correlations may be made.
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GARIJO MFRANCISCA, VAL DANIEL, VAL-BERNAL JFERNANDO. Pagetoid dyskeratosis of the nipple epidermis: an incidental finding mimicking Paget's disease of the nipple. APMIS 2008; 116:139-46. [DOI: 10.1111/j.1600-0463.2008.00826.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Piqué-Duran E, Palacios-Llopis S, Moreno-Ramis P, Pérez-Cejudo JA, Martínez-Martín MS. Comparative Study of Pagetoid Dyskeratosis Between Acrochordons and Soft Fibromas. Am J Dermatopathol 2006; 28:478-81. [PMID: 17122491 DOI: 10.1097/01.dad.0000208265.05109.a0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pagetoid dyskeratosis (PD) is considered a casual finding. We can find it in some conditions, including acrochordons and soft fibromas. OBJECTIVE (1) to compare the presence of PD in soft fibromas and acrochordons and (2) to compare PD positive fibromas and PD negative fibromas. MATERIALS AND METHODS We reviewed all acrochordons and soft fibromas diagnosed in the General Hospital of Lanzarote, Spain, between January 2001 and December 2002. We assessed the presence of PD, size, acanthosis, basal pigmentation, and the presence of pseudohorn cysts. RESULTS Three hundred sixty one acrochordons and 164 soft fibromas were included in this study. There were striking differences in the presence of PD, size, acanthosis, and basal pigmentation between both entities. PD positive fibromas predominated in axillas. There were no other differences between PD positive fibromas and PD negative fibromas. CONCLUSION Although soft fibromas and acrochordons are actually fibroepithelial polyps, including the presence of PD, there are striking differences between them. Thus, both conditions have to be considered as different entities. PD could be related to friction and moisture. PD has to be distinguished from other conditions such as Paget's disease, pagetoid melanoma, koilocytes, clear cell papulosis, among others.
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Affiliation(s)
- Enric Piqué-Duran
- Department of Dermatology, Hospital General of Lanzarote, Canary Islands, Spain.
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Abstract
Distinction between benign and malignant melanocytic lesions commonly represents a big challenge for the pathologist. Equally difficult is separating tumours with melanocytic lineage from those displaying other lines of differentiation. This is because benign and malignant melanocytic lesions are able to display a wide range of histological appearances that frequently closely mimic reactive and neoplastic lesions (benign and malignant). This applies to processes with almost any line of differentiation. Difficulties in differential diagnosis are mainly found in melanocytic lesions restricted to the dermis or those in which the junctional component is minimal. Although purely junctional melanocytic lesions less commonly pose a problem in differential diagnosis, they may be very problematic, especially in small biopsies. Immunohistochemistry is usually a very important aid in the differential diagnosis of mimics of melanocytic lesions but pitfalls often occur. This is particularly true when small samples are analysed and when close clinicopathological correlation is lacking. This review discusses the histological differential diagnosis of mimics of melanocytic lesions. These mimics are separated into those primarily presenting in the epidermis and those presenting in the dermis.
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Affiliation(s)
- E Calonje
- St John's Institute of Dermatology, St Thomas' Hospital, London, UK.
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