Psuedoepitheliomatous Hyperplasia Mimicking Squamous Cell Cancer in a Post-burn Scalp Wound: Case Report and Review of Literature

Introduction: Pseudoepitheliomatous hyperplasia is a benigncondition characterized by hyperplasia of the epidermis andadnexal epithelium commonly occurring in reaction to severalconditions including chronic burn wound.Case Report: An 18 month old male patient presented withscald burns to the scalp and face with chronicity and infectionof the burn wound as consent for skin grafting was not givenby the parents. Initial histology of incision biopsy specimenrevealed a well-differentiated squamous cell carcinoma ina chronic burn wound on the scalp. This did not correlatewith the clinical picture of the wound necessitating a secondhistologic review of the biopsy specimen, which this timewas confirmed as pseudoepitheliomatous hyperplasia.Patient further declined excision and grafting with the woundeventually healing with scarring after 10 months.Conclusion: A very high index of suspicion is required inmaking the diagnosis of PEH. Public enlightenment is neededto educate people on wounds and their management if optimalresults must be obtained.

Clinical analysis of pseudoepitheliomatous keratotic and micaceous balanitis: five case reports / 中华皮肤科杂志

Objective To investigate clinical and pathological features of pseudoepitheliomatous keratotic and micaceous balanitis (PKMB).Methods The clinical and pathological features as well as treatment of PKMB were retrospectively analyzed in 5 male patients collected from Janumy 2008 to December 2013.Results The age at onset of PKMB varied from 56 to 67 years in these 5 patients,and none of the patients had received prepucectomy.Indurated keratotic plaques were observed in the glans of penis and inner lamina of the prepuce with no tenderness on palpation,whose surfaces were covered with grayish yellow,adherent and hard micaceous crusts.Histopathological study revealed obvious hyperkeratosis complicated by parakeratosis,epidermal pseudoepitheliomatous hyperplasia,thickened spinous layer,and normal cell polarity in the epidermis,as well as telangiectasis and mild to moderate lymphocytic infiltration in the upper dermis.Immunohistochemical examination showed positive nuclear staining of epidermal cells for human papillomavirus (HPV) in 2 cases.Two patients took small doses of prednisone,but achieved no obvious improvement.Oral isotretinoin had resulted in a favorable outcome in another two cases,but relapse occurred after dose reduction,and thick crusts still appeared after topical application of glucocorticoid cream and tacrolimus cream,or carbon dioxide laser treatment and photodynamic therapy.Conclusions PKMB is a chronic and obstinate disease,and should be diagnosed based on pathological findings.Its treatment is difficult,and tretinoin has some effects,but relapse often occurs after drug withdrawal and maintenance treatment is needed.

Pseudoepitheliomatous Hyperplasia Mimicking Esophageal Squamous Cell Carcinoma in a Patient with Lye-induced Esophageal Stricture / 대한소화기학회지

Pseudoepitheliomatous hyperplasia is a benign condition that may be caused by prolonged inflammation, chronic infection, and/or neoplastic conditions of the mucous membranes or skin. Due to its histological resemblance to well-differentiated squamous cell carcinoma, pseudoepitheliomatous hyperplasia may occasionally be misdiagnosed as squamous cell carcinoma. The importance of pseudoepitheliomatous hyperplasia is that it is a self-limited condition that must be distinguished from squamous cell carcinoma before invasive treatment. We report here on a rare case of esophageal pseudoepitheliomatous hyperplasia in a 67-year-old Korean woman with a lye-induced esophageal stricture. Although esophageal pseudoepitheliomatous hyperplasia is infrequently encountered, pseudoepitheliomatous hyperplasia should be considered in the differential diagnosis of esophageal lesions.

Pseudoepitheliomatous Hyperplasia Mimicking Esophageal Squamous Cell Carcinoma in a Patient with Lye-induced Esophageal Stricture / 대한소화기학회지

Pseudoepitheliomatous hyperplasia is a benign condition that may be caused by prolonged inflammation, chronic infection, and/or neoplastic conditions of the mucous membranes or skin. Due to its histological resemblance to well-differentiated squamous cell carcinoma, pseudoepitheliomatous hyperplasia may occasionally be misdiagnosed as squamous cell carcinoma. The importance of pseudoepitheliomatous hyperplasia is that it is a self-limited condition that must be distinguished from squamous cell carcinoma before invasive treatment. We report here on a rare case of esophageal pseudoepitheliomatous hyperplasia in a 67-year-old Korean woman with a lye-induced esophageal stricture. Although esophageal pseudoepitheliomatous hyperplasia is infrequently encountered, pseudoepitheliomatous hyperplasia should be considered in the differential diagnosis of esophageal lesions.

A Case of Malignant Melanoma with Pseudoepitheliomatous Hyperplasia on the Sole / 대한피부과학회지

No abstract available.

Expressions of E-cadherin, Cortactin and MMP-9 in Pseudoepitheliomatous Hyperplasia and Squamous Cell Carcinoma of the Head and Neck: Their Relationships with Clinicopathologic Factors and Prognostic Implication

BACKGROUND: E-cadherin, cortactin, and matrix metalloproteinase (MMP)-9 have roles in tumor development or progression, but their expression has not been fully investigated in pseudoepitheliomatous hyperplasia (PEH) and squamous cell carcinoma (SCC) of the head and neck. METHODS: We evaluated the immunohistochemical expression of E-cadherin, cortactin, and MMP-9 in 29 cases of PEH and 97 cases of SCC. Additionally, we evaluated their relationship with clinicopathologic factors and prognostic implications in SCC. RESULTS: Thirty-five cases of SCC showed reduced expression of E-cadherin, whereas none of the PEH did. A total of 20 cases and 11 cases of SCC were immunoreactive for cortactin and MMP-9, respectively, whereas none of the PEH did. In SCC, reduced expression of E-cadherin was correlated with cortactin expression and invasion depth. Cortactin expression was correlated with differentiation, T classification, and recurrence and/or metastasis. MMP-9 expression was correlated with invasion depth. Cortactin expression was correlated with poor overall survival and relapse-free survival and it was an independent prognostic factor. CONCLUSIONS: The reduced expression of E-cadherin and the expression of cortactin may be helpful for the differential diagnosis of PEH and SCC. Furthermore, cortactin expression in association with reduced E-cadherin expression is correlated with poor prognosis in SCC.

Concurrent mycetoma and chromomycosis.

Chromoblastomycosis and Madura foot are chronic localised mycotic infection of the skin and subcutaneous tissue that follows the implantation of the fungi through minor trauma, mainly found in persons working outdoors on bare foot. In cases where both Madura and chromoblastomycosis are present, the treatment becomes difficult with low cure rates and frequent relapses. Here, we present such a very rare case of a 38-year-old cattle farmer who presented with verrucose nodules, tumefaction and multiple discharging nodules on the left lower 1/3 rd leg and foot since last 9 years. Direct KOH mount of the verrucose tissue showed Fonsecaea pedrosoi sclerotic muriform bodies and a biopsy of one granule discharging nodule demonstrated fungal mycetoma. He was put on tab. Itraconazole 200 mg o.d. and cotrimoxazole bid for 6 months with very little improvement. The rarity of this combination is most probably due to different geographical distribution.

'Unstained' and 'de stained' sections in the diagnosis of chromoblastomycosis: A clinico-pathological study.

Background: Diagnosis of chromoblastomycosis is frequently missed for many reasons: (1) rarity of the lesion (2) requirement of careful search for diagnostic 'sclerotic' bodies which are often sparse in clinical material such as tissue and exudates (3) often they elicit tissue reactions such as verrucous lesion and micro abscesses, misleading the diagnosis (4) lack of 'clinical suspicion'. Aims: (1) To compare the feasibility of 'unstained', 'stained' and 'de stained' sections in identification of the diagnostic ' sclerotic' bodies (2) To study histopathological features of chromoblastomycosis, and (3) To highlight the importance of clinical suspicion in the diagnosis of chromoblastomycosis. Design : This is a retrospective study conducted on six clinically unsuspected, histopathologically diagnosed cases of chromoblastomycosis. Results: Most common clinical presentation was verrucous lesion over extremities affecting adult men engaged in outdoor works. Sclerotic bodies and their characteristic features were easily identified in both 'unstained' and 'de stained' sections. Special stains such as Fontana Masson and Gomori's methenamine silver nitrate are useful for demonstrating hyphal forms in keratinized layers and for illustration purposes. Conclusion: Both 'unstained' and 'de stained' sections can be used for rapid screening of sclerotic bodies. 'De stained' sections can be used as a suitable substitute for special stains for confirmation and for retrospective review of all verrucous lesions to diagnose the missed lesion. Clinical suspicion is very important in the diagnosis of chromoblastomycosis as it helps pathologist to screen for diagnostic sclerotic bodies.

Pseudoepitheliomatous, keratotic, and micaceous balanitis presenting as cutaneous horn in an adult male.

Pseudoepitheliomatous, keratotic, and micaceous balanitis is an extremely rare condition occurring over the glans in elderly characterized by silvery white plaque with mica-like crust, which can undergo malignant transformation. Herein we present a case of pseudoepitheliomatous, keratotic, and micaceous balanitis occurring in an adult male presenting as a cutaneous horn.

A Case of Primary Cutaneous Anaplastic Large Cell Lymphoma Mimmicking Keratoacanthoma / 대한피부과학회지

Pseudoepitheliomatous hyperplasia with a massive neutrophil infiltrate associated with primary cutaneous anaplastic large cell lymphoma has been rarely reported. Herein we report on a 33-year-old man who presented with multiple asymptomatic erythematous walnut-sized rapidly growing tumors on the axilla, trunk and left inguinal area for 1 month. The histopathologic features showed a keratoacanthoma-like epithelial hyperplasia in the epidermis and several large atypical lymphoid cells with nuclear plemorphism and abundant cytoplasm in the dermis. The atypical cells were obscured by a rich infiltrate of neutrophils and some eosionophils. Immunohistochemical studies confirmed the majority of the large anaplastic cells in the dermis were CD30+ cells. In addition, the expressions of anaplastic lymphoma kinase (ALK) and epithelial membrane antigen (EMA) were negative. There was no evidence of extracutaneous involvement. The patient was diagnosed with primary cutaneous anaplastic large cell lymphoma (ALCL) and he was treated with low dose methotrexate (15 mg/week). We think that this case was challenging both clinically and histologically.

Nasal Type NK/T Cell Lymphoma with Pseudoepitheliomatous Hyperplasia: A Case Report

A case of prominent pseudoepitheliomatous hyperplasia (PEH), that was misdiagnosed as squamous cell carcinoma (SCC) on the frozen section occured in the nasal mucosa of a patient suffering with nasal type NK/T cell lymphoma. To prevent misdiagnosis of this lesion, pathologists should be aware that NK/T cell lymphoma may be associated with overlying mucosal PEH, and so the physician must adhere to strict diagnostic criteria for making the diagnosis of SCC. The pathogenesis of PEH associated with NK/T cell lymphoma is not still clear, but it may be related to the production of growth factors, especially epidermal growth factor and transforming growth factor, by the underlying tumors.

Immunohistochemical Expression of MMP-7 and MMP-13 in Chronic Cutaneous Ulcers and Squamous Cell Carcinomas / 대한피부과학회지

BACKGROUND: The risk of squamous cell carcinoma (SCC) is significantly increased in chronic cutaneous ulcers. Moreover, if the proliferating epithelium of the ulcer margin shows pseudoepitheliomatous hyperplasia, it can be very difficult to discriminate between the two diseases. Enzymes such as matrix metalloproteinases (MMPs) are thought to be implicated at all stages of tumorigenesis. OBJECTIVE: We investigated the expression patterns of epithelial MMP-7 and MMP-13 in chronic ulcers and SCCs by an immunohistochemical technique and the usefulness in differentiating these two entities. METHODS: Formalin-fixed and paraffin-embedded tissues obtained from 16 chronic ulcers and 12 SCC patients were studied using an immunohistochemical staining method for MMP-7 and MMP-13. RESULTS: MMP-7 and MMP-13 were expressed by the malignant tumor cells of 4 (33.3%) and 9 SCC samples (75%), respectively, while they were absent from the proliferating epithelium of chronic ulcers. CONCLUSION: Our results suggest that epithelial expression of both MMP-7 and MMP-13 have a specificity in differentiating the benign epithelial proliferation of chronic ulcer from malignant tumor cells, but MMP-13 seems to be a more sensitive and useful marker due to the lower sensitivity of MMP-7 in SCCs.

Instability of epithelial-mesenchymal cells transdifferentiation (EMT) in the formation of pseudoepitheliomatous hyperplasia / 解放军医学杂志

Objective To explore the correlation of the formation of pseudoepitheliomatous hyperplasia (PEH) after healing of inappropriately treated wound of skin with epithelial mesenchymal cells transdifferentiation (EMT). Methods Morphological change in epithelial tissue was observed with histopathologic methods in epithelial cells from PEH lesions ( n =11) and normal skin specimens obtained adjacent to PEH (PEH N, n =6) from 11 patients with PEH. At the same time, the characteristic of expressions and distribution of type Ⅰ and Ⅲ collagen, alpha smooth muscule actin (? SMA), vimentin (Vim), desmin (Des), transforming growth factor ?1 (TGF ?1)and its receptor (TGFRI), pan cytokeratin (CKp), and type Ⅳ collagen in PEH were examined with indirect immunofluorescent double labelling method. Results In comparison with PEH N, squamous epithelium in PEH presented a picture of atypical hyperplasia, there was a derangement of basal apical polarity, disrupture in structure, and a displacement of cells foward mesenchyme. Examination under electron microscope revealed deformation of epithelial basal cells, with loose intercellular junction, and newly formed tumor like cells distingaishable from original epithelial cells. Expressions of type Ⅰ and Ⅲ collagen,? SMA,Vim and Des could be detected in the epithelial cells of PEH. However,the protein expressions of CKp, Ⅳ type collagen were significantly decreased in basal epithelial cells. Furthermore, free epithelial cells expressing CKp were found in the deep layer of mesenchyme. Conclusion It was confirmed for the first time that there was a phenomenon of EMT during the course of PEH formation. Epithelial cells in PEH lesion with granuloma and non hypertrophic scar are characteristized by de differentiation, redifferentiation and a decrement of TGF ?1 induction, which are involved in reactive hyperplasia of the epithelium.

Two Cases of Pseudoepitheliomatous , Keratotic and Micaceous Balanitis / 대한피부과학회지

Pseudoepitheliomatous, keratotic and micaceous balanitis is a rare distictive clinical entity that represents a histologic spectrum ranging from hypertrophic hyperpalstic penile dystrophy to verrucous carcinoma. This condition is thought to be a malignant growth potential by resistance to treatment and its tendency toward local recurrence. We report two cases with similar clinical presentation of hyperkeratotic plaque and micaceous scaly patches on the glans penis that were compatible with pseudoepitheliomatous, keratotic and micaceous balanitis. Histopathologically, case 1, 48 year-old male was progressed to squamous cell carcinoma and case 2, 78 year-old male, was shown pseudoepitheliomatous hyperplasia without malignant changes.