Warty dyskeratoma: Difference between revisions

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{{SI}}
{{SI}}


{{CMG}}; {{M.P}}
{{CMG}}; {{AE}} {{M.P}} {{KS}}


{{SK}} Isolated dyskeratosis follicularis
{{SK}} Isolated dyskeratosis follicularis
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==Historical Perspective==
==Historical Perspective==
Warty dyskeratoma was first described by Graham and Helwig as isolated [[Darier’s disease]] in 1954. This name, warty dyskeratoma was first coined by Szymanski in 1957 after his review of the cases.
Warty dyskeratoma was first described by Graham and Helwig as isolated [[Darier’s disease]] in 1954. The name warty dyskeratoma was first coined by Szymanski in 1957 after his review of the cases.


==Causes==
==Causes==
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==Differentiating Warty Dyskeratoma from other Conditions==
==Differentiating Warty Dyskeratoma from other Conditions==
Warty dyskeratoma can also be thought of as one of the manifestations of focal [[acantholytic]] [[dyskeratosis]], an epidermal reaction pattern that can be seen in several disorders, including [[Darier's disease]] and [[Grover's disease]].<ref name="Andrews">{{cite book |author=James, William D.; Berger, Timothy G.; et al. |title=Andrews' Diseases of the Skin: clinical Dermatology |publisher=Saunders Elsevier |location= |year=2006 |pages= |isbn=0-7216-2921-0 |oclc= |doi= |accessdate=}}</ref> But the main difference between Darier disease and warty dyskeratoma, is that [[Darier's disease]] inherited [[dermatosis]] ([[autosomal dominant]]) consisting of multiple [[keratotic]] [[papules]] on the [[face]], [[torso|trunk]], and [[Limb (anatomy)|extremities]], while WD occurs as an isolated, noninherited, single keratotic nodule mainly confined to the [[head]] and [[neck]] as mentioned earlier.<ref name="pmid6642851"/>
* Warty dyskeratoma can also be thought of as one of the manifestations of focal [[acantholytic]] [[dyskeratosis]], an epidermal reaction pattern that can be seen in several disorders, including [[Darier's disease]] and [[Grover's disease]].<ref name="Andrews">{{cite book |author=James, William D.; Berger, Timothy G.; et al. |title=Andrews' Diseases of the Skin: clinical Dermatology |publisher=Saunders Elsevier |location= |year=2006 |pages= |isbn=0-7216-2921-0 |oclc= |doi= |accessdate=}}</ref> But the main difference between Darier disease and warty dyskeratoma, is that [[Darier's disease]] inherited [[dermatosis]] ([[autosomal dominant]]) consisting of multiple [[keratotic]] [[papules]] on the [[face]], [[torso|trunk]], and [[Limb (anatomy)|extremities]], while WD occurs as an isolated, noninherited, single keratotic nodule mainly confined to the [[head]] and [[neck]] as mentioned earlier.<ref name="pmid6642851"/>
* Warty dyskeratoma must be differentiated from viral-induced squamous lesions.


Warty dyskeratoma must be differentiated from viral-induced squamous lesions and others such as
===Differential Diagnosis===
* [[Actinic keratosis]]
* [[Basal cell carcinoma]]
* [[Bowenoid papulosis]]
* [[Bowenoid papulosis]]
* [[Condyloma]]
* [[Condyloma]]
* [[Darier's disease]]
* [[Grover's disease]]
* [[Squamous carcinoma]]
* [[Squamous carcinoma]]
* [[Actinic keratosis]]
* [[Basal cell carcinoma]]
* [[Vulvar dysplasia]]<ref name="pmid6642851"/>
* [[Vulvar dysplasia]]<ref name="pmid6642851"/>


==Epidemiology and Demographics==
==Epidemiology and Demographics==
Warty dyskeratoma is a rare epidermal tumor that frequently arises as a papule or nodule on the head or neck of middle-aged or older persons.
Warty dyskeratoma is a rare epidermal [[tumor]] that frequently arises as a [[papule]] or [[nodule]] on the head or neck of middle-aged or older persons.


==Diagnosis==
==Diagnosis==
===History and Symptoms===
===History and Symptoms===
The patient usally comes complaing of pruritus. It is usually limited to the [[head]], [[neck]],<ref name="pmid6642851">{{cite journal |author=Duray PH, Merino MJ, Axiotis C |title=Warty dyskeratoma of the vulva |journal=[[Int. J. Gynecol. Pathol.]] |volume=2 |issue=3 |pages=286–93 |year=1983 |pmid=6642851 |doi= 10.1097/00004347-198303000-00006|url= |issn=}}</ref> [[scalp]]<ref name="pmid9499610">{{cite journal |author=Griffiths TW, Hashimoto K, Sharata HH, Ellis CN |title=Multiple warty dyskeratomas of the scalp |journal=[[Clin. Exp. Dermatol.]] |volume=22 |issue=4 |pages=189–91 |year=1997 |month=July |pmid=9499610 |doi= 10.1111/j.1365-2230.1997.tb01059.x|url= |issn=}}</ref> or [[face]] and [[vulva]].<ref name="pmid6642851"/> Lesions are generally [[wikt:solitary|solitary]] and sporadic and may be associated with a [[follicular unit]]. [[Mouth|Oral]] involvement,<ref name="pmid6698687"/> particularly the [[hard palate]], and [[genital]] involvement have been reported. They may also complain of recurrent foul-smelling cheesy drainage from the lesions. There may be central bleeding associated with trauma to the lesion.
* The patient usally comes complaing of pruritus that is usually limited to the [[head]], [[neck]],<ref name="pmid6642851">{{cite journal |author=Duray PH, Merino MJ, Axiotis C |title=Warty dyskeratoma of the vulva |journal=[[Int. J. Gynecol. Pathol.]] |volume=2 |issue=3 |pages=286–93 |year=1983 |pmid=6642851 |doi= 10.1097/00004347-198303000-00006|url= |issn=}}</ref> [[scalp]]<ref name="pmid9499610">{{cite journal |author=Griffiths TW, Hashimoto K, Sharata HH, Ellis CN |title=Multiple warty dyskeratomas of the scalp |journal=[[Clin. Exp. Dermatol.]] |volume=22 |issue=4 |pages=189–91 |year=1997 |month=July |pmid=9499610 |doi= 10.1111/j.1365-2230.1997.tb01059.x|url= |issn=}}</ref> or [[face]] and [[vulva]].<ref name="pmid6642851"/>
* Lesions are generally [[wikt:solitary|solitary]] and sporadic and may be associated with a [[follicular unit]].
* [[Mouth|Oral]] involvement, particularly the [[hard palate]], and [[genital]] involvement have been reported. They may also complain of recurrent foul-smelling cheesy drainage from the lesions.<ref name="pmid6698687"/>
* There may be central bleeding associated with trauma to the lesion.


===Laboratory Findings===
===Laboratory Findings===
Hisotopathological examination of the lesions may reveal a cup-shaped invagination filled with a keratotic plug. The invagination contains numerous acantholytic dyskeratotic cells and typical corps ronds can be seen at the entrance to the invagination. The lower portion of the invagination may show the presence of many villi that are often covered by a single layer of basaloid cells and these villi protrude upward.
* Hisotopathological examination of the lesions may reveal a cup-shaped invagination filled with a keratotic plug.
* The invagination contains numerous acantholytic dyskeratotic cells and typical corps ronds can be seen at the entrance to the invagination.
* The lower portion of the invagination may show the presence of many [[villi]] that are often covered by a single layer of basaloid cells and these villi protrude upward.
[[Image:800px-SkinTumors-P5280031.JPG|centre|HPE of warty dyskeratoma showing keratotic plug|300px]]
[[Image:800px-SkinTumors-P5280031.JPG|centre|HPE of warty dyskeratoma showing keratotic plug|300px]]
''Copyleft image obtained courtesy of [https://en.wikipedia.org/wiki/File:SkinTumors-P5280031.JPG#file Wikipedia]; L Wozniak & KW Zielinski''
 
===Physical Examination===
====Skin====
=====Trunk=====
<gallery>
Image:warty dyskeratoma01.jpg|Warty dyskeratoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
 
Image:warty dyskeratoma02.jpg|Warty dyskeratoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:warty dyskeratoma03.jpg|Warty dyskeratoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
 
 
 
Image:warty dyskeratoma04.jpg|Warty dyskeratoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
 
 
</gallery>


==Treatment==
==Treatment==
The treatment of choice of WD is surgical excision. Other possible modalities of treatment are
* The treatment of choice of WD is surgical excision.
* Curettement with electro-desiccation
* Other possible modalities of treatment are available but they are frequently associated with recurrences. These modalities include:
* [[Irradiation]] with X-ray.<ref name="pmid5773508">{{cite journal| author=Tanay A, Mehregan AH| title=Warty dyskeratoma. | journal=Dermatologica | year= 1969 | volume= 138 | issue= 3 | pages= 155-64 | pmid=5773508 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5773508  }} </ref>
** Curettement with electro-desiccation
* Tazarotenic acid gel.<ref name="pmid11807455">{{cite journal| author=Abramovits W, Abdelmalek N| title=Treatment of warty dyskeratoma with tazarotenic acid. | journal=J Am Acad Dermatol | year= 2002 | volume= 46 | issue= 2 Suppl Case Reports | pages= S4 | pmid=11807455 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11807455  }} </ref>
** [[Irradiation]] with [[X-ray]] <ref name="pmid5773508">{{cite journal| author=Tanay A, Mehregan AH| title=Warty dyskeratoma. | journal=Dermatologica | year= 1969 | volume= 138 | issue= 3 | pages= 155-64 | pmid=5773508 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5773508  }} </ref>
The other modalities are frequently associated with recurrences.
** Tazarotenic acid gel <ref name="pmid11807455">{{cite journal| author=Abramovits W, Abdelmalek N| title=Treatment of warty dyskeratoma with tazarotenic acid. | journal=J Am Acad Dermatol | year= 2002 | volume= 46 | issue= 2 Suppl Case Reports | pages= S4 | pmid=11807455 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11807455  }} </ref>


==References==
==References==

Latest revision as of 17:12, 3 October 2014

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mugilan Poongkunran M.B.B.S [2] Kiran Singh, M.D. [3]

Synonyms and keywords: Isolated dyskeratosis follicularis

Overview

Warty dyskeratoma (WD) is a benign epidermal proliferation[1] with distinctive histological findings that may mimic invasive squamous cell carcinoma[2] and commonly manifests as an umbilicated (having a central mark or depression resembling a navel) lesion with a keratotic plug.[3]

Historical Perspective

Warty dyskeratoma was first described by Graham and Helwig as isolated Darier’s disease in 1954. The name warty dyskeratoma was first coined by Szymanski in 1957 after his review of the cases.

Causes

The etiology of warty dyskeratoma is unclear, but a viral infection, smoking, autoimmunity, and ultraviolet light have been postulated to play a role. Several hypothesis reveal histopathologic similarities to viral warts but it's not caused by HPV and the majority of these lesions display overall histopathologic features consistent with a follicular adnexal neoplasm.[4]

Differentiating Warty Dyskeratoma from other Conditions

Differential Diagnosis

Epidemiology and Demographics

Warty dyskeratoma is a rare epidermal tumor that frequently arises as a papule or nodule on the head or neck of middle-aged or older persons.

Diagnosis

History and Symptoms

  • The patient usally comes complaing of pruritus that is usually limited to the head, neck,[6] scalp[7] or face and vulva.[6]
  • Lesions are generally solitary and sporadic and may be associated with a follicular unit.
  • Oral involvement, particularly the hard palate, and genital involvement have been reported. They may also complain of recurrent foul-smelling cheesy drainage from the lesions.[3]
  • There may be central bleeding associated with trauma to the lesion.

Laboratory Findings

  • Hisotopathological examination of the lesions may reveal a cup-shaped invagination filled with a keratotic plug.
  • The invagination contains numerous acantholytic dyskeratotic cells and typical corps ronds can be seen at the entrance to the invagination.
  • The lower portion of the invagination may show the presence of many villi that are often covered by a single layer of basaloid cells and these villi protrude upward.
HPE of warty dyskeratoma showing keratotic plug
HPE of warty dyskeratoma showing keratotic plug

Physical Examination

Skin

Trunk

Treatment

  • The treatment of choice of WD is surgical excision.
  • Other possible modalities of treatment are available but they are frequently associated with recurrences. These modalities include:

References

  1. ↑ Diallo M, Cribier B, Scrivener Y (2007). "[Warty dyskeratoma: infundibular histogenesis. Anatomoclinical study of 43 cases]". Ann Dermatol Venereol (in French). 134 (8–9): 633–6. PMID 17925685.
  2. ↑ Chau MN, Radden BG (1984). "Oral warty dyskeratoma". J. Oral Pathol. 13 (5): 546–56. doi:10.1111/j.1600-0714.1984.tb01455.x. PMID 6434720. Unknown parameter |month= ignored (help)
  3. ↑ 3.0 3.1 Kaugars GE, Lieb RJ, Abbey LM (1984). "Focal oral warty dyskeratoma". Int. J. Dermatol. 23 (2): 123–30. doi:10.1111/j.1365-4362.1984.tb05686.x. PMID 6698687. Unknown parameter |month= ignored (help)
  4. ↑ Kaddu S, Dong H, Mayer G, Kerl H, Cerroni L (2002). "Warty dyskeratoma--"follicular dyskeratoma": analysis of clinicopathologic features of a distinctive follicular adnexal neoplasm". J. Am. Acad. Dermatol. 47 (3): 423–8. doi:10.1067/mjd.2002.122756. PMID 12196754. Unknown parameter |month= ignored (help)
  5. ↑ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.
  6. ↑ 6.0 6.1 6.2 6.3 Duray PH, Merino MJ, Axiotis C (1983). "Warty dyskeratoma of the vulva". Int. J. Gynecol. Pathol. 2 (3): 286–93. doi:10.1097/00004347-198303000-00006. PMID 6642851.
  7. ↑ Griffiths TW, Hashimoto K, Sharata HH, Ellis CN (1997). "Multiple warty dyskeratomas of the scalp". Clin. Exp. Dermatol. 22 (4): 189–91. doi:10.1111/j.1365-2230.1997.tb01059.x. PMID 9499610. Unknown parameter |month= ignored (help)
  8. ↑ 8.0 8.1 8.2 8.3 "Dermatology Atlas".
  9. ↑ Tanay A, Mehregan AH (1969). "Warty dyskeratoma". Dermatologica. 138 (3): 155–64. PMID 5773508.
  10. ↑ Abramovits W, Abdelmalek N (2002). "Treatment of warty dyskeratoma with tazarotenic acid". J Am Acad Dermatol. 46 (2 Suppl Case Reports): S4. PMID 11807455.


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