RESUMO
Seborrheic keratosis(SK) is a very common skin tumor which is mostly frequently observed in the trunck, head, neck. SK in the auricle is rare and this condition should be excluded the possibility of malignancy by pathologic diagnosis. We report a case of 66-year-old man who presented with a brownish, papillomatous, verrucous mass in the auricle for the past seven years, which began to growing faster during the previous year. Dermoscopy and histopathological examination were performed and the patient was diagnosed with SK. He was treated with the carbon dioxide(CO2) laser and aminolevulinate photodynamic therapy (ALA-PDT). The CO2 laser was used for the removal of the thick hypertrophic lesions and to enhance the transdermal absorption efficiency of ALA. A 20% ALA cream(118 mg/cm2) was applied to his lesion and sealed for 3 h without light, followed by irradiation with 630-nm LED light (96 J/cm2, 80 mw/cm2). We use fluorescent diagnosis with aminolevulinic acid to define the tumor margins at the first session of ALA-PDT. After 4 sessions of ALA-PDT, the lesion was completely removed and did not recur. Therefore, we consider that ALA-PDT combined with CO2 laser is a safe and effective choice for the treatment of seborrheic keratosis in the auricle.
Assuntos
Ceratose Seborreica , Lasers de Gás , Fotoquimioterapia , Masculino , Humanos , Idoso , Fotoquimioterapia/métodos , Dióxido de Carbono , Fármacos Fotossensibilizantes/uso terapêutico , Ceratose Seborreica/tratamento farmacológico , Ceratose Seborreica/cirurgia , Lasers de Gás/uso terapêutico , Recidiva Local de Neoplasia/tratamento farmacológico , Ácido Aminolevulínico/uso terapêuticoRESUMO
Seborrheic keratosis is a benign epidermal tumor. Seborrheic keratosis with clonal pattern (CPSK) displays histologic features distinct from other subtypes of SK (non-CPSK). We sought to quantitatively assess the risk of recurrence and progression to squamous cell carcinoma (SCC), either in situ or invasive, of incompletely excised CPSKs. We studied all 244 cases from 238 patients of "seborrheic keratosis, clonal pattern" diagnosed in our institution over a 10-year period (2008-2018). Demographic, clinical, pathologic, and follow-up data were gleaned from electronic health records. Following glass slide review, CPSK lesions were divided into 2 groups: CPSK with cytologic atypia and CPSK without cytologic atypia. For comparison, 107 non-CPSKs were studied as controls. The minimum follow-up period was 2 years (median=4 y). All lesions were incompletely excised. Eighteen of 244 CPSKs (7.4%) recurred at or adjacent to the site of initial partial removal compared with 1.9% of non-CPSKs. Five of the 18 (28%) recurrent CPSKs recurred as CPSK, 11 (61%) as SCC in situ, and 3 (17%) as invasive SCC. The mean time to recurrence was 3.1 years. Two non-CPSKs recurred as non-CPSKs. Overall CPSKs were more likely to recur than non-CPSKs ( P =0.04). CPSKs with atypia were more likely to recur than CPSKs without atypia ( P =0.03). The upgrade rate to SCC at least in situ of all recurrent CPSK lesions with atypia was 78%. Our results suggest that pathologists should report the presence of clonal pattern when observed in seborrheic keratoses, indicate the presence of atypia, and provide lesional margin assessment.
Assuntos
Carcinoma de Células Escamosas , Ceratose Seborreica , Neoplasias Cutâneas , Humanos , Ceratose Seborreica/cirurgia , Ceratose Seborreica/patologia , Carcinoma de Células Escamosas/patologia , Epiderme/patologia , Neoplasias Cutâneas/patologiaRESUMO
BACKGROUND: Seborrheic keratoses (SKs) are the most common benign epithelial tumors encountered in clinical practice. Complications associated with traditional treatments of SKs urge the scientists to seek alternative treatment modalities. Objective To compare the efficacy and safety of 2940-nm erbium-doped yttrium aluminum garnet (Er:YAG) laser versus 980-nm diode laser both clinically and dermoscopically for the treatment of seborrheic keratosis. METHODS: Thirty subjects with multiple SKs were randomized to receive two sessions of either Er:YAG laser (n = 15) or diode laser (n = 15) and were followed up for 2 weeks after each session, and at 3 and 6 months after the second session. RESULTS: Both lasers exhibited significant clearance of SKs with no significant difference in clinical and dermoscopic improvement between the two systems. However, Er:YAG laser showed shorter total downtime but more serious erythema, while scarring and hyperpigmentation were observed in diode laser group. No recurrence was detected in both groups at 6 months follow-up. CONCLUSION: Er:YAG and diode lasers both are effective, non-invasive and well-tolerated techniques in treatment of SKs.
Assuntos
Ceratose Seborreica , Terapia a Laser , Lasers de Estado Sólido , Humanos , Ceratose Seborreica/cirurgia , Lasers Semicondutores/efeitos adversos , Érbio , Lasers de Estado Sólido/efeitos adversos , Estudos Prospectivos , Resultado do TratamentoRESUMO
INTRODUCTION: Seborrheic keratosis-like lesion of the cervix and vagina is a rare lesion and shows similar morphology to vulvar seborrheic keratosis; 3 of the 7 previously reported cases were associated with low-risk human papillomavirus (HPV) type 42. We report a case of seborrheic keratosis-like lesion of the cervix and provide the first description of the cytological features of this lesion. CASE PRESENTATION: A woman in her late forties presented with postcoital bleeding. She had a cervical screening test following which she underwent cervical biopsy, endocervical and endometrial curettage, large loop excision of the transformation zone of the cervix, and hysterectomy. RESULTS: The liquid-based cytology preparation showed cohesive groups of mildly atypical squamoid cells with a spindle cell morphology, mildly increased nuclear to cytoplasmic ratio, prominent nucleoli, and occasional nuclear grooves. No koilocytes were identified. Molecular genotyping revealed positivity for HPV type 42. DISCUSSION/CONCLUSION: This represents the first description of the cytological features of a seborrheic keratosis-like lesion of the cervix, which are distinctive and unusual. Whilst the mild squamous atypia raised the possibility of a low-grade squamous intraepithelial lesion, no koilocytes were identified. The association in our case with a low-risk HPV type, HPV 42, provides further evidence for a role of this HPV type in the pathogenesis of these lesions.
Assuntos
Colo do Útero/patologia , Ceratose Seborreica/cirurgia , Infecções por Papillomavirus/patologia , Neoplasias do Colo do Útero/cirurgia , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Ceratose Seborreica/complicações , Ceratose Seborreica/patologia , Pessoa de Meia-Idade , Infecções por Papillomavirus/diagnóstico , Risco , Lesões Intraepiteliais Escamosas/cirurgia , Lesões Intraepiteliais Escamosas Cervicais/patologia , Neoplasias do Colo do Útero/patologia , Displasia do Colo do Útero/patologia , Displasia do Colo do Útero/cirurgiaAssuntos
Dermatoses Faciais/cirurgia , Ceratose Seborreica/cirurgia , Lasers de Gás/uso terapêutico , Ablação por Radiofrequência , Idoso , Eritema/etiologia , Feminino , Humanos , Hiperpigmentação/etiologia , Lasers de Gás/efeitos adversos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Ablação por Radiofrequência/efeitos adversos , Ablação por Radiofrequência/métodosRESUMO
Cryosurgery is the application of freezing temperatures to achieve the destruction of tissue. Cutaneous cryosurgery has become a commonly performed outpatient procedure because of the combination of its safety, effectiveness, low cost, ease of use, lack of need for injectable anesthetic, and good cosmetic results. Cryosurgery may be performed in the outpatient setting using dipstick, spray, or cryoprobe techniques to treat a variety of benign, premalignant, and malignant skin lesions with high cure rates. Benign lesions such as common and plantar warts, anogenital condylomas, molluscum contagiosum, and seborrheic keratoses can be treated with cryotherapy. Basal and squamous cell carcinomas with low-risk features may be treated with cryosurgery. Contraindications to cryosurgery include neoplasms with indefinite margins or when pathology is desired, basal cell or squamous cell carcinomas with high-risk features, and prior adverse local reaction or hypersensitivity to cryosurgery. Potential adverse effects include bleeding, blistering, edema, paresthesia, and pain and less commonly include tendon rupture, scarring, alopecia, atrophy, and hypopigmentation.
Assuntos
Criocirurgia/métodos , Medicina de Família e Comunidade/métodos , Dermatopatias/cirurgia , Criocirurgia/efeitos adversos , Crioterapia/métodos , Humanos , Ceratose Seborreica/cirurgia , Molusco Contagioso/cirurgia , Verrugas/cirurgiaRESUMO
AIM: Waitemata District Health Board has implemented a new approach to the management of skin cancers by triaging lesions to specialist-trained general practitioners (GPSI) with the aim of reducing patient wait times and treatment costs. The primary outcome was to determine positive margin rates for the GP surgeons, with secondary outcome being infection rates. METHOD: A retrospective audit was conducted on all excisions (n=2,705) performed between 1 January 2016 and 31 December 2016 by the 13 WDHB GPSIs. Electronic patient records were accessed to review data. Each lesion was classified into benign, in-situ (pre-malignant) and malignant categories. Surgical margins were analysed for non-melanotic skin cancers (NMSC) and determined as positive, close or negative. Infection rates determined by microbiology results and prescribing information and time to treat analyses were conducted. RESULTS: WDHB GPSIs performed 2,705 excisions, 1,887 (69.8%) of which were malignant lesions. Among the 1,486 NMSC excised, a positive surgical margin was observed in 51 (3.4%). There were 294 (10.9%) cases of infection in 2,705 excisions. Median time to treat was 31 days across all lesions. New Zealand papers from the last two decades estimate the NMSC positive margin rate among primary care physicians varies between 16-31%; most recent papers have published rates 6.8-9.5%.European publications describe positive margin rates ranging between 13.9-33.5%. CONCLUSION: This study validates the use of surgically trained GP surgeons and shows their integral role in managing the high volume of skin cancer in New Zealand.
Assuntos
Atenção à Saúde , Medicina Geral/métodos , Clínicos Gerais/educação , Neoplasias Cutâneas/cirurgia , Carcinoma Basocelular/patologia , Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Humanos , Ceratoacantoma/patologia , Ceratoacantoma/cirurgia , Ceratose Actínica/patologia , Ceratose Actínica/cirurgia , Ceratose Seborreica/patologia , Ceratose Seborreica/cirurgia , Margens de Excisão , Auditoria Médica , Melanoma/patologia , Melanoma/cirurgia , Nevo/patologia , Nevo/cirurgia , Nova Zelândia , Garantia da Qualidade dos Cuidados de Saúde , Qualidade da Assistência à Saúde , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Neoplasias Cutâneas/patologia , Infecção da Ferida Cirúrgica/epidemiologia , Tempo para o Tratamento/estatística & dados numéricosRESUMO
Seborrheic keratosis, one of the most common lesions of the epidermis, is rarely seen on mucosal surfaces. We report a case of a distinctive epithelial neoplasm of the esophagus showing close resemblance to seborrheic keratosis that was resected with endoscopic submucosal dissection. A 65-year-old patient's previous esophageal biopsy showed suspicious low grade dysplasia and the patient was referred for endoscopic submucosal dissection of a flat lesion in the mid-esophagus. Macroscopic examination revealed a well circumscribed, pigmented and elevated lesion with a diameter of 20 mm. Microscopically, the lesion was well circumscribed, with plaque-like elevation, and showed hyperkeratosis, acanthosis, and papillomatosis. Broad coalescing solid sheets and interconnecting trabeculae of basaloid cells were the consistent feature throughout the lesion. Squamous eddies and occasional central keratinization were present. Mitotic activity and koilocytes were not identified. Immunohistochemically, the lesion showed diffuse nuclear positivity with p63 and negativity with p16. Ki-67 index was confined to the basal cell layer. With the help of histopathologic and immunohistochemical findings, we diagnosed this morphologically benign case as "seborrheic keratosis-like lesion of the esophagus". It should be kept in mind that seborrheic keratosis-like lesions might be rarely seen on mucosal surfaces such as the esophagus. Endoscopic submucosal dissection is a new, curative, and safe endoscopic resection technique in en-bloc resection of superficial esophageal lesions. To our knowledge, this is the first case of the aforementioned lesion in the esophagus being resected with endoscopic submucosal dissection.
Assuntos
Ressecção Endoscópica de Mucosa , Doenças do Esôfago/cirurgia , Mucosa Esofágica/cirurgia , Ceratose Seborreica/cirurgia , Idoso , Doenças do Esôfago/patologia , Mucosa Esofágica/patologia , Humanos , Ceratose Seborreica/patologia , Masculino , Resultado do TratamentoRESUMO
We compare the results of clinical observation and histopathology analysis for developing a differential diagnosis of seborrheic keratosis (SK) of the external auditory canal (EAC). A 46-year-old man with a history of a recurrent lesion in the EAC underwent clinical observation of the skin lesion's appearance, computed tomography (CT) scan, magnetic resonance imaging (MRI), and several biopsies. Initially, a benign form of SK was diagnosed based on several biopsies performed over a 10-year period. The lesion's appearance was consistent with a malignant disease, which led the clinician to perform a CT scan and an MRI scan. The patient underwent partial petrosectomy to completely remove the lesion as CT and MRI scans showed an infiltrative process. Squamous carcinoma was the final histological diagnosis. The patient was disease free at 1 year of follow-up after petrosectomy. In conclusion, if there are inconsistencies between clinical observation and histological report, additional tests should be performed to exclude the malignity of a lesion.
Assuntos
Carcinoma de Células Escamosas/diagnóstico , Neoplasias da Orelha/diagnóstico , Ceratose Seborreica/diagnóstico , Biópsia , Carcinoma de Células Escamosas/cirurgia , Diagnóstico Diferencial , Meato Acústico Externo/cirurgia , Neoplasias da Orelha/cirurgia , Humanos , Ceratose Seborreica/cirurgia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/cirurgia , Exame Físico , Tomografia Computadorizada por Raios XRESUMO
Full-thickness skin grafts (FTSGs) and flaps from the upper eyelid or cheek can be used for reconstruction of lower eyelid defects, including the anterior lamella. However, the upper eyelid has a limited and insufficient amount of skin, whereas cheek flaps have a restricted arch of rotation. Here we report the procedure and outcomes of a perforator/subcutaneous pedicled propeller flap for reconstruction of lower eyelid defects including the anterior lamella. A retrospective study of 12 patients who underwent treatment for eyelid anterior lamella defects with perforator/subcutaneous pedicled propeller flaps was conducted between March 2015 and June 2017. The propeller flap was planned to rotate around the perforator (as the pivot point), which was detected with a hand-held Doppler in the vicinity of the defect. The flaps were perforator pedicled for 10 patients and subcutaneous pedicled for the other two patients. The flap was rotated around the pedicle and placed on each patient's defect without tension. No vascular compromise occurred with any of the flaps. The most important complications were post-operative oedema and ecchymosis. Inferior eyelid defects including the anterior lamella could be reconstructed by using propeller flaps from the adjacent tissue. The main advantages of this flap included easy access to the defect, no impairment in eyelid function and very good aesthetic results.
Assuntos
Pálpebras/cirurgia , Retalhos Cirúrgicos , Adulto , Idoso , Carcinoma Basocelular/cirurgia , Neoplasias Palpebrais/cirurgia , Feminino , Humanos , Ceratose Seborreica/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplante de Pele/métodosAssuntos
Criocirurgia/efeitos adversos , Peróxido de Hidrogênio/efeitos adversos , Ceratose Seborreica/tratamento farmacológico , Ceratose Seborreica/cirurgia , Melanócitos/patologia , Administração Tópica , Sobrevivência Celular , Criocirurgia/métodos , Feminino , Humanos , Peróxido de Hidrogênio/uso terapêutico , Marcação In Situ das Extremidades Cortadas , Técnicas In Vitro , Ceratose Seborreica/patologia , Masculino , Sensibilidade e Especificidade , Índice de Gravidade de DoençaRESUMO
Reconstruction of scalp defects caused by tumor resection or trauma is very challenging. A majority of the surgeons prefer to use local flap rather than skin graft or free flap for scalp defects repair. The aim of this study is to investigate the technique of modified unilateral pedicled V-Y advancement flap for the reconstruction of scalp defect.A retrospective review was performed in a series of 18 patients who had a modified unilateral pedicled V-Y advancement flap to restore scalp defect from May 2013 to January 2017. Their mean age is 58 (24-78) years. These patients suffered from basal cell carcinoma, seborrhoeic keratosis, squamous cell carcinoma, or trauma on the scalp. All of them underwent preoperative Doppler scanning to identify the scalp arteries and then individually designed. The flap size ranged from 33â×â50âmm to 68â×â105âmm. Patients were followed for an average of 12 months postoperatively (ranged from 6 to 37 months). No major complications occurred, only 2 cases had a minor distal epidermal necrosis or obstruction of venous backflow observed for the first 3 days of the surgery, and they both healed well. Modified unilateral pedicled V-Y flap technique with fairly rapid recovery and acceptable reorientation of hair follicles leads to esthetical outcome and patient satisfaction. Most importantly, no tumor recurrence at the original site during the follow-up period was seen.The modified unilateral pedicled V-Y advancement flap is a simple but efficient technique, particularly suitable for the repair of small and medium size scalp defects with advantages including the safety of the procedure and overall esthetic results like hairline preservation and less scarring when compared to other local flap techniques.
Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Couro Cabeludo/cirurgia , Neoplasias Cutâneas/cirurgia , Retalhos Cirúrgicos , Adulto , Idoso , Artérias/diagnóstico por imagem , Feminino , Humanos , Ceratose Seborreica/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Couro Cabeludo/lesões , Retalhos Cirúrgicos/efeitos adversos , Retalhos Cirúrgicos/irrigação sanguínea , Resultado do Tratamento , Ultrassonografia Doppler , Ferimentos e Lesões/cirurgia , Adulto JovemRESUMO
BACKGROUND: Seborrheic keratosis (SK) of the outer ear canal is rarely described in literature. Etiological risk factors involved in SK such as exposure to human papillomavirus (HPV) and ultraviolet (UV) light are established but must still be confirmed. In recent years, new insights into the pathogenesis of SKs occurred in the area of molecular pathogenesis. Fibroblast growth factor receptor 3 (FGFR3) gene and p110α subunit of phosphoinositide 3-kinase (PIK3CA) oncogene mutations are known to be involved. METHODS: We describe two cases of SK of the outer ear canal. We conducted a review of literature and examined the role of etiological risk factors involved in our cases. The lesions were primarily treated with surgical resection. Postoperatively, in both patients, the lesions recurred after a considerably long disease-free interval. We tested both FGFR3 and PIK3CA genes for mutations, in the primary and recurrent lesions. RESULTS: We did not find any mutations in both genes in all samples. CONCLUSION: Additional research is needed to further establish possible etiological risk factors and to clarify the involvement of PIK3CA and FGFR3 genes in the pathogenesis of seborrheic keratosis of the outer ear canal. These cases underscore the need for meticulous diagnosis, treatment, and sufficient long-term follow-up.
Assuntos
Classe I de Fosfatidilinositol 3-Quinases/genética , Ceratose Seborreica/genética , Ceratose Seborreica/patologia , Receptor Tipo 3 de Fator de Crescimento de Fibroblastos/genética , Adulto , Biópsia por Agulha , Meato Acústico Externo , Seguimentos , Regulação da Expressão Gênica , Humanos , Imuno-Histoquímica , Ceratose Seborreica/diagnóstico por imagem , Ceratose Seborreica/cirurgia , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
BACKGROUND: The self-assembling peptide barrier T45K (SAPB-T45K) is an oligopeptide that rapidly forms a biocompatible hemostatic barrier when applied to wounds. OBJECTIVE: Evaluate safety and performance of SAPB-T45K in cutaneous surgery. MATERIALS AND METHODS: In this single-blind study, after sequential shave excision of 2 lesions, wounds were randomized (intrapatient) to SAPB-T45K or control treatment. Safety was assessed at treatment, Day 7, and Day 30. Performance was evaluated using time to hemostasis (TTH) and ASEPSIS wound scores, with a subgroup analysis for patients with or without antiplatelet therapy. RESULTS: Each of 46 patients (10 [22%] with antiplatelet therapy) received randomized SAPB-T45K or control treatment for 2 wounds. Safety assessments were similar, and ASEPSIS scores reflected normal healing in both wound groups. SAPB-T45K demonstrated significantly faster median TTH (24.5 [range, 7-165] seconds) compared with control (44 [10-387] seconds), for a 41% median TTH reduction (18 [95% confidence interval, 7-35] seconds, p < .001). SAPB-T45K provided an identical median TTH of 24 seconds, regardless of antiplatelet therapy. Control median TTH was 90 and 40 seconds for patients taking or not taking antiplatelet therapy, respectively. CONCLUSIONS: SAPB-T45K provided significantly faster median TTH versus control, especially with antiplatelet therapy, and safety profiles were similar.
Assuntos
Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Hemostasia Cirúrgica/métodos , Ceratose Seborreica/cirurgia , Hemorragia Pós-Operatória/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Motivos de Aminoácidos , Materiais Biocompatíveis , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oligopeptídeos , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/patologia , Método Simples-Cego , CicatrizaçãoRESUMO
Seborrhoeic keratoses (SK) are benign tumors that mainly occur in the head and in the trunk. Their size generally varies from a few millimeters up to a few centimeters. Giant lesions are very rare but pose a problem in terms both of treatment and transformation. Their occurrence in the genital area is even more rare, posing a problem in differential diagnosis of genital warts. Differentiation is only based on histopathology. We report the case of a 80-year old man, with no particular past medical history, who presented with asymptomatic abdominal and genital lesions evolving over the last twenty years. Clinical examination showed four hyperpigmented, humped, well-defined tumors, with warty surface measuring 2-10 cm along its longer axis (A). Dermoscopic examination showed cerebriform convolutions appearance suggesting seborrhoeic keratoses (B). Histology confirmed the diagnosis, without signs of viral infection or malignant transformation. The patient underwent surgical resection resulting in permanent scar.
Assuntos
Condiloma Acuminado/diagnóstico , Dermoscopia/métodos , Doenças dos Genitais Masculinos/diagnóstico , Ceratose Seborreica/diagnóstico , Idoso de 80 Anos ou mais , Condiloma Acuminado/cirurgia , Diagnóstico Diferencial , Doenças dos Genitais Masculinos/patologia , Doenças dos Genitais Masculinos/cirurgia , Humanos , Ceratose Seborreica/cirurgia , MasculinoRESUMO
Seborrheic keratosis (SK) are very common benign epidermal tumors. Giant seborrheic keratosis (GSK) is a rare variant with clinical characteristics, which leads very often to misdiagnosis. A genital site of SK is very unusual clinical manifestation and although the cause is still unknown, current literature data point to a possible pathogenetic role of chronic friction and HPV infection. The rare genital localization makes Buschke-Löwenstein tumor and verrucous carcinoma important differential diagnoses. GSK may also show some clinical features of a melanoacanthoma, which makes cutaneous melanoma as another possible differential diagnosis. The clinical diagnosis of genital GSK is often a very difficult one, because the typical clinical features of GSK disappear and the most common dermoscopic features of GSK are usually not seen in the genital region lesions. The diagnosis of GSK of the anogenital area should be made only and always after the exact histological verification and variety of differential diagnosis should be carefully considered. The treatment of GSK is primary surgically. We present a rare case of GSK with concomitant HPV infection in the anogenital region of 72-year-old patient. Surgical approach was performed with excellent outcome.
Assuntos
Doenças do Ânus/diagnóstico , Ceratose Seborreica/diagnóstico , Infecções por Papillomavirus/diagnóstico , Idoso , Doenças do Ânus/patologia , Doenças do Ânus/cirurgia , Dermoscopia , Diagnóstico Diferencial , Doenças dos Genitais Masculinos/diagnóstico , Doenças dos Genitais Masculinos/patologia , Doenças dos Genitais Masculinos/cirurgia , Humanos , Ceratose Seborreica/patologia , Ceratose Seborreica/cirurgia , Masculino , Melanoma/diagnóstico , Infecções por Papillomavirus/patologia , Neoplasias Cutâneas/diagnósticoRESUMO
We report a series of 7 unusual and morphologically distinct cervical or upper vaginal lesions in women aged 41 to 70 years. The lesions involved the cervix in 3 cases, the upper vagina in 2, the cervix and vagina in 1, and in 1 case the site of origin could not be determined. The lesions had a consistent morphologic appearance with a surface "plaque-like" or "stuck-on" configuration apparent in those cases where surrounding normal tissues were present. Broad coalescing solid sheets and interconnecting trabeculae of cytologically bland cells with a rather "basaloid" appearance emanated from the surface and there were scattered squamous eddies. Other features included peripheral palisading and a stroma containing hyalinized basement membrane-like material. Immunohistochemically, the lesions were diffusely positive with p63, CK5/6, and 34ßE12 and focally positive with CK7, but largely negative with CK20, EMA, CEA, and BerEP4. p16 was negative or exhibited nonblock-type immunoreactivity and GATA3 was negative or weakly positive. Molecular testing detected human papillomavirus type 42 in 3 of 7 cases, with no virus detected in the remaining 4 cases. Rarely, similar cases have been reported previously as inverted transitional papilloma of the cervix or vagina, but based on the morphology and immunophenotype we do not feel these represent transitional lesions. We suggest the term seborrheic keratosis-like lesions to designate this new and rare entity, which may be associated with low-risk human papillomavirus infection. Limited follow-up in a small number of cases suggests that these lesions follow a benign clinical course.