Problems and pitfalls in oral mucosal pathology diagnostic. Pseudoepitheliomatous hyperplasia is an uncommon finding in primary cutaneous anaplastic large cell lymphoma, and may mimic squamous cell carcinoma as pseudomalignancy. Peh may be present in a number of conditions characterized by prolonged inflammation andor chronic infection, as well as in association with many cutaneous neoplasms. Pseudoepitheliomatous hyperplasia is a benign proliferation of the epidermis into irregular squamous strands extending down into the dermis. The aim of our study was to analyse a series of enktls concomitant with peh mimicking squamous cell carcinoma scc. Limbal pseudoepitheliomatous hyperplasia mimicking ocular.
Pseudoepitheliomatous hyperplasia mimicking invasive squamous. The appearance of many skin diseases vary at different stages of their development and may be altered by attempted treatment and secondary changes such as scratching or infection. Pseudoepitheliomatous hyperplasia medigoo health tests. Florid pseudoepitheliomatous hyperplasia is a rare and poorly recognized complication of tattooing. A clinical entity mistaken for squamous cell carcinoma suvadip chakrabarti 1, preeti rihal chakrabarti 2, deepak agrawal 1, shreyas somanath 1 1 department of surgical oncology, sri aurobindo medical college and pg institute, indore, madhya pradesh, india 2 department of pathology, sri aurobindo medical.
Pseudoepitheliomatous hyperplasia may be present in a number of conditions characterized by prolonged inflammation andor chronic infection, as well as in association with. Pseudoepitheliomatous hyperplasia can be seen in a number of settings, as outlined above, and its presence should prompt a search for an underlying infectious process, inflammatory process or. The aim of our study was to analyse a series of enktls concomitant with peh. Many articles of peh involving the oral mucosa are available on the internet, but ocular involvement is infrequent. The diagnosis can occasionally be difficult as there are many lesions that are mimics, clinically and on pathologic examination. A study of morphometrical differences between normal mucosa. We report herein the first case to our knowledge of peh tattoo reaction treated with carbon dioxide laser. Skin nonmelanocytic tumor dermatopathology patterns. Pdf pseudoepitheliomatous hyperplasia, also called hecks disease, is an epithelial, inconstant and conjunctive proliferation that develops as a. Pseudoepitheliomatous hyperplasia peh, a neglected entity by oral pathologist possesses utmost importance in the field of research.
Malhotra c, jain ak, thapa b case rep ophthalmol med. Apocrine adenoma of the external auditory canal with. Pseudoepitheliomatous hyperplasia arising from purple tattoo pigment. Pseudoepitheliomatous hyperplasia in chronic inflammation has long been difficult to diagnose. It, however, has not been reported as a manifestation in the palpebral form of the disease and needs to be kept in the differential diagnosis of a limbal mass lesion in vernal. Lipid with surrounding granulomatus reaction molluscum contagiosum. Elena zarovnaya and candice black 2005 distinguishing pseudoepitheliomatous hyperplasia from squamous cell carcinoma in mucosal biopsy specimens from the head and neck. Pseudoepitheliomatous hyperplasia arising from purple. Pseudoepitheliomatous hyperplasia peh is a benign condition, characterized by hyperplasia of the epidermis and adnexal epithelium, closely simulating squamous cell carcinoma. Both atypical cells and proliferating epithelial cells can selectively concentrate the photosensitizing agents, which may trigger photodynamic reactions or secondary effects. Pseudoepitheliomatous hyperplasia peh is a histopathological reaction pattern to various stimuli, which includes trauma, infection, inflammation, neoplasia. However, it has not yet been extensively documented in extranodal natural killert. Pseudoepitheliomatous hyperplasia international journal of. It is an uncommon manifestation of vernal keratoconjunctivitis and has been reported previously in limbal vkc.
May 01, 2008 read recurrent primary cutaneous lymphoma with florid pseudoepitheliomatous hyperplasia masquerading as squamous cell carcinoma, histopathology on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Pseudoepitheliomatous hyperplasia is a benign condition, characterized by hyperplasia of the epidermis and adnexal epithelium, closely simulating squamous cell carcinoma. Cytokeratin expression in pseudoepitheliomatous hyperplasia. Pseudoepitheliomatous tattoo reaction diagnostic histopathology. The inflammatory infiltrate is comprised of histiocytes with multinucleated giant cells, and numerous neutrophils figures 3,4 and 5. A soft reddish protruding lesion was revealed at the posterosuperior portion. Primary cutaneous lymphomaassociated pseudoepitheliomatous. A study of morphometrical differences between normal. Pathological changes may arise in epidermis, dermis andor subcutaneous tissue. Pseudoepitheliomatous hyperplasia peh is a rare tattoo reaction often arising within areas of red or purple ink. With the rising popularity of tattoos, adverse skin reactions to this practise are being increasingly recognized.
It is associated with poor denture hygiene, denture overuse, and illfitting dentures. Lack of awareness of this association may result in a misdiagnosis of squamous cell carcinoma. Competent pathologists have occasionally been surprised by the spontaneous healing of a lesion which they had diagnosed squamous cell carcinoma microscopically. Superficial biopsies from the lesion 4 years prior to presentation revealed pseudoepitheliomatous hyperplasia suggestive of squamous cell carcinoma, which led to the excision of the lesion along with 2 digits of the left hand. Inflammatory papillary hyperplasia is a hyperplasia overgrowth of soft tissue, usually beneath a denture. Some forms of epidermal hyperplasia regular, irregular. Pseudoepitheliomatous hyperplasia peh, a neglected entity. This diagnostic test is rapid, costeffective, and can replace the nonquantitative and subjective diagnostic methods currently used. Distinguishing pseudoepitheliomatous hyperplasia from. All cases of pmycosis showed pseudoepitheliomatous hyperplasia, with acanthosis and long rete pegs. T1 pseudoepitheliomatous hyperplasia mimicking vulvar cancer in a patient with aids.
Pseudoepitheliomatous hyperplasia arising from purple tattoo. Pdf pseudoepitheliomatous hyperplasia peh is a benign condition. Most tattoo reactions involve dermal inflammatory changes. Kelly thornbury1, pratik rastogi 1, robertgates 1 severe burns unit, royal north shore hospital introduction patients with severe burns are subject to significant physiological, immunological and inflammatory insults in both the acute and chronic.
Keratinocyte atypia is usually mild and confined to the basal. Pseudoepitheliomatous hyperplasia at the limbus can mimic an ocular surface squamous neoplasia. Considering the extent to which atypia can occur in pseudoepitheliomatous hyperplasia overlying a granular cell tumor, one can similarly extrapolate what can be found in association with nsm. Of all the investigative challenges, peh, a reactive. The patient reported back to us after 1 week with the histopathology report. It, however, has not been reported as a manifestation in the palpebral form of the disease and needs to be kept in the differential diagnosis of a limbal mass lesion in. Pseudoepitheliomatous hyperplasia, abbreviated peh, is a benign reactive change of squamous mucosa that can mimic squamous cell carcinoma. A 75yearold retired farmer presented with an erythematous verrucous plaque on the dorsal aspect of the left hand of 4 years duration. May 24, 20 squamous cell carcinoma is the second most common cutaneous malignancy. Pseudoepitheliomatous hyperplasia mimicking vulvar cancer. The invention utilizes markers that have been identified through gene expression profile analysis of squamous cell carcinoma and pseudoepitheliomatous hyperplasia. It is a closely related condition to inflammatory fibrous hyperplasia epulis fissuratum, but the appearance and location differs.
Diagnostic markers to distinguish between squamous cell. Pathology outlines pseudoepitheliomatous hyperplasia. Pseudoepitheliomatous hyperplasia peh is a benign reactive. Pseudoepitheliomatous hyperplasia jama dermatology jama. Erythematous verrucous plaque on the hand mdedge dermatology. Pseudoepitheliomatous hyperplasia can be seen in a number of settings, as outlined above, and its presence should prompt a search for an underlying infectious process, inflammatory process or tumor as appropriate. Pseudoepitheliomatous hyperplasia in the setting of cd30. Pseudoepitheliomatous hyperplasia peh is a benign reactive inflammatory reaction of the epithelial cells to various conditions.
Pseudoepitheliomatous hyperplasia an unusual reaction following tattoo. Apr 28, 2015 pseudoepitheliomatous hyperplasia peh is a histopathological reaction pattern to various stimuli, which includes trauma, infection, inflammation, neoplasia. The pattern of changes may allow a diagnosis to be made or it may be nonspecific. This website is intended for pathologists and laboratory personnel, who understand that medical information is imperfect and must be interpreted using reasonable medical judgment. Epidermis hyperplasia an overview sciencedirect topics.
Squamous cell carcinoma is the second most common cutaneous malignancy. A 46yearold man presented with otorrhea, itching, and a foreign body sensation in his right ear. Only buccal mucosa was chosen,to standardize the results in all the 4 study groups,as the fractal dimensions of different zones of oral mucosa vary considerably. From the department of pathology, dartmouthhitchcock medical. Pseudoepitheliomatous hyperplasia of the overlying squamous mucosa is commonly present when the lesion involves the palate. Limbal pseudoepitheliomatous hyperplasia mimicking ocular surface squamous neoplasia in palpebral vernal keratoconjunctivitis. Pseudoepitheliomatous hyperplasia may be present in a number of conditions characterized by prolonged inflammation andor chronic infection, as well as in association with many cutaneous neoplasms. Van marck, department of community health, federal university r. Pseudoepitheliomatous hyperplasia of tongue treated by. Frequently a foreign body such as a wood splinter can be seen. Epithelial infiltration by inflammatory cells was common, as were microabscesses in the superficial layer. Pseudoepitheliomatous hyperplasia can arise either from the epidermis or from adnexal epithelium, and is almost always associated with persistent inflammation of the subjacent dermis due to a chronic wound, ulcer, infection, malignancy, retained foreign. Pseudoepitheliomatous hyperplasia peh is a benign condition.
Some forms of epidermal hyperplasia regular, irregular, and pseudocarcinomatous can develop in sequence. The tumors derived of the ceruminous gland in the external auditory canal are rare. Recurrent primary cutaneous lymphoma with florid pseudoepitheliomatous hyperplasia masquerading as squamous cell carcinoma. Here, we report a case of a ceruminous adenoma apocrine adenoma with refractory chronic inflammation in the external auditory canal.
Histopathological study of oral pseudoepitheliomatous hyperplasia. Malhotra c, jain ak, thapa b case rep ophthalmol med, 20. It is seen as tongue like epithelial proliferation invading the connective tissue and should not be mistaken for squamous cell carcinoma scc. Read recurrent primary cutaneous lymphoma with florid pseudoepitheliomatous hyperplasia masquerading as squamous cell carcinoma, histopathology on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Pdf histopathological study of oral pseudoepitheliomatous. For each pattern the histological features are described, the differential diagnosis is discussed and the. Pseudoepitheliomatous hyperplasia peh is defined as a pattern of epidermal reaction. Differentiating cutaneous squamous cell carcinoma and. Pseudoepitheliomatous hyperplasia mimicking vulvar cancer in. Pseudoepitheliomatous hyperplasia jama dermatology.
Histologic evaluation reveals projections of epithelium with jagged bases extending into the dermis. It is a diagnostic dilemma which simulates malignancy, especially squamous cell carcinoma scc. Scanning power view of phaeohyphomycosis shows a deeply extending granulomatous pattern figure 1 which may show areas of necrosis figure 2. Hyperplasia is a response common to a variety of stimuli, often chronic, and occurs in a variety of types, including regular, irregular, papillated, and pseudocarcinomatous pseudoepitheliomatous fig. Pseudoepitheliomatous hyperplasia peh, a neglected entity by oral pathologist possesses utmost importance in the field of. Feb 20, 2019 a soft reddish protruding lesion was revealed at the posterosuperior portion of the entry to the right external auditory canal by otoscopy. At high power branching septate pigmented fungal hyphae can be seen figure 6. Pseudoepitheliomatous hyperplasia peh is a benign condition characterised by hyperplasia of the epidermis and adnexal epithelium closely simulating squamous cell carcinoma scc. The epidermis commonly shows pseudoepitheliomatous hyperplasia. The 47 lesions of pseudoepitheliomatous hyperplasia in the oral mucosa were diagnosed in association with a great diversity of clinical entities, from infectious stomatites tuberculosis, actinomycosis and candidosis, to chronic inflammatory conditions oral lichen planus and to neoplastic lesions, respectively granular cell tumor and oral squamous carcinoma.
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