Warty dyskeratoma. A note concerning its occurrence on the oral mucosa, and its possible pathogenesis

Oral Warty Dyskeratoma—A Systematic Review of the Literature

Objective: To systematically review the clinicopathological features of oral warty keratoma based on published literature. Materials and Methods: PubMed and Scopus databases were searched for reports of oral warty dyskeratoma. Of the 52 identified articles, only 25 articles (43 cases) satisfied the selection criteria (case report/series in the English language reporting clinicopathologically diagnosed oral warty dyskeratoma/oral focal acantholytic keratosis/oral isolated dyskeratosis follicularis in humans). Risk of bias was assessed using the Joanna Briggs institute critical appraisal checklist for case reports and case series. Results: Most cases had well-circumscribed, white, nodular verruco-papillary lesions with a central depressed/crater-like area. Alveolar ridges were the most frequent sites of occurrence and tobacco was the most commonly associated risk factor. Histopathologically, the most pathognomonic feature was the supra-basal clefting. The cleft had dyskeratotic acantholytic cells (corps ronds, and grains). Below the cleft were projections of the connective tissue villi lined by basal cells. The basal cells in a few cases exhibited hyperplasia in the form of budding into the stroma, but epithelial dysplasia was not reported. The surface epithelium had crypts filled with keratin debris. Conclusion: Oral warty dyskeratoma is a rare solitary self-limiting benign entity, which due to its clinical and histopathological resemblance and associated habit history could be misdiagnosed as leukoplakia or carcinoma. None of the assessed articles provided molecular data, which in turn could be the reason for the lack of insight into the etiopathogenesis of this enigmatic lesion.

Keratosis follicularis of the oral mucosa with oral squamous cell carcinoma

Darier's disease or keratosis follicularis is a genodermatosis which may involve the oral mucosa. Malignant degeneration is rare. We report the first case of the combined manifestation of oral keratosis follicularis and oral squamous cell carcinoma and discuss the possible involvement of ATP2A2 (located in 12q23-24.1) which encodes the sarco/endoplasmic reticulum Ca(2+)-ATP isoform 2 (SERCA2), in the pathogenesis.

Focal acantholytic dyskeratosis arising in an intraoral skin flap

A case is described of a patient with a myocutaneous pectoralis major flap who presented with an oral lesion of focal acantholytic dyskeratosis that was clinically suspicious of recurrent tumour.

Oral focal acantholytic dyskeratosis

Focal acantholytic dyskeratosis (FAD) is an uncommon lesion of the oral mucosa with only 22 cases reported in the medical/dental literature. Fifteen additional cases of solitary oral FAD are presented. Of these cases, 4 occurred clinically as leukoplakia. Leukoplakia-associated lesions may be an addition to the current classification of solitary FAD.

Warty dyskeratoma of the oral mucosa

A case of oral warty dyskeratoma is presented and the literature is reviewed in brief. While warty dyskeratoma of the oral mucosa is rare, it appears to exhibit a variability of clinical appearance and to have a special predilection for keratinised mucosae exposed to friction and mechanical stress.

Focal acantholytic dyskeratosis and epidermolytic hyperkeratosis of the oral mucosa adjacent to squamous cell carcinoma

A 74-year-old woman presented with an ulcerating squamous cell carcinoma of the posterior mandibular gingiva. Biopsy of the mucosa directly anterior to the tumor revealed areas of both focal acantholytic dyskeratosis (FAD) and epidermolytic hyperkeratosis (EH). Rare solitary lesions of FAD have been described in the oral mucosa; this is the first report of FAD as an incidental finding. EH has only recently been reported in the mouth, and the concept is unknown in the oral pathology literature. Both FAD and EH may represent nonspecific reaction patterns of skin and oral mucosa to numerous stimuli, including carcinogens or adjacent neoplasms.

Oral warty dyskeratoma

Warty dyskeratoma (WD) is a benign solitary lesion of unknown aetiology affecting the skin and oral mucosa. The profound dyskeratotic changes may mimic invasive squamous cell carcinoma. Two cases of oral WD, which were originally diagnosed as early squamous cell carcinoma, are presented. The clinical features, histopathology and aetiology are reviewed together with other reports in the literature. These 2 cases have been followed for 14 and 6 years respectively and they are the longest follow-up periods reported in the literature in English. The lesions have not recurred.

Warty dyskeratoma of the oral mucosa. Correlated light and electron microscopic study

A warty dyskeratoma arising from the palatal mucosa of a 36-year-old man was studied by light and electron microscopy. The ultrastructural features of this lesion were compared with those of the lesions of Darier's disease. Histologic sections showed a keratin-filled depression of the epithelial surface, suprabasal clefting, and acantholytic, dyskeratotic grains and corps ronds. Electron microscopic examination revealed a decrease in the number of intact attachment sites on the surfaces of the epithelial cells adjacent to the suprabasal cleft. Acantholytic grains within the cleft contained dense bands of tonofilaments and were devoid of attachment sites. Corps ronds within the stratum granulosum appeared as dyskeratotic vacuolated cells. Warty dyskeratomas and the lesions of Darier's disease are clinically distinct, but the acantholytic and dyskeratotic cells characteristic of both show many ultrastructural similarities.

Focal acantholytic dyskeratosis of the oral mucosa

Focal acantholytic dyskeratosis represents a clinically heterogeneous group of dermatologic and mucosal lesions which share common histologic features. Oral mucosal variants of this condition are extremely uncommon. Two intraoral cases are presented, of which one depicts a solitary nodular pattern (warty dyskeratoma) and the other represents a papular lesion exhibiting multiple acantholytic foci.

Focal oral warty dyskeratoma

A 49-year-old white man developed focal oral warty dyskeratoma, which is a solitary, elevated nodule with a keratotic umbilicated center. The term "focal oral warty dyskeratoma" was suggested to distinguish these lesions from the histologically similar oral lesions found in Darier's disease. This paper reviews previously published reports of the lesion and presents an additional case. The average age of patients was 52.2 years, and a slight male predilection was noted. In almost all cases, the lesion was found in tissue overlying bone, with the maxillary alveolar ridge and palate being the most common locations. When the side of involvement was given, all lesions were noted to be on the left side. No evidence of a viral presence was seen with light or electron microscopic study, but the possibility of chronic irritation, such as tobacco usage, exists as an etiologic agent.

Focal acantholytic dyskeratosis in experimental oral carcinogenesis in rats

Thrice weekly applications of carcinogen 4-nitroquinoline N-oxide to rat oral mucosa, induced focal acantholytic dyskeratosis (FAD) in about 50% of the animals. Mucosa overlying bone (palate and attached buccal gingiva) was the area of predilection. The number of oral foci per affected animal ranged between 1 and 3. Histologically, the experimental FAD foci showed all the characteristic features described for human focal acantholytic dyskeratosis. FAD appeared unrelated to malignancy development. It is suggested that FAD represents an induced epithelial differentiation or maturation defect caused by a variety of stimuli among which are chemical carcinogens. The present experimental model seems suitable for further histo- and cytopathogenetic studies.