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Marcoval J, Moreno-Vílchez C, Torrecilla-Vall-Llossera C, Muntaner-Virgili C, Penín RM. Clear Cell Acanthoma: A Series of 70 Cases. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:668-673. [PMID: 37127205 DOI: 10.1016/j.ad.2023.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Clear cell acanthoma (CCA) is an uncommon lesion histologically characterized by the presence of epidermal acanthosis with keratinocytes containing clear cytoplasm. Although many single cases of CCA have been described, few case series have been published. The aim of this study was to describe the clinical characteristics of CCA in our practice setting. MATERIAL AND METHODS Retrospective study of patients diagnosed with CCA at Hospital Universitario de Bellvitge in Barcelona, Spain, between 1995 and 2021. We conducted a chart review to record age, sex, number and location of lesions, diameter, time since onset, clinical characteristics, suspected clinical diagnosis, and treatment. RESULTS Seventy patients (30 women and 40 men) with a mean (SD) age of 62 (13) years were diagnosed with CCA during the study period. Median (interquartile range) time since onset was 2 (4) years and median lesion diameter was 6 (5) mm. One woman had multiple lesions. Lesions were located on the lower extremities in 57 patients (81%), the posterior aspect of the trunk in 8 (11%), the anterior aspect of the trunk in 4 (5%), and the upper extremities in 1 (1%). CCA was clinically suspected in 40% of patients seen by dermatologists. CONCLUSIONS CCA presents as an erythematous, dome-shaped lesion with pinpoint vessels and an epidermal collarette. The accuracy of clinical diagnosis has improved relative to earlier series, possibly due to a better clinical understanding of this lesion and a greater use of dermoscopy.
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Affiliation(s)
- J Marcoval
- Servicio de Dermatología, Hospital Universitari de Bellvitge, Barcelona, España.
| | - C Moreno-Vílchez
- Servicio de Dermatología, Hospital Universitari de Bellvitge, Barcelona, España
| | | | - C Muntaner-Virgili
- Servicio de Dermatología, Hospital Universitari de Bellvitge, Barcelona, España
| | - R M Penín
- Servicio de Anatomía Patológica, Hospital Universitari de Bellvitge, Barcelona, España
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Marcoval J, Moreno-Vílchez C, Torrecilla-Vall-Llossera C, Muntaner-Virgili C, Penín RM. [Translated article] Clear Cell Acanthoma: A Series of 70 Cases. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T668-T673. [PMID: 37453546 DOI: 10.1016/j.ad.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/20/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Clear cell acanthoma (CCA) is an uncommon lesion histologically characterized by the presence of epidermal acanthosis with keratinocytes containing clear cytoplasm. Although many single cases of CCA have been described, few case series have been published. The aim of this study was to describe the clinical characteristics of CCA in our practice setting. MATERIAL AND METHODS Retrospective study of patients diagnosed with CCA at Hospital Universitario de Bellvitge in Barcelona, Spain, between 1995 and 2021. We conducted a chart review to record age, sex, number and location of lesions, diameter, time since onset, clinical characteristics, suspected clinical diagnosis, and treatment. RESULTS Seventy patients (30 women and 40 men) with a mean (SD) age of 62 (13) years were diagnosed with CCA during the study period. Median (interquartile range) time since onset was 2 (4) years and median lesion diameter was 6 (5)mm. One woman had multiple lesions. Lesions were located on the lower extremities in 57 patients (81%), the posterior aspect of the trunk in 8 (11%), the anterior aspect of the trunk in 4 (5%), and the upper extremities in 1 (1%). CCA was clinically suspected in 40% of patients seen by dermatologists. CONCLUSIONS CCA presents as an erythematous, dome-shaped lesion with pinpoint vessels and an epidermal collarette. The accuracy of clinical diagnosis has improved relative to earlier series, possibly due to a better clinical understanding of this lesion and a greater use of dermoscopy.
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Affiliation(s)
- J Marcoval
- Servicio de Dermatología, Hospital Universitari de Bellvitge, Barcelona, Spain.
| | - C Moreno-Vílchez
- Servicio de Dermatología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - C Muntaner-Virgili
- Servicio de Dermatología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - R M Penín
- Servicio de Anatomía Patológica, Hospital Universitari de Bellvitge, Barcelona, Spain
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Hidden clear cell acanthoma with uncommon dermoscopic findings. An Bras Dermatol 2021; 96:517-518. [PMID: 34006397 PMCID: PMC8245719 DOI: 10.1016/j.abd.2020.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 11/01/2022] Open
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Wagner G, Back W, Sachse MM. Klarzellakanthome. J Dtsch Dermatol Ges 2021; 19:31-36. [PMID: 33491899 DOI: 10.1111/ddg.14270_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/10/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Gunnar Wagner
- Klinik für Dermatologie, Allergologie und Phlebologie, Klinikum Bremerhaven-Reinkenheide, Bremerhaven
| | | | - Michael Max Sachse
- Klinik für Dermatologie, Allergologie und Phlebologie, Klinikum Bremerhaven-Reinkenheide, Bremerhaven
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Wagner G, Back W, Sachse MM. Clear cell acanthoma. J Dtsch Dermatol Ges 2020; 19:31-36. [PMID: 32989899 DOI: 10.1111/ddg.14270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/10/2020] [Indexed: 11/27/2022]
Abstract
Clear cell acanthoma is a rarely diagnosed tumor with variable clinical morphology that is usually only recognized by its histopathological features. The primary lesion is a red papule a few millimeters in diameter that often occurs as a single lesion on the lower extremities. In dermoscopy, resemblance of the vessels to a string of pearls is a largely specific finding of clear cell acanthoma. In contrast to the initially uncharacteristic clinical findings, histopathology of clear cell acanthomas is characterized by a typical compact, well-demarcated acanthosis consisting of pale-staining, PAS-reactive keratinocytes. As etiology and pathogenesis are both unclear, nosology of clear cell acanthoma is also controversial, with an ongoing debate as to its classification as cutaneous neoplasia or reactive inflammatory dermatosis.
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Affiliation(s)
- Gunnar Wagner
- Department of Dermatology, Allergology and Phlebology, Hospital Bremerhaven-Reinkenheide, Bremerhaven, Germany
| | - Walter Back
- Pathological Institute Bremerhaven, Bremerhaven, Germany
| | - Michael Max Sachse
- Department of Dermatology, Allergology and Phlebology, Hospital Bremerhaven-Reinkenheide, Bremerhaven, Germany
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Deitermann AM, Fiessinger LA, Miller DD, Jaimes JP. Polarizing-specific white lines in a clear cell acanthoma. JAAD Case Rep 2020; 6:829-831. [PMID: 32885010 PMCID: PMC7452362 DOI: 10.1016/j.jdcr.2020.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Lori A. Fiessinger
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Daniel D. Miller
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Juan P. Jaimes
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
- Correspondence to: Juan P. Jaimes, MD, MS, Department of Dermatology, 516 Delaware St SE, Minneapolis, MN 55455.
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The string of pearls pattern in dermoscopy of a chest papule. An Bras Dermatol 2020; 95:392-393. [PMID: 32265053 PMCID: PMC7253919 DOI: 10.1016/j.abd.2019.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 06/14/2019] [Indexed: 11/20/2022] Open
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Iseki K, Negishi M, Nakano M, Togawa Y, Matsue H. Differences in dermoscopic findings between early and mature clear cell acanthoma. J Dermatol 2020; 47:646-650. [PMID: 32180264 DOI: 10.1111/1346-8138.15311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 02/18/2020] [Indexed: 12/01/2022]
Abstract
Clear cell acanthoma (CCA) is a rare benign epidermal tumor that is difficult to diagnose by visual inspection. Conversely, its diagnosis by dermoscopy is relatively easy owing to the characteristic serpiginous arrangement of coiled vessels, sometimes described as the "string-of-pearls" formation. However, in few published reports, the dermoscopic diagnosis of mature CCA has been reported. Here, we report the histopathological and detailed dermoscopic findings of two CCA cases. Between these, one case was of early (~6 months) CCA exhibiting the characteristic vascular string-of-pearls formation, whereas the other was of a more mature (~10 years) CCA; although the latter case showed combined thick and thin white intersecting lines with large coiled vessels and/or red clods, it had the string-of-pearls formation. Thus, regardless of CCA maturity, the string-of-pearls formation was present. We propose that the combination of combined thick and thin white intersecting lines along with the vascular string-of-pearls formation reflecting large coiled vessels and/or red clods on dermoscopy is a diagnostic clue to mature CCA.
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Affiliation(s)
- Kozue Iseki
- Department of Dermatology, Chiba University of Graduate School of Medicine, Chiba, Japan
| | - Mayuko Negishi
- Department of Dermatology, Chiba University of Graduate School of Medicine, Chiba, Japan
| | - Michiyo Nakano
- Department of Dermatology, Chiba University of Graduate School of Medicine, Chiba, Japan
| | - Yaei Togawa
- Department of Dermatology, Chiba University of Graduate School of Medicine, Chiba, Japan
| | - Hiroyuki Matsue
- Department of Dermatology, Chiba University of Graduate School of Medicine, Chiba, Japan
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Kuo KL, Lo CS, Lee LY, Yang CH, Kuo TT. Clear cell acanthoma (CCA)-like lesions of the nipple/areola: A clinicopathological study of 12 cases supporting a nonneoplastic eczematous disease. J Am Acad Dermatol 2019; 80:749-755. [DOI: 10.1016/j.jaad.2016.07.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/08/2016] [Accepted: 07/14/2016] [Indexed: 10/27/2022]
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Cunha DG, Kassuga-Roisman LEDBP, Silveira LKCDB, de Macedo FC. Dermoscopic features of clear cell acanthoma. An Bras Dermatol 2018; 93:449-450. [PMID: 29924237 PMCID: PMC6001098 DOI: 10.1590/abd1806-4841.20186977] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/13/2017] [Indexed: 11/22/2022] Open
Abstract
Clear cell acanthoma is an uncommon type of benign epithelial tumor. Typically, it is a solitary lesion found on the lower limbs. It presents as a nodule or small plaque with slow and well-defined growth. Diagnosis used to be clinical and histopathological, but the advent of dermoscopy has led to an increase in diagnostic accuracy. We describe a case in which dermoscopy proved highly useful for diagnosis of the lesion.
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Affiliation(s)
- Daniela Gomes Cunha
- Dermatology Service, Instituto Nacional do Câncer (Inca),
Rio de Janeiro (RJ), Brazil
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Potenziani S, Applebaum D, Krishnan B, Gutiérrez C, Diwan AH. Multiple clear cell acanthomas and a sebaceous lymphadenoma presenting in a patient with Cowden syndrome - a case report. J Cutan Pathol 2016; 44:79-82. [PMID: 27682856 DOI: 10.1111/cup.12823] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/07/2016] [Accepted: 09/15/2016] [Indexed: 11/28/2022]
Abstract
Cowden syndrome (CS) is an uncommon autosomal dominant multiorgan/system genodermatosis. It is characterized by the development of multiple hamartomas of endodermal, mesodermal and ectodermal origin, an increased lifetime risk of breast, thyroid, endometrial and other cancers and an identifiable germline mutation. Mucocutaneous hamartomas are the most common lesions seen and mainly include facial trichilemmomas, oral mucosal papillomas and benign acral keratoses. Herein, we report a case of a 63-year-old Caucasian male with a long-established diagnosis of CS and history of thyroid cancer, colonic polyps, and innumerable trichilemmomas, seborrheic keratoses, squamous papillomas and non-melanoma skin cancers excised in the past. He presented in four separate occasions with small skin-colored papulonodular lesions that upon excision revealed to be clear cell acanthomas. He also developed a tumor in the preauricular area that was completely resected and was found to be a sebaceous lymphadenoma (SLA) of the parotid gland. This is to our knowledge, the second report of clear cell acanthoma and also the second reported case of SLA in a patient with CS.
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Affiliation(s)
- Silvia Potenziani
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
| | | | - Bhuvaneswari Krishnan
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA.,Department of Pathology, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Carolina Gutiérrez
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
| | - A Hafeez Diwan
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA.,Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
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Malignant Clear Cell Acanthoma: Report of a Rare Case of Clear Cell Acanthoma-Like Tumor With Malignant Features. Am J Dermatopathol 2016; 38:553-6. [PMID: 26885606 DOI: 10.1097/dad.0000000000000499] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An erythematous and moist tumor nodule on the left temple of a 92-year-old woman was biopsied and identified as a clear cell acanthoma (CCA)-like tumor with malignant cytology and high proliferation activity. This case is similar to 2 cases reported previously as atypical CCA. The authors believe that these tumors are malignant counterparts of CCA and propose to call them malignant CCA. The clinicopathologic features of the present case are described along with dermoscopic findings.
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