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Wang MD, Bresler SC, Chan MP, Patel RM, Chapel DB. Acantholytic Dyskeratoses of the Vulva: Clinicopathologic Characterization of 16 Cases and Review of the Literature. Int J Gynecol Pathol 2024:00004347-990000000-00192. [PMID: 39173136 DOI: 10.1097/pgp.0000000000001066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
The vulva and perineum are rarely involved by acantholytic dyskeratoses, including Hailey-Hailey disease, Darier disease, papular acantholytic dyskeratosis of the genitocrural area, acantholytic dyskeratotic acanthoma, and warty dyskeratoma. These entities show broad histomorphologic overlap, generally requiring clinical correlation for definitive classification. This institutional series aims to better characterize vulvar acantholytic dyskeratoses and provide a practical literature review and diagnostic aid for gynecologic pathologists. Our institutional archives contained 16 vulvar acantholytic dyskeratoses diagnosed between 1990 and 2023. Affected patients were 36 to 79 (mean, 58) years old and presented with one or more asymptomatic (n = 9) or pruritic (n = 6) lesions involving the vulva (predominantly the labia majora), with additional perineal involvement in 2. Four patients have known Hailey-Hailey disease. Eleven cases comprised singular, raised, erythematous, or skin-colored papules, measuring 0.2 to 0.6 (mean, 0.3) cm. Two patients had oligofocal (both with known Hailey-Hailey disease) vulvar lesions, and 2 had multifocal vulvar lesions (one with known Hailey-Hailey disease). Histologically, all showed acantholysis and dyskeratoses (abundant in 8, focal in 8, with corps ronds generally more conspicuous than corps grains). Additional features included suprabasal clefting (n = 14), dermal papillomatosis (n = 12), and acanthosis (n = 8). Adnexal involvement was rare (n = 1). No histologic features reliably distinguished sporadic versus syndromic acantholytic dyskeratoses. Sporadic lesions were cured by local excision. Patients with Hailey-Hailey disease were variably responsive to corticosteroids. Neither our series nor the literature indicate a significant correlation between sporadic or syndromic acantholytic dyskeratosis and squamous cell carcinoma. Important differential diagnoses include pemphigus vulgaris and pemphigus vegetans, for which direct immunofluorescence may be performed, when indicated.
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Affiliation(s)
- Maxwell D Wang
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Scott C Bresler
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - May P Chan
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Rajiv M Patel
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
- Department of Cutaneous Pathology, WCP Laboratories, Inc., Maryland Heights, Missouri
| | - David B Chapel
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
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Ettinger M, Burner T, Lackner A, Guenova E, Kimeswenger S, Hoetzenecker W. Ein Fall von papulöser akantholytischer Dyskeratose mit IL-23/TNF-α-dominantem Immunprofil: A case of papular acantholytic dyskeratosis with IL-23/TNF-α dominant immune profile. J Dtsch Dermatol Ges 2024; 22:274-277. [PMID: 38361189 DOI: 10.1111/ddg.15293_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/28/2023] [Indexed: 02/17/2024]
Affiliation(s)
- Monika Ettinger
- Universitätsklinik für Dermatologie und Venerologie, Kepler Universitätsklinikum Linz, Linz, Österreich
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Fakultät, Johannes-Kepler-Universität Linz, Linz, Österreich
| | - Teresa Burner
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Fakultät, Johannes-Kepler-Universität Linz, Linz, Österreich
| | - Angelika Lackner
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Fakultät, Johannes-Kepler-Universität Linz, Linz, Österreich
| | - Emmanuella Guenova
- Universitätsklinik für Dermatologie, Fachbereich Biologie und Medizin, Universität Lausanne, Lausanne, Schweiz
- Abteilung für Dermatologie, Hospital 12 de octubre, Medizinische Fakultät, Universität Complutense, Madrid, Spanien
| | - Susanne Kimeswenger
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Fakultät, Johannes-Kepler-Universität Linz, Linz, Österreich
| | - Wolfram Hoetzenecker
- Universitätsklinik für Dermatologie und Venerologie, Kepler Universitätsklinikum Linz, Linz, Österreich
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Fakultät, Johannes-Kepler-Universität Linz, Linz, Österreich
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Ettinger M, Burner T, Lackner A, Guenova E, Kimeswenger S, Hoetzenecker W. A case of papular acantholytic dyskeratosis with IL-23/TNF-α dominant immune profile. J Dtsch Dermatol Ges 2024; 22:274-276. [PMID: 38200563 DOI: 10.1111/ddg.15293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/28/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Monika Ettinger
- Department of Dermatology and Venereology, Kepler University Clinic Linz, Linz, Austria
- Department of Dermatology and Venereology, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Teresa Burner
- Department of Dermatology and Venereology, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Angelika Lackner
- Department of Dermatology and Venereology, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Emmanuella Guenova
- Department of Dermatology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Dermatology, Hospital 12 de octubre, Medical school, University Complutense, Madrid, Spain
| | - Susanne Kimeswenger
- Department of Dermatology and Venereology, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Wolfram Hoetzenecker
- Department of Dermatology and Venereology, Kepler University Clinic Linz, Linz, Austria
- Department of Dermatology and Venereology, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
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Bar-Ilan E, Mashiah J, Molho-Pessach V, Horev L, Confino Y, Gál AI, Szalai Z, Gallo ES, Barzilai A, Greenberger S, Ollech A. Infantile anogenital digitate keratoses: A case series of a novel entity. JAAD Case Rep 2022; 32:35-40. [PMID: 36624812 PMCID: PMC9823137 DOI: 10.1016/j.jdcr.2022.11.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Efrat Bar-Ilan
- Department of Pediatric Dermatology, Heim Pál National Children's Institute, Budapest, Hungary,Department of Dermatology, Pediatric Dermatology Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Jacob Mashiah
- Division of Dermatology, Pediatric Dermatology Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vered Molho-Pessach
- Department of Dermatology, Pediatric Dermatology Service, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Liran Horev
- Department of Dermatology, Pediatric Dermatology Service, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yizhak Confino
- Dermatology Unit, Edith Wolfson Medical Center, Holon, Israel
| | - Andrea I. Gál
- Department of Pediatric Dermatology, Heim Pál National Children's Institute, Budapest, Hungary
| | - Zsuzsanna Szalai
- Department of Pediatric Dermatology, Heim Pál National Children's Institute, Budapest, Hungary
| | - Elisa S. Gallo
- Division of Dermatology, Pediatric Dermatology Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Aviv Barzilai
- Department of Dermatology, Pediatric Dermatology Unit, Sheba Medical Center, Ramat Gan, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Institute of Pathology, Sheba Medical Center, Ramat Gan, Israel
| | - Shoshana Greenberger
- Department of Dermatology, Pediatric Dermatology Unit, Sheba Medical Center, Ramat Gan, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ayelet Ollech
- Department of Dermatology, Pediatric Dermatology Unit, Sheba Medical Center, Ramat Gan, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Correspondence to: Ayelet Ollech, MD, Dermatology Department, Pediatric Dermatology Unit, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel 5262000.
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Harrell J, Nielson C, Beers P, Rudnick E, Walker A, Motaparthi K. Eruption on the vulva and groin. JAAD Case Rep 2020; 6:6-8. [PMID: 31890827 PMCID: PMC6928262 DOI: 10.1016/j.jdcr.2019.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Shi X, Shi X, Jia A, Meng X, Luan H. Papules on the vulva and perianal area in a young woman. Indian J Dermatol Venereol Leprol 2019; 87:736-738. [PMID: 31823903 DOI: 10.4103/ijdvl.ijdvl_587_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/01/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Xiuyan Shi
- Department of Dermatology, Liaocheng People's Hospital, Liaocheng, China
| | - Xiaohui Shi
- Department of Dermatology, Liaocheng People's Hospital, Liaocheng, China
| | - Aihua Jia
- Department of Pathology, Shanghai Xuhui District Central Hospital, Shanghai, China
| | - Xianmin Meng
- Department of Dermatology, Liaocheng People's Hospital, Liaocheng, China
| | - Hong Luan
- Department of Dermatology, Liaocheng People's Hospital, Liaocheng, China
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Incidental Acantholysis in Hailey-Hailey Disease (Microscopic Nikolsky Sign): An Underappreciated Histologic Sign. Am J Dermatopathol 2019; 42:e61-e64. [PMID: 31584450 DOI: 10.1097/dad.0000000000001534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Identification of subtle disease-specific histologic changes may be of significant help in early diagnosis of acantholytic skin diseases. Hailey-Hailey disease (HHD) is an autosomal dominant genodermatosis characterized by vesiculoerosive lesions favoring the intertriginous areas. Histologically, HHD is characterized by full-thickness acantholysis of the spinous layer in association with dyskeratosis of individual keratinocytes; a pemphigus vulgaris-like suprabasal pattern of acantholysis may be observed in the earliest stages of disease. HHD is characterized by highly variable expressivity regarding the age at onset and severity of the disease. Patients may present with late-onset and/or only mild disease. We report the recurrent presence of incidental foci of variably extensive, subclinical acantholysis in multiple bioptic specimens taken from a patient with known HHD for dermatologic conditions other than HHD. Such histologic finding has gone underappreciated in the literature, despite being a likely frequent occurrence in skin biopsies from HHD patients; recognition of this finding might represent a valuable diagnostic clue in selected cases of HHD.
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Bains A, Singh S, Dubey A, Rao M. Genitocrural Plane-Topped Papules in a Young Female. Indian J Dermatol 2018; 63:527-529. [PMID: 30504989 PMCID: PMC6233041 DOI: 10.4103/ijd.ijd_198_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Anupama Bains
- Department of Dermatology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Saurabh Singh
- Department of Dermatology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Apoorvi Dubey
- Department of Pathology, Dr. SN Medical College, Jodhpur, Rajasthan, India
| | - Meenakshi Rao
- Department of Pathology, AIIMS, Jodhpur, Rajasthan, India
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Vodo D, Malchin N, Furman M, Sarig O, Sprecher E. Identification of a recurrent mutation in ATP2C1
demonstrates that papular acantholytic dyskeratosis and Hailey-Hailey disease are allelic disorders. Br J Dermatol 2018; 179:1001-1002. [DOI: 10.1111/bjd.16915] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- D. Vodo
- Department of Dermatology; Tel Aviv Sourasky Medical Center; 6 Weizmann Street Tel Aviv 64239 Israel
- Department of Human Molecular Genetics and Biochemistry; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - N. Malchin
- Department of Dermatology; Tel Aviv Sourasky Medical Center; 6 Weizmann Street Tel Aviv 64239 Israel
| | - M. Furman
- Department of Dermatology; Tel Aviv Sourasky Medical Center; 6 Weizmann Street Tel Aviv 64239 Israel
| | - O. Sarig
- Department of Dermatology; Tel Aviv Sourasky Medical Center; 6 Weizmann Street Tel Aviv 64239 Israel
| | - E. Sprecher
- Department of Dermatology; Tel Aviv Sourasky Medical Center; 6 Weizmann Street Tel Aviv 64239 Israel
- Department of Human Molecular Genetics and Biochemistry; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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Chou S, Zhao C, Hwang SJE, Fernandez-Penas P. PD-1 inhibitor-associated lichenoid inflammation with incidental suprabasilar acantholysis or vesiculation-Report of 4 cases. J Cutan Pathol 2017; 44:851-856. [DOI: 10.1111/cup.13013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/22/2017] [Accepted: 07/25/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Shaun Chou
- Tissue Pathology and Diagnostic Oncology; Westmead Hospital; Sydney Australia
| | - Cathy Zhao
- Department of Dermatology; Westmead Hospital; Sydney Australia
- Sydney Medical School; University of Sydney; Sydney Australia
| | - Shelley Ji Eun Hwang
- Department of Dermatology; Westmead Hospital; Sydney Australia
- Sydney Medical School; University of Sydney; Sydney Australia
| | - Pablo Fernandez-Penas
- Department of Dermatology; Westmead Hospital; Sydney Australia
- Sydney Medical School; University of Sydney; Sydney Australia
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Aragón-Miguel R, Andrés-Lencina JJ, Calleja-Algarra A, Tous-Romero F, Ortiz-Romero PL, Guerra-Tapia A, Maroñas-Jiménez L. Condyloma-like lesions in a young woman: Not always synonym of genital warts. Eur J Obstet Gynecol Reprod Biol 2017; 213:142-143. [DOI: 10.1016/j.ejogrb.2017.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
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