Pseudoepitheliomatous hyperplasia formation after skin injury

Usage of negative pressure wound therapy in pseudoepitheliomatous hyperplasia secondary to burn injury: a case series

Pseudoepitheliomatous hyperplasia (PEH) is a reactive epithelial proliferation secondary to a wide range of stimuli, including traumatic injury, inflammation, infection, and tumors of the skins. PEH secondary to burn injury is rarely reported. We report 3 cases of PEH patients after burn injury. All three cases were confirmed with the existence of bacterial infection, and all these cases were second or third degree burns. All 3 patients were treated with negative pressure wound therapy after wound debridement or tangential excision. All the wounds healed without split-thickness skin grafting and recurrence.

Histopathological Study of Oral Pseudoepitheliomatous Hyperplasia

ABSTRACT: Pseudoepitheliomatous hyperplasia, also called Heck’s disease, is an epithelial, inconstant and conjunctive proliferation that develops as a response to a great variety of stimuli. It is a lesion associated to different diseases, being found in the following etiopathogenic conditions: infectious pathogenic conditions, tumoral pathogenic conditions, inflammatory pathogenic conditions. We studied oral pseudoepitheliomatous hyperplasia for which we performed a histopathological study, on a group of 47 cases of oral pseudoepitheliomatous hyperplasias, where we investigated the following: oral epithelium changes, changes in the underlying lamina propria and associated etiopathogenic conditions. The main changes of the oral epithelium were: elongation of the epithelial apexes (17.02%), acanthosis (100%), dyskeratosis (14.89%), and in the underlying lamina propria: fibrosis (29.78%), inflammatory infiltrate (70.21% and vascular proliferation (10.64%). The most frequent associated etiopathogenic conditions were the infectious ones (55.31%), followed by the tumoral ones (29.79%), on the last place being the inflammatory conditions (14.89%).

Histopathologic pitfalls of Mohs micrographic surgery and a review of tumor histology

Mohs micrographic surgery is a specialized subset of staged surgical excisions with each subsequent stage being driven largely by the histologic findings of the previous stage. Therefore, it is imperative that histologic analysis is performed in an accurate manner. Frozen section and tissue flattening is a crucial step in Mohs surgery. Frozen sections introduce certain artifacts and these artifacts must be interpreted in the correct context. Basal and squamous cell carcinomas are the most common tumors encountered in Mohs micrographic surgery, and their histopathology is also associated with certain "pitfalls". Basal cell carcinoma should be distinguished from hair follicles, folliculocentric basaloid proliferations, poromas, nevus sebaceous, desmoplastic trichoepitheliomas, and spiradenomas, to name but a few histologic entities. Similarly, squamous cell carcinoma should be distinguished from hypertrophic actinic keratoses, pseudoepitheliomatous hyperplasia, sebaceous carcinoma, and microcystic adnexal carcinoma. In addition, there are numerous subtypes of basal cell and squamous carcinomas that the Mohs surgeon should be aware of due to differences in the biologic behavior of these tumors. This review presents a number of the common histologic pitfalls of Mohs micrographic surgery and a review of tumor histology.

Lesions With an Epidermal Hyperplastic Pattern: Morphologic Clues in the Differential Diagnosis

In this report, we review the most common entities that show a epidermal hyperplastic pattern in the biopsy. These entities include inflammatory, reactive, infectious, hamartomatous, and tumoral conditions, each with a very different prognosis. Therefore, an approach based on the classic "patterns and clues" tools used in dermatopathology can bring a lot of information to the dermatopathologist or the general pathologist evaluating these lesions.

Pseudoepitheliomatous hyperplasia mimicking invasive squamous cell carcinoma in extranodal natural killer/T-cell lymphoma: a report of 34 cases

AIMS

Pseudoepitheliomatous hyperplasia (PEH) is defined as a pattern of epidermal reaction. However, it has not yet been extensively documented in extranodal natural killer/T-cell lymphoma (ENKTL). The aim of our study was to analyse a series of ENKTLs concomitant with PEH mimicking squamous cell carcinoma (SCC).

METHODS AND RESULTS

We analysed 34 cases of ENKTL with PEH. In our study, the incidence of PEH was 3.8% in ENKTLs diagnosed over a 13-year period. All 34 cases presented with PEH, appearing as tongue-like projections of squamous epithelium into the underlying submucosa/dermis with variable depths and jagged borders. The keratinocytes sometimes showed a minor degree of cytological atypia, mostly in the stratum basale, and keratinocyte necrosis was absent. Atypical mitoses and a high nuclear/cytoplasmic ratio were absent. The submucosa and the squamous cell cords were also permeated by atypical lymphocytes.

CONCLUSIONS

ENKTL can be associated with PEH, and the atypical lymphoid cell population can be highly subtle, and therefore may be easily mistaken for SCC, leading to inappropriate therapy. A correct diagnosis requires awareness and recognition of this pitfall by recognizing the associated conditions listed above, which distinguish PEH from SCC.

Pseudoepitheliomatous hyperplasia mimicking esophageal squamous cell carcinoma in a patient with lye-induced esophageal stricture

Pseudoepitheliomatous hyperplasia is a benign condition that may be caused by prolonged inflammation, chronic infection, and/or neoplastic conditions of the mucous membranes or skin. Due to its histological resemblance to well-differentiated squamous cell carcinoma, pseudoepitheliomatous hyperplasia may occasionally be misdiagnosed as squamous cell carcinoma. The importance of pseudoepitheliomatous hyperplasia is that it is a self-limited condition that must be distinguished from squamous cell carcinoma before invasive treatment. We report here on a rare case of esophageal pseudoepitheliomatous hyperplasia in a 67-year-old Korean woman with a lye-induced esophageal stricture. Although esophageal pseudoepitheliomatous hyperplasia is infrequently encountered, pseudoepitheliomatous hyperplasia should be considered in the differential diagnosis of esophageal lesions.

Florid pseudoepitheliomatous hyperplasia related to tattoo: a case report

Pseudoepitheliomatous hyperplasia is a benign condition defined by an exuberant proliferation of the epithelium with downward progression into the dermis. It may occur in reaction to several conditions including chronic cutaneous wound. We describe an unusual case of a florid pseudoepitheliomatous hyperplasia mimicking a well-differentiated squamous cell carcinoma, restricted to the red part of a rose tattoo.

Expression of laminin-5 γ2 chain in cutaneous pseudocarcinomatous hyperplasia

BACKGROUND

Since the use of laminin-5 as a marker of invasiveness has been proposed by several authors, our objective was to compare the expression of this protein in pseudocarcinomatous hyperplasia and squamous cell carcinoma (SCC).

METHODS

Sixty-four paraffin-embedded skin biopsy samples with diagnosis of epidermal hyperplasia (non-pseudocarcinomatous), pseudocarcinomatous hyperplasia, actinic keratosis/carcinoma in situ, microinvasive and frankly invasive SCC were obtained for immunohistochemical study.

RESULTS

Adjacent normal epithelium and epidermal hyperplasia (non-pseudocarcinomatous) showed no staining. In pseudocarcinomatous hyperplasia, laminin-5 was positive, at least focally, in 14 of 16 (87.5%) samples and was concentrated in peripheral cells of elongated rete pegs and in migrating cells in dermis. In samples of microinvasive carcinoma (n = 7), the expression was observed in all cases and was concentrated in the leading edge of the tumor. All cases (n = 21) of frankly invasive SCC showed cells expressing laminin-5, at least focally. Well-differentiated areas of the tumor presented a pattern of expression in peripheral cells of tumor nests while a diffuse pattern of expression was observed in less differentiated areas.

CONCLUSION

We showed that cytoplasmic laminin-5 expression should not be used as a criterion of malignancy and is not useful in distinguishing pseudocarcinomatous hyperplasia from microinvasive and well-differentiated SCC.

Pseudoepitheliomatous hyperplasia treated by photodynamic therapy with variable irradiation dose and concentration of photosensitizer

OBJECTIVE

The aim of this study was to test the effectiveness of photodynamic therapy (PDT) in treating pseudoepitheliomatous hyperplasia (PEH) after skin wounding.

BACKGROUND DATA

PEH is a difficult-to-treat extreme-degree acanthosis characterized by proliferation of the epithelium. Topical PDT offers an effective and non-invasive treatment for intraepithelial neoplasia and inflammatory dermatosis. These disorders and PEH show the same histological features: epidermal hyperplasia. To our knowledge, there have been no clinical trials published about therapeutic responses of PDT for PEH.

MATERIALS AND METHODS

After application of 10-30% methyl aminolaevulinate (MAL) emulsion, each lesion was irradiated with 633-nm red light at a total dose of 113-339 J/cm(2). Therapeutic response was assessed by clinical examination at 3 months.

RESULTS

Only 4 of 16 lesions clinically showed a minimal response. No response was observed in 12 of the 16 lesions, either with different cumulative doses or different concentrations of MAL.

CONCLUSION

PEH after skin wounding responds poorly to the topical MAL-PDT. Besides removal of underlying diseases, surgical excision is still the recommended first option.

Focal injection of vancomycin combined with surgical debridement-dermatoplasty in the treatment of pseudo-epitheliomatous granuloma

BACKGROUND

Pseudo-epitheliomatous granuloma (PEG) can occur in some small skin wounds with secondary infections resulting from improper treatments. It is difficult to heal and can easily relapse.

OBJECTIVES

This study explores the clinical and pathological characteristics of PEG and effective treatments.

PATIENTS AND METHODS

Tissue specimens of PEG obtained from 11 patients (age range: 2-67 years) were sent for microbial examination and histological observation. The local lesions were treated by focal injection of vancomycin combined with surgical debridement-dermatoplasty.

RESULTS

The diagnosis of PEG was based on histological examination, which revealed long epithelial peduncle encapsulated granulation tissue-like honeycomb in which more vessels, macrophages, lymphocytes and mast cells and less extracellular matrix were distributed. Bacteria such as Staphylococcus aureus, Bacillus pyocyaneus, ethylene-type Streptococcus, stool Streptococcus and F-citric acid Bacillus were found in the microbial culture of the specimens. They were tolerant to celbenin but sensitive to vancomycin. PEG could be cured by focal application of vancomycin combined with free skin or skin flap after thorough debridement. The relapse of PEG could be prevented by the therapy.

CONCLUSION

Focal injection of vancomycin combined with surgical debridement-dermatoplasty is an effective therapy for PEG.