Pigmented malignant hidroacanthoma simplex mimicking irritated seborrheic keratosis. 2006

Julia Yu-Yun Lee, and Ming-Hsien Lin
Department of Dermatology, College of Medicine, National Cheng Kung University, Tainan, Taiwan. yylee@mail.ncku.edu.tw

Pigmented variant of malignant hidroacanthoma simplex (PMHS) is very rare. We are aware of only two reported cases, all arising in pigmented hidroacanthoma simplex (HS). We report the third case of PMHS arising in a pigmented HS. A 71-year-old-woman presented with a well-demarcated pigmented hyperkeratotic tumor on the right knee resembling irritated seborrheic keratosis. Histopathologic examination of the excised tumor revealed intraepidermal proliferation of atypical polygonal poroid cells forming large, sharply demarcated nests with colonization of dendritic melanocytes. In addition, there were focal changes of a benign pigmented HS and syringofibroadenoma. The key diagnostic features of ductal structures and intracytoplasmic lumina were highlighted by carcinoembryonic antigen and epithelial membrane antigen immunostaining. PMHS should be differentiated from irritated seborrheic keratosis, melanoacanthoma, Bowen's disease and malignant melanoma both clinically and pathologically.

UI MeSH Term Description Entries
D008545 Melanoma A malignant neoplasm derived from cells that are capable of forming melanin, which may occur in the skin of any part of the body, in the eye, or, rarely, in the mucous membranes of the genitalia, anus, oral cavity, or other sites. It occurs mostly in adults and may originate de novo or from a pigmented nevus or malignant lentigo. Melanomas frequently metastasize widely, and the regional lymph nodes, liver, lungs, and brain are likely to be involved. The incidence of malignant skin melanomas is rising rapidly in all parts of the world. (Stedman, 25th ed; from Rook et al., Textbook of Dermatology, 4th ed, p2445) Malignant Melanoma,Malignant Melanomas,Melanoma, Malignant,Melanomas,Melanomas, Malignant
D001913 Bowen's Disease A persistent progressive non-elevated red scaly or crusted plaque which is due to an intradermal carcinoma and is potentially malignant. Atypical squamous cells proliferate through the whole thickness of the epidermis. The lesions may occur anywhere on the skin surface or on mucosal surfaces. The cause most frequently found is trivalent arsenic compounds. Freezing, cauterization or diathermy coagulation is often effective. (From Rook et al., Textbook of Dermatology, 4th ed, pp2428-9) Bowen Disease,Bowens Disease,Disease, Bowen,Disease, Bowen's
D003937 Diagnosis, Differential Determination of which one of two or more diseases or conditions a patient is suffering from by systematically comparing and contrasting results of diagnostic measures. Diagnoses, Differential,Differential Diagnoses,Differential Diagnosis
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D012878 Skin Neoplasms Tumors or cancer of the SKIN. Cancer of Skin,Skin Cancer,Cancer of the Skin,Neoplasms, Skin,Cancer, Skin,Cancers, Skin,Neoplasm, Skin,Skin Cancers,Skin Neoplasm
D013544 Sweat Gland Neoplasms New abnormal growth of tissue in the SWEAT GLANDS. Neoplasms, Sweat Gland,Neoplasm, Sweat Gland,Sweat Gland Neoplasm
D017492 Keratosis, Seborrheic Benign eccrine poromas that present as multiple oval, brown-to-black plaques, located mostly on the chest and back. The age of onset is usually in the fourth or fifth decade. Seborrheic Keratosis,Keratosis Seborrheica,Keratoses, Seborrheic,Seborrheic Keratoses
D018226 Fibroadenoma An adenoma containing fibrous tissue. It should be differentiated from ADENOFIBROMA which is a tumor composed of connective tissue (fibroma) containing glandular (adeno-) structures. (From Dorland, 27th ed) Fibroadenomas

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