BACKGROUND AND OBJECTIVES: Cancer of the oral cavity is a disease of the head and neck that is difficult to treat. Periodic observation and biopsy are important for its early diagnosis once a premalignant lesion in the oral cavity is confirmed. The purpose of this study was to determine the importance of early excisional biopsy by investigating the histological features of oral leukoplakia and the rate of malignant change in the oral cavity. SUBJECTS AND METHOD: A total of 327 patients who underwent punch biopsy of oral cavity from January 2011 to December 2017 were reviewed retrospectively for the presence of initial gross lesions and for their biopsy results. The histological findings of 6 initial gross lesion groups were compared. Additional excisional biopsies were performed in the seven oral cavity subsites. RESULTS: There were 33 cases of oral leukoplakia. The punch biopsies of 3 of these cases (9.1%) showed malignancy. Additional excisional biopsies were performed in 6 cases, 4 of which were malignant (66.7%). Additional excisional biopsies of the tongue were performed in 14 cases (9.0%), 5 of which (35.7%) were malignant. The rate of atypia in leukoplakia (9.1%) was higher than in other atypia groups. Additional excisional biopsies were performed in 3 cases (100%) of atypia of leukoplakia, all of which were assessed to be malignant. CONCLUSION: For tongue leukoplakia, performing an early excisional biopsy rather than an incisional biopsy is recommendable. Moreover, additional excisional biopsies are needed when the initial biopsy is suggestive of hyperkeratosis, parakeratosis, or atypia.
Biopsy ; Early Diagnosis ; Head ; Humans ; Leukoplakia ; Leukoplakia, Oral ; Methods ; Mouth ; Neck ; Parakeratosis ; Retrospective Studies ; Tongue

A giant cutaneous horn (GCH) is a morphological description of huge, conical, dense, hyperkeratotic protrusion. Because of its bizarre shape and associated risk of malignancy, GCH requires proper treatment. A 48-year-old male patient visited our department with a GCH on a burn scar of his right hand. It had started to develop about 8 months previously. At initial physical examination, the lesion presented as a hard, dark brown mass of basal area 4×3.5 cm², and height 3.5 cm. Preoperative biopsy confirmed the absence of malignancy. We performed excision of the entire GCH, and biopsy and repaired the resulting defect with full-thickness skin graft. Histopathologic results revealed that all surgical margin were negative for malignancy. Microscopically, the lesion exhibited marked regular acanthosis, parakeratosis and hyperkeratosis with granular layer loss. At 3 months postoperatively, no complication was observed. According to Mantese et al., 58.56% of GCHs originate from malignant or premalignant lesions. And thus, a histopathologic examination is mandatory, and if an accompanying malignant lesion is found, additional resection should be undertaken. In another study, it was concluded the risk of premalignancy or malignancy depends on development time. In our case, the GCH had grown from a burn scar, this has not been previously reported in Korea. Surgeons need to be aware cutaneous horn harbors risks of premalignancy or malignancy, and that histopathological evaluation is indispensable for treatment decision making.
Animals ; Biopsy ; Burns* ; Cicatrix* ; Decision Making ; Hand ; Horns* ; Humans ; Korea ; Male ; Middle Aged ; Parakeratosis ; Physical Examination ; Skin ; Surgeons ; Transplants

BACKGROUND: The differential diagnosis of psoriasis and seborrheic dermatitis can be difficult when both conditions are localized to the scalp without the involvement of other skin sites. OBJECTIVE: We aimed to evaluate the histopathological differences between psoriasis and seborrheic dermatitis on the scalp and identify favorable criteria for their differential diagnosis. METHODS: We evaluated 15 cases of psoriasis and 20 cases of seborrheic dermatitis of the scalp that had been clinicopathologically diagnosed. Skin biopsy sections stained with H&E were examined. Additional immunohistochemistry was performed, including Ki-67, keratin 10, caspase-5, and GLUT-1. RESULTS: On histopathological examination, mounds of parakeratosis with neutrophils, spongiform micropustules of Kogoj, and clubbed and evenly elongated rete ridges were significantly more frequently observed in psoriasis. Follicular plugging, shoulder parakeratosis and prominent lymphocytic exocytosis were significantly more common in seborrheic dermatitis. Moreover, significantly higher mitotic figures were observed in psoriatic lesions than in seborrheic dermatitis. Immunohistochemistry did not show any difference between psoriasis and seborrheic dermatitis. CONCLUSION: Histopathological features favoring psoriasis include mounds of parakeratosis with neutrophils, spongiform micropustules of Kogoj, clubbed and evenly elongated rete ridges, and increased mitotic figures (≥6/high-powered field). Features indicating seborrheic dermatitis are follicular plugging, shoulder parakeratosis and prominent lymphocytic exocytosis. Immunohistochemistry was not helpful in differentiating psoriasis from seborrheic dermatitis.
Biopsy ; Dermatitis, Seborrheic* ; Diagnosis, Differential* ; Exocytosis ; Immunohistochemistry ; Keratin-10 ; Neutrophils ; Parakeratosis ; Psoriasis* ; Scalp* ; Shoulder ; Skin

BACKGROUND: It is difficult to distinguish between actinic cheilitis and lichen planus histologically, because both types of lesions exhibit variable degrees of epidermal dysplasia and dermal lichenoid inflammation. There is currently no consensus on suitable immunohistochemical markers for distinguishing these 2 conditions. OBJECTIVE: This study aims to determine histological features and immunohistochemical markers that could be used to differentiate actinic cheilitis from lichen planus. METHODS: Fifteen cases of actinic cheilitis and 11 cases of lichen planus of the lips were included in the study. Histological changes such as parakeratosis, hyperkeratosis, atrophy, acanthosis, ulceration, necrosis, dermal solar elastosis, degrees of epidermal dysplasia and dermal inflammatory cell infiltration were examined. Verhoeff-van Gieson stained sections were quantified for the degree of elastosis using computer software. The following immunohistochemical markers were stained for: bcl-2, Ki-67, proliferating cell nuclear antigen, indoleamine 2, 3-dioxygenase, matrix metalloproteinase-3, matrix metalloproteinase-9, CD4, CD8, c-kit, and prolyl-4-hydroxylase. RESULTS: The only histologically appreciable difference between the diseases was the degree of epidermal dysplasia. No differences were observed with respect to solar elastosis using the Verhoeff-van Gieson stain. We found that cell proliferation markers such as proliferating cell nuclear antigen and Ki-67 were more highly expressed in actinic cheilitis than in lichen planus. In addition, the number of c-kit-positive cells observed in actinic cheilitis was significantly higher than in lichen planus. The expression levels of the other tested markers were not significantly different between the 2 diseases. CONCLUSION: The immunohistochemical markers proliferating cell nuclear antigen, Ki-67, and c-kit may help to differentiate actinic cheilitis from lichen planus of the lips.
Actins* ; Atrophy ; Cell Proliferation ; Cheilitis* ; Consensus ; Inflammation ; Lichen Planus* ; Lip* ; Matrix Metalloproteinase 9 ; Necrosis ; Parakeratosis ; Proliferating Cell Nuclear Antigen ; Ulcer

Eczematid-like purpura of Doucas and Kapetanakis is a type of pigmented purpuric dermatoses. It is clinically characterized by pruritic seasonal eruptions occurring in the spring and summer, and histopathologically characterized by spongiosis and parakeratosis in the epidermis and by the lymphocyte-mediated leakage of erythrocytes from capillaries in the papillary dermis. We report a case of eczematid-like purpura of Doucas and Kapetanakis that showed clinical improvement with narrowband UVB (NB-UVB). The patient was a 66-year-old man with pruritic, well-demarcated scaly purpuric patches on his feet that appeared 2 months prior. A histopathological study showed mild superficial perivascular lymphocytic infiltration, focal spongiosis with exocytosis, and erythrocyte leakage. We initiated treatment with an oral antihistamine, ascorbic acid, and a topical steroid, but the lesion was aggravated. We therefore treated the patient with NB-UVB for 6 months, and the lesions regressed progressively with residual postinflammatory hyperpigmentation.
Aged ; Ascorbic Acid ; Capillaries ; Dermis ; Epidermis ; Erythrocytes ; Exocytosis ; Foot ; Humans ; Hyperpigmentation ; Parakeratosis ; Purpura* ; Seasons ; Skin Diseases

Darier's disease is an autosomal dominant acantholytic skin disorder. The disease is characterized by symmetric distribution of hyperkeratotic papules in seborrheic regions of the skin and nail changes with potential for exacerbation by ultraviolet light, heat, occlusion, or stress. It presents as generalized (hypertrophic or vesiculobullous type) or localized (linear or zosteriform type) condition. A 53-year-old male patient presented with hyperkeratotic verrucous papules on the back that had an onset in childhood. Clinically, his condition resembled lichen simplex chronicus. The lesions were exacerbated by sun exposure or sweating. A 3-mm punch biopsy specimen revealed prominent acantholysis with hyperkeratosis and parakeratosis. Numerous corps grains and corps ronds were present near the granular layer. We report a case of localized Darier's disease mimicking lichen simplex chronicus on the back. The skin lesion improved following treatment with a topical corticosteroid. Localized Darier's disease should be considered as one of the differential diagnoses of lichen simplex chronicus on the back.
Acantholysis ; Biopsy ; Edible Grain ; Darier Disease* ; Diagnosis, Differential ; Hot Temperature ; Humans ; Male ; Middle Aged ; Neurodermatitis* ; Parakeratosis ; Skin ; Solar System ; Sweat ; Sweating ; Ultraviolet Rays

Verruciform xanthoma (VX) is a rare, benign lesion that presents in the oral cavity, skin, or genital organs as a verrucous, papillomatous, or flat papule with varying colors. VX has indistinct clinical features, making histopathological examination necessary for a definitive diagnosis. Histologically, VX is characterized by parakeratosis, rete ridges with uniform depth, and an accumulation of the foam cells, which are also known as the "xanthoma cells". These foam cells test positive for antibodies, such as CD-68 and vimentin; it is thought that VX foam cells are derived from the monocyte-macrophage lineage, and that VX's pathogenic mechanism is partly related to an immune mechanism. Nevertheless, the pathogenesis of VX remains unclear. VX can be treated by surgical excision; other medical, chemical, and radiological treatments are not required postoperatively. Recurrence and malignant transformation of VX are rare. Two patients, each with a mass of unknown origin on the palatal gingiva, were presented at our clinic. Excisional biopsies of the masses were performed for a histological diagnosis after clinical and radiological examinations. Histological examination confirmed a diagnosis of VX in both cases.
Antibodies ; Biopsy ; Diagnosis ; Foam Cells ; Genitalia ; Gingiva* ; Humans ; Mouth ; Parakeratosis ; Recurrence ; Skin ; Vimentin ; Xanthomatosis*

BACKGROUND/AIMS: Esophageal lichen planus (LP) has been described as a cause of nonspecific esophagitis that may cause dysphagia, but its incidence is unknown. We aimed to estimate the incidence of esophageal LP in a defined geographic region and describe the clinical characteristics of affected patients. METHODS: A histopathology database for a population of 1 million people was searched for all esophageal mucosal biopsy results over an 8-year period. Cases showing inflammation or abnormalities without a diagnosis after three or more biopsies were reviewed for findings of LP. RESULTS: Of 13,589 esophageal biopsies, only one received a diagnosis of LP. Seven patients (four male; mean age, 59 years; range, 39 to 76 years) were identified as having chronic dysphagia and nonspecific proximal esophagitis for which no diagnosis could be made. All patients had proximal inflammation, and six of seven had full-thickness lymphocytic infiltration. Elongation of the lamina propria papillae was noted in all patients, whereas six patients had parakeratosis and ballooning. Only one patient had findings potentially consistent with, but not sufficient for, a diagnosis of esophageal LP. CONCLUSIONS: Esophageal LP appears to be extremely uncommon in this North American population, and esophageal biopsy alone is likely not sufficient to establish a diagnosis of LP.
Biopsy ; Deglutition Disorders ; Esophagitis ; Esophagus ; Gastroesophageal Reflux ; Humans ; Incidence ; Inflammation ; Lichen Planus ; Lichens ; Mucous Membrane ; Parakeratosis

OBJECTIVES: This study was designed to evaluate the clinical, histological and immunohistochemical findings and treatment of chronic actinic dermatitis in Korean patients. METHODS: Seventeen Korean patients with chronic actinic dermatitis were enrolled for this study. The clinical and histological findings and the results of phototest were reviewed with medical records, clinical photographs and pathologic slides. We also reviewed the effectiveness of the treatments in all patients with chronic actinic dermatitis. RESULTS: In all patients with chronic actinic dermatitis, pruritus was severe, and the patients present in the early stages with erythemas on the face, neck and the back of the hands. As the eruption progresses, it became lichenified and scaly plaques and papules developed. The face, upper extremity and neck were most commonly affected. The most common abnormal results of the phototests were decreased MED-UVB alone. In 8 patients with actinic reticuloid, histopathologic findings showed irregular acanthosis, parakeratosis, spongiosis, atypical hyperchromatic cells with cerebriform nuclei, epidermotropism, Pautrier-like microabscess, deep perivascular lymphocytic infiltrates, vertically-streaked collagen in the papillary dermis, stellate and multinucleated fibroblasts. Treatment includes topical tacrolimus and corticosteroid, oral corticosteroid, azathioprine and cyclosporine. CONCLUSIONS: Our study showed classic clinical and histological findings. The most common abnormal results of the phototests were decreased MED-UVB alone. Topical steroid, tacrolimus and systemic cyclosporine, azathioprine are effective in treating chronic actinic dermatitis.
Actins ; Azathioprine ; Collagen ; Cyclosporine ; Dermis ; Erythema ; Fibroblasts ; Hand ; Humans ; Medical Records ; Neck ; Parakeratosis ; Photosensitivity Disorders* ; Pruritus ; Tacrolimus ; Upper Extremity

BACKGROUND: Inflammatory labial lesions are quite common in dermatology. However, a few studies have been performed regarding the clinical and histopathological findings of inflammatory labial diseases. OBJECTIVE: The purpose of this study was to investigate the clinical and histopathological features of inflammatory labial diseases. METHODS: We retrospectively reviewed the data of 48 patients who underwent biopsy for inflammatory labial lesions between June 2005 and December 2012. Clinical features and histopathological findings of the lesions were investigated, and they were compared to each other for differential diagnosis. RESULTS: The most frequent inflammatory labial diseases were actinic cheilitis (25%), oral lichen planus (23%), plasma cell cheilitis (23%), oral lichenoid lesion (17%), and eczema (12%). Most of the labial lesions were located on the lower lip (87%). We found a broad overlap in the clinical features of lesions with each other, and in many cases, clinical impressions were inconsistent with their final diagnosis. Histopathologically, the degree of eosinophilic infiltrates in actinic cheilitis was comparable to those in eczema. Oral lichen planus showed orthokeratotic hyperkeratosis rather than parakeratosis, and oral lichenoid lesion displayed more frequent perivascular and deep inflammatory cell infiltrates than oral lichen planus. CONCLUSION: The diagnosis of inflammatory labial diseases may be challenging, because inflammatory labial diseases often show similar clinical features and have a broad overlap in histological features. Therefore, clinico-pathologic correlation is necessary to confirm the diagnosis and for proper management.
Actins ; Biopsy ; Cheilitis ; Dermatology ; Eczema ; Eosinophils ; Humans ; Lichen Planus ; Lichen Planus, Oral ; Lichens ; Lip ; Parakeratosis ; Plasma Cells ; Retrospective Studies