Cases reported "Keratosis"

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1/402. Hypergranulotic dyscornification: a distinctive histologic pattern of maturation of epidermal epithelium present in solitary keratoses.

    Hypergranulotic dyscornification is an appellation proposed to designate a newly recognized distinctive pattern of epidermal maturation that is analogous to other epithelial reaction patterns such as epidermolytic hyperkeratosis, focal acantholytic dyskeratosis, cornoid lamellation, pale-cell acanthosis, and follicular mucinosis. The name "benign hypergranulotic keratosis with dyscornification" is proposed to specify solitary keratoses with digitated epidermal hyperplasia that exhibit this exceptional pattern of cornification. This abnormal type of cornification is characterized by hypergranulosis. A pale-staining basophilic substance is present intercellularly within the upper spinous layer and the hyperplastic granular layer. Overlying the thickened granular layer in foci at tips of epidermal papillations are orthokeratotic mounds of large, dull, eosinophilic staining corneocytes that are sharply demarcated from the thickened granular layer. Basophilic keratohyalin granules are focally retained within these corneocytes. There is overlying compact orthokeratosis that extends across the entire lesion. The compact orthokeratosis is slightly basophilic, and lies below a laminated and basket-weave orthokeratotic stratum corneum. There is a predominantly lymphocytic infiltrate at the base of these neoplasms with some spongiosis. There is parakeratosis focally present in the stratum corneum overlying these individual areas of abnormal cornification. The histopathologic and clinical findings in eight lesions that exhibit hypergranulotic dyscornification, a heretofore undescribed unique pattern of epidermal cornification, are presented.
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2/402. The hyperkeratotic variant of disseminated superficial actinic porokeratosis (DSAP).

    A 78-year-old South Korean man was referred to us from the Medical intensive care Unit (MICU) for an opinion. He was comatose and was on ventilatory care due to aspiration pneumonia. Multiple tiny papules had developed 10 years previously and since then the number and size had been increasing gradually. He had been diabetic for the past 4 years, and had Parkinson's disease diagnosed 1 year previously. Laboratory examinations revealed an elevated level of white blood cells (WBCs) (25,000/microL) and decreased hemoglobin (8.8 g/dL). Other laboratory results were negative or within normal limits. skin examination showed multiple, discrete, crust-like, brownish papules over the erythematous base on the face, upper extremities, and lower extremities. With the clinical impressions of irritated verruca vulgaris, seborrheic keratosis, or cutaneous fungal infection, a skin biopsy was taken from a papule on the left shin, and histopathologic examination revealed several pronounced hyperkeratotic and parakeratotic columns, and characteristic cornoid lamellae in the stratum corneum. Beneath the cornoid lamellae, the granular layer was decreased. A number of round or oval, dyskeratotic, homogenized eosinophilic cells with pyknotic nuclei were scattered in the prickle cell layer below the cornoid lamellae. A mild lymphohistiocytic infiltrate was observed in the papillary dermis and around the blood vessels in the upper dermis. Also, actinic degeneration was present in the upper dermis.
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3/402. Linear melanonychia due to subungual keratosis of the nail bed: a report of two cases.

    Longitudinal melanonychia displaying features of keratinized acanthoma is described in two patients. In both cases, a pigmented band consisting of a subungual keratinized epithelial ridge originated in the nail bed. We have been able to show, using the clinical and histological findings, that the origin of the pigment is linked to its synthesis within the acanthoma of the nail bed. These lesions are reminiscent of pigmented seborrhoeic keratosis. The horny cysts are replaced, because of the special physiological longitudinal arrangement of the ridges in the nail bed, by a single, prominent, longitudinal, keratinized and pigmented mass.
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4/402. Submammary granular parakeratosis: an acquired punctate hyperkeratosis of exogenic origin.

    Granular parakeratosis is a histologic phenomenon that produces a characteristic clinical picture with multiple brownish and hyperkeratotic papules. In all 6 published cases of localized axillary parakeratosis, excessive use of different topical preparations (cream-type products, deodorants that include roll-on and stick types, antiperspirants, shampoos, bath soaps) was reported by the authors. The exact pathogenic causal relationships have not yet been resolved. In the case reported below, we demonstrate for the first time that the macro- and micromorphological entities can also occur in the submammary region.
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5/402. Plantar hyperkeratosis due to fusarium verticillioides in a patient with malignancy.

    We report the case of an 82-year-old man with hyperkeratosis of the right sole caused by a fusarium verticillioides infection mimicking verrucous tuberculosis; the infection was confirmed by direct potassium hydroxide microscopy, biopsy and cultures. The biopsy specimen showed an unusually deep invasion of fungal elements into the epidermis. This is an uncommon presentation in a localized cutaneous infection by fusarium but in this case, repeated local injuries were the portal of entry initiating the process. Clinical patterns of cutaneous fusarium infections in general are also discussed.
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6/402. Keratosis pilaris and ulerythema ophryogenes associated with an 18p deletion caused by a Y/18 translocation.

    We present a patient with partial monosomy of the short arm of chromosome 18 caused by de novo translocation t(Y;18) and a generalized form of keratosis pilaris (keratosis pilaris affecting the skin follicles of the trunk, limbs and face-ulerythema ophryogenes). Two-color FISH with centromere-specific Y and 18 dna probes identified the derivative chromosome 18 as a dicentric with breakpoints in p11.2 on both involved chromosomes. The patient had another normal y chromosome. This is a third report the presence of a chromosome 18p deletion (and first case of a translocation involving 18p and a sex chromosome) with this genodermatosis. Our data suggest that the short arm of chromosome 18 is a candidate region for a gene causing keratosis pilaris. Unmasking of a recessive mutation at the disease locus by deletion of the wild type allele could be the cause of the recessive genodermatosis.
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7/402. Demonstration of antibody to 230 kDa bullous pemphigoid antigen in lichen planus-like keratosis.

    We describe a 67-year-old man with lichen planus-like keratosis associated with anti-230 kDa bullous pemphigoid antigen (BPAG1) autoantibody. The patient had noticed solitary dark brown macule more than 6 years previously on his left chest. Histological findings showed hypergranulosis, irregular acanthosis, liquefaction degeneration of basal cells, band-like infiltration of lymphocytes at the subepidermal portion, and a cleft at the basement membrane zone (BMZ), resulting in the formation of subepidermal blisters. Direct immunofluorescence findings of perilesional skin showed a linear deposition of IgG at BMZ. On indirect immunofluorescent study using normal human skin, circulating IgG autoantibody to BMZ was present in the patient's serum at a titer of 1:80. The antigen located on the epidermal site of normal skin split by 1M NaCl was reacted with the patient's serum. Immunoblot analysis using epidermal extracts demonstrated the presence of IgG antibody directed to BPAG1 in the patient's serum. These observations suggest that the presence of an antibody to BPAG1 could be caused by the damage of basal cells following lichen planus-like keratosis.
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8/402. Treatment of hyperkeratosis areolae mammae naeviformis with the carbon dioxide laser.

    Hyperkeratosis of the nipple and areola is a rare mamma condition. Typical lesions are characterized by persistent verrucous thickening and dark pigmentation of the nipple or areola (or both) and may occur unilaterally or bilaterally in both sexes. We report what we believe to be the first therapeutic trial with carbon dioxide laser in a patient with hyperkeratosis areolae mammae naeviformis.
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9/402. Nevoid keratosis of the nipple.

    A patient with nevoid keratosis of the nipple is described. The clinical features, histology, therapy, and prognosis are discussed.
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10/402. Selective inflammatory effect of systemic fluorouracil in actinic keratosis.

    A selective inflammatory reaction involving actinic keratosis may occur in patients receiving systemic 5-fluorouracil as part of a chemotherapeutic protocol. This may be effectively treated with topical 5-fluorouracil.
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