CASE 33

1. CASE 33 Alejandro García-Varona, MD Hospital El Bierzo

2. Initial Presentation and Management • 34 year-old female • No relevant individual or family medical history • At her annual pap test screening visit, her doctor noted a single, asymptomatic, discrete, cystic (kind of papillary) lesion on her left labia majora, about 0,3 cm

3. Initial Presentation and Management • She told the patient and performed a biopsy of the lesion • We received an irregular, reddish, cutaneous fragment, 0,5 cm

8. DIAGNOSIS WARTY DYSKERATOMA

9. Warty Dyskeratoma • Benign papulo-nodular lesion with an endophytic proliferation of squamous epithelium, often in relation to a foliculosebaceous unit and showing prominent acantholytic dyskeratosis • Unknown etiology. Unrelated to HPV • Typically involves head and neck. Oral, laryngeal and vulval location have been reported

10. Warty Dyskeratoma • Solitary pink/brown papules, nodules or cysts with an umbilicated or pore-like centre or central keratin plug • Between 1 and 10 mm

11. Jang EJ, et al. Ann Dermatol 2011;23:98-100

12. Warty Dyskeratoma • Well-demarcated endophytic lesion • Abundant keratin that forms a plug in the center • Superficial keratinous debris contains conspicuous corps ronds • Prominent acantholytic dyskeratosis • Suprabasal clefting with villi formation • Underlying dermis with lymphocytic infiltrate

13. Warty Dyskeratoma • Common mitotic figures • Three variants: • Cup-shaped • Cystic • Nodular • Epidermal collarette present • Connection to folliculosebaceous structure is commonly demonstrable

14. Warty Dyskeratoma • DD with comedonal Darier disease (similar histology, differentiated on clinical grounds)

15. THANK YOU…