Fibroepithelial polyp

Fibroepithelial polyp
	Diagnosis in short
	; Fibroepithelial polyp. H&E stain.
LM	On a stalk / epithelium on three sides, benign epidermis, fibrous core, +/-inflammation
LM DDx	Regressing melanocytic lesions (esp. intradermal melanocytic nevus), pedunculated seborrheic keratosis, nevus lipomatosus superficialis, neurofibroma
Gross	raised skin-coloured lesion
Site	skin
Syndromes	Birt–Hogg–Dubé syndrome
Prevalence	very common
Prognosis	benign

Fibroepithelial polyp, also known as acrochordon and skin tag, is a very common benign skin lesion.

General

Benign.
Older people.
May be associated with pregnancy, diabetes, intestinal polyposis.^[1]
Can be a component of Birt–Hogg–Dubé syndrome.

May be divided into:
Epithelial type - abundant epithelium.
Stromal type - abundant fibrous stroma.

Gross

Raised skin-coloured lesion.

Image:

Skin tag (WC).

Microscopic

Features:

On a stalk / epithelium on three sides.
Benign epidermis.
Fibrous core.
+/-Inflammation.

DDx:

Pedunculated seborrheic keratosis - typically have epidermal hyperplasia, hyperkeratosis, horn cysts.^[2]
Regressing melanocytic lesions.
- Intradermal melanocytic nevus.
Nevus lipomatosus superficialis - abundant adipocytes in the superficial dermis.
Neurofibroma.
Seborrheic keratosis - usu. horn cysts.

Images

Skin tag. (WC)

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EYELID ("TAG"), RIGHT, REMOVAL:
- BENIGN FIBROEPITHELIAL POLYP.

SKIN ("SKIN TAG"), THIGH, REMOVAL:
- FIBROEPITHELIAL POLYP.

Micro

The sections show a fragment of skin with epithelium on three sides. The epithelium matures normally and is not hypertrophic. Orthokeratosis is present. The core of the lesion has fibrous tissue. There is no significant inflammation. No melanocytic nests are identified.

Hyperkeratosis

The sections show a fragment of skin with epithelium on three sides. The epidermis matures toward the surface and no significant basilar atypia is identified. A prominent granular layer is present. Mild hyperkeratosis is present. The core of the lesion consists of fibrous tissue. There is no significant inflammation. No melanocytic nests are identified.

Inflamed

The sections show a fragment of skin with epithelium on three sides. The epithelium matures and is acanthotic. Minimal parakeratosis is present. The core of the lesion consists of fibrous tissue with a mild lymphocyte-predominant dermal infiltrate. Rare siderophages are present.

There is mild basal nuclear enlargement. No significant nuclear atypia is apparent. The dermal-epidermal interface is well-demarcated. Rare basal mitotic activity is identified.

References

↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 596. ISBN 978-1416054542.
↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 342. ISBN 978-0443066542.
↑ URL: http://dermatlas.med.jhmi.edu/derm/result.cfm?Diagnosis=1196583692. Accessed on: 1 September 2011.
↑ URL: http://dermatology-s10.cdlib.org/143/case_presentations/skintags/allegue.html. Accessed on: 9 January 2013.

[Ref_PCPBoD8.7C596-1] Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 596. ISBN 978-1416054542.

[Ref_Derm342-2] Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 342. ISBN 978-0443066542.

[3] URL: http://dermatlas.med.jhmi.edu/derm/result.cfm?Diagnosis=1196583692. Accessed on: 1 September 2011.

[4] URL: http://dermatology-s10.cdlib.org/143/case_presentations/skintags/allegue.html. Accessed on: 9 January 2013.

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