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| Micro = horn cysts, pigmented basal layer, hyperkeratosis | | Micro = horn cysts, pigmented basal layer, hyperkeratosis | ||
| Subtypes = acanthotic seborrheic keratosis, reticulated seborrheic keratosis, irritated seborrheic keratosis, digitated seborrheic keratosis, stucco keratosis | | Subtypes = acanthotic seborrheic keratosis, reticulated seborrheic keratosis, irritated seborrheic keratosis, digitated seborrheic keratosis, stucco keratosis | ||
| LMDDx = [[actinic keratosis]], [[verruca vulgaris]], [[basal cell carcinoma]] (fibroepitheliomatous pattern) - for reticulated SK, [[melanocytic nevus]], [[condyloma acuminatum]], | | LMDDx = [[actinic keratosis]], [[verruca vulgaris]], [[basal cell carcinoma]] (fibroepitheliomatous pattern) - for reticulated SK, [[melanocytic nevus]], [[condyloma acuminatum]], [[inverted follicular keratosis]], [[fibroepithelial polyp]] | ||
[[inverted follicular keratosis]] | |||
| Stains = | | Stains = | ||
| IHC = | | IHC = | ||
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==Gross== | ==Gross== | ||
[[Image:Seborrheic keratosis on human back.jpg|thumb|right|Clinical image showing a large number of SKs (Leser–Trélat sign). (WC/Heilman)]] | |||
*"Stuck-on" appearance - raised lesion. | *"Stuck-on" appearance - raised lesion. | ||
==Microscopic== | ==Microscopic== | ||
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*Hyperkeratosis - stratum corneum extra thick. | *Hyperkeratosis - stratum corneum extra thick. | ||
**May be minimal. | **May be minimal. | ||
**Usually predominantly [[basketweave pattern]]. | |||
*Horn cysts - intraepidermal collections of keratin - '''key feature'''. | *Horn cysts - intraepidermal collections of keratin - '''key feature'''. | ||
**Actually invaginations - '''not''' true cysts; thus, they may more accurately be called ''pseudohorn cysts''.<ref>URL: [http://www.healthcare.uiowa.edu/dermatology/dpt/HornCyst.htm http://www.healthcare.uiowa.edu/dermatology/dpt/HornCyst.htm]. Accessed on: 13 September 2012.</ref> | **Actually invaginations - '''not''' true cysts; thus, they may more accurately be called ''pseudohorn cysts''.<ref>URL: [http://www.healthcare.uiowa.edu/dermatology/dpt/HornCyst.htm http://www.healthcare.uiowa.edu/dermatology/dpt/HornCyst.htm]. Accessed on: 13 September 2012.</ref> | ||
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DDx:<ref name=Ref_Derm338-9>{{Ref Derm|338-9}}</ref> | DDx:<ref name=Ref_Derm338-9>{{Ref Derm|338-9}}</ref> | ||
*[[Actinic keratosis]] - especially, irritated SKs; have nuclear atypia and parakeratosis. | *[[Actinic keratosis]] - especially, irritated SKs; have nuclear atypia and parakeratosis. | ||
*[[Verruca vulgaris]] - | *[[Verruca vulgaris]] - koilocytes, compact hyperkeratosis and parakeratosis. | ||
**SKs typically have prominent basketweave hyperkeratosis. | |||
**SKs may have papillomatous projections. | |||
*[[Basal cell carcinoma]], fibroepitheliomatous pattern - esp. reticulated SK. | *[[Basal cell carcinoma]], fibroepitheliomatous pattern - esp. reticulated SK. | ||
*[[Melanocytic nevus]]. | *[[Melanocytic nevus]]. | ||
*[[Condyloma acuminatum]] - may have horn cysts, more probable than SK in the genital area. | *[[Condyloma acuminatum]] - may have horn cysts, more probable than SK in the genital area.<ref name=pmid7978069>{{Cite journal | last1 = Li | first1 = J. | last2 = Ackerman | first2 = AB. | title = "Seborrheic keratoses" that contain human papillomavirus are condylomata acuminata. | journal = Am J Dermatopathol | volume = 16 | issue = 4 | pages = 398-405; discussion 406-8 | month = Aug | year = 1994 | doi = | PMID = 7978069 }}</ref> | ||
*[[Inverted follicular keratosis]] - predominantly endophytic growth pattern, may be considered a variant of seborrheic keratosis.<ref name=Ref_Derm341>{{Ref Derm|341}}</ref> | *[[Inverted follicular keratosis]] - predominantly endophytic growth pattern, may be considered a variant of seborrheic keratosis.<ref name=Ref_Derm341>{{Ref Derm|341}}</ref> | ||
*Collision with another lesion. | *Collision with another lesion. | ||
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**It is postulated that melanocytic lesions are associated with SKs.<ref name=pmid23785597>{{Cite journal | last1 = Defazio | first1 = J. | last2 = Zalaudek | first2 = I. | last3 = Busam | first3 = KJ. | last4 = Cota | first4 = C. | last5 = Marghoob | first5 = A. | title = Association between melanocytic neoplasms and seborrheic keratosis: more than a coincidental collision? | journal = Dermatol Pract Concept | volume = 2 | issue = 2 | pages = 202a09 | month = Apr | year = 2012 | doi = 10.5826/dpc.0202a09 | PMID = 23785597 }}</ref> | **It is postulated that melanocytic lesions are associated with SKs.<ref name=pmid23785597>{{Cite journal | last1 = Defazio | first1 = J. | last2 = Zalaudek | first2 = I. | last3 = Busam | first3 = KJ. | last4 = Cota | first4 = C. | last5 = Marghoob | first5 = A. | title = Association between melanocytic neoplasms and seborrheic keratosis: more than a coincidental collision? | journal = Dermatol Pract Concept | volume = 2 | issue = 2 | pages = 202a09 | month = Apr | year = 2012 | doi = 10.5826/dpc.0202a09 | PMID = 23785597 }}</ref> | ||
*[[Papillomatous compound nevus]] - a beign nevus with seborrheic keratosis-like features. | *[[Papillomatous compound nevus]] - a beign nevus with seborrheic keratosis-like features. | ||
*[[Acanthosis nigricans]] - site important. | |||
*[[Fibroepithelial polyp]], epithelial type - may have abundant compact keratin, lack horn cysts. | |||
*[[Eccrine poroma]] - lack horn cysts. | |||
===Images=== | ===Images=== | ||
<gallery> | <gallery> | ||
Image:SkinTumors-P5280040.JPG | Seborrheic keratosis. (WC) | |||
Image:Seborrheic_keratosis_(1).jpg | Seborrheic keratosis - low mag. (WC) | Image:Seborrheic_keratosis_(1).jpg | Seborrheic keratosis - low mag. (WC) | ||
Image:Seborrheic_keratosis_%282%29.jpg | Seborrheic keratosis - high mag. (WC) | Image:Seborrheic_keratosis_%282%29.jpg | Seborrheic keratosis - high mag. (WC) | ||
</gallery> | </gallery> | ||
www | <gallery> | ||
Image: Seborrheic keratosis - low mag.jpg | SK - low mag. (WC) | |||
Image: Seborrheic keratosis - intermed mag.jpg | SK - intermed. mag. (WC) | |||
Image: Seborrheic keratosis - high mag.jpg | SK - high mag. (WC) | |||
</gallery> | |||
====www==== | |||
*[http://www.dermatlas.org/derm/IndexDisplay.cfm?ImageID=-1985374774 Seborrheic keratosis - high mag. (dermatlas.org)]. | *[http://www.dermatlas.org/derm/IndexDisplay.cfm?ImageID=-1985374774 Seborrheic keratosis - high mag. (dermatlas.org)]. | ||
*[http://www.dermatlas.org/derm/IndexDisplay.cfm?ImageID=-1880960893 Seborrheic keratosis - low mag. (dermatlas.org)]. | *[http://www.dermatlas.org/derm/IndexDisplay.cfm?ImageID=-1880960893 Seborrheic keratosis - low mag. (dermatlas.org)]. | ||
*[http:// | *[http://ispub.com/IJD/7/2/7627 Gallery of SK variants (ispub.com)].<ref>{{Cite journal | last1 = Sarma | first1 = DP. | last2 = Repertinger | first2 = S. | title = Seborrheic Keratosis: A Pictorial Review of the Histopathologic Variations. | journal = The Internet Journal of Dermatology| volume = 7 | issue = 2 | pages = | month = | year = | doi = | PMID = |URL = http://ispub.com/IJD/7/2/7627 }}</ref> | ||
*[http:// | *[http://ispub.com/IJD/6/2/3323 Acantholytic SK (ispub.com)].<ref>{{Cite journal | last1 = Wang | first1 = J | last2 = Wang | first2 = B | last3 = Shehan | first3 = J | last4 = Sarma | first4 = D | title = Acantholytic Seborrheic Keratosis | journal = The Internet Journal of Dermatology. | volume = 6 | issue = 2 | pages = | month = | year = 2007 | doi = | PMID = | PMC = | url = http://print.ispub.com/api/0/ispub-article/3323 }}</ref> | ||
===Histologic subtypes=== | ===Histologic subtypes=== | ||
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==Sign out== | ==Sign out== | ||
<pre> | |||
Skin Lesion, Left Lower Leg, Excision: | |||
- Seborrheic keratosis, completely excised. | |||
- Solar elastosis. | |||
</pre> | |||
<pre> | |||
Skin Lesion (Submitted "Seborrheic Keratosis"), Right Back, Excision: | |||
- Extensively fragmented bland superficial squamous epithelium with | |||
horn cysts and keratineous material, compatible with impression of | |||
seborrheic keratosis; deeper lesion cannot be excluded. | |||
</pre> | |||
===Block letters=== | |||
<pre> | <pre> | ||
SKIN LESION, MID BACK, BIOPSY: | SKIN LESION, MID BACK, BIOPSY: | ||
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SKIN LESION ("NEVUS"), RIGHT TRUNK AT BRA LINE, SHAVE BIOPSY: | SKIN LESION ("NEVUS"), RIGHT TRUNK AT BRA LINE, SHAVE BIOPSY: | ||
- IRRITATED SEBORRHEIC KERATOSIS (HYPERKERATOTIC TYPE). | - IRRITATED SEBORRHEIC KERATOSIS (HYPERKERATOTIC TYPE). | ||
</pre> | |||
<pre> | |||
SKIN LESION, LEFT POSTERIOR SHOULDER, EXCISION: | |||
- SEBORRHEIC KERATOSIS (ACANTHOTIC TYPE), COMPLETELY EXCISED. | |||
</pre> | |||
<pre> | |||
SKIN LESION, LEFT POSTERIOR SHOULDER, EXCISION: | |||
- SEBORRHEIC KERATOSIS WITH PIGMENTATION (ACANTHOTIC TYPE), COMPLETELY EXCISED | |||
IN THE PLANE OF SECTION. | |||
- NEGATIVE FOR MELANOCYTIC LESION. | |||
</pre> | </pre> | ||
===Micro=== | ===Micro=== | ||
The sections show skin with acanthosis, pseudohorn cysts | The sections show skin with acanthosis, pseudohorn cysts, hyperkeratosis and focal basal epidermal pigmentation. There is no basal nuclear atypia, and there are no | ||
melanocytic nests | melanocytic nests. Mitotic activity is not apparent. There is minimal dermal inflammation. There is no apparent solar elastosis. | ||
apparent solar elastosis. | |||
====Without horn pseudocysts==== | ====Without horn pseudocysts==== | ||
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There is no hyperkeratosis or acanthosis. No pigmentation is apparent. No large blood | There is no hyperkeratosis or acanthosis. No pigmentation is apparent. No large blood | ||
vessels are identified. No nuclear atypia is seen. | vessels are identified. No nuclear atypia is seen. | ||
====Irritated SK==== | |||
The sections show skin with acanthosis, pseudohorn cysts, hyperkeratosis and basal epidermal pigmentation. There are no melanocytic nests. Mitotic activity is not readily apparent. A dermal lymphohistiocytic infiltrate is present. Reactive basal cell changes are present. There is no apparent solar elastosis. The lesion is incompletely | |||
excised. | |||
====Wart-like SK==== | |||
The sections show skin with papillomatous acanthosis and, predominantly, basketweave hyperkeratosis. A lesser amount of compact hyperkeratosis and parakeratosis is present. | |||
Koilocytes are not identified. Blood vessels close to the dermal-epidermal junction are not prominent. Pseudohorn cysts are not apparent. | |||
There are no melanocytic nests. There is no apparent solar elastosis. There is a moderate lymphohistiocytic dermal infiltrate. There is minimal basal atypia. Mitotic activity is not readily apparent. | |||
====Stucco keratosis==== | |||
The sections show skin with pointed papillomatous projections and hyperkeratosis. | |||
There is no basal nuclear atypia, and there are no melanocytic nests. Mitotic activity is | |||
not apparent. There is minimal dermal inflammation. Solar elastosis is present. | |||
The lesion is excised in the plane of section. | |||
Note: | |||
*Signed out as ''seborrheic keratosis, early''. | |||
==See also== | ==See also== |
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