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 Table of Contents  
LETTER TO EDITOR
Year : 2020  |  Volume : 7  |  Issue : 1  |  Page : 48-49

Nodules in the nose: An unusual location of warty dyskeratoma


Department of Dermatology, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India

Date of Submission12-Feb-2020
Date of Decision05-Apr-2020
Date of Acceptance12-Apr-2020
Date of Web Publication02-Jun-2020

Correspondence Address:
Bhushan A Darkase
Department of Dermatology, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdpdd.ijdpdd_19_20

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How to cite this article:
Choudhary P, Darkase BA, Dongre A, Khopkar U. Nodules in the nose: An unusual location of warty dyskeratoma. Indian J Dermatopathol Diagn Dermatol 2020;7:48-9

How to cite this URL:
Choudhary P, Darkase BA, Dongre A, Khopkar U. Nodules in the nose: An unusual location of warty dyskeratoma. Indian J Dermatopathol Diagn Dermatol [serial online] 2020 [cited 2020 Nov 30];7:48-9. Available from: https://www.ijdpdd.com/text.asp?2020/7/1/48/285794



Sir,

Warty dyskeratoma (WD) is an uncommon benign entity, characterized by a solitary papule or nodule on the head or neck with comedo-like plug.[1] Multiple WD involving the nasal mucosa is an extremely rare condition and has been previously reported in just a single case report.[2]

A 78-year-old male presented to our dermatology department with a 1–2-year history of nodules in both the nostrils. There was no history of any oozing, discharge, or bleeding from the lesion. He denied any rapid or sudden increase in the size of the lesion. Cutaneous examination revealed multiple, firm, skin-colored verrucous papules and nodules with crusting, seated in both nostrils [Figure 1]. These multiple papules varied in size, ranging between 0.5 and 1.3 cm. The nodules were non-tender and did not bleed on touch. Clinical differential diagnoses of keratoacanthoma, verruca, and appendageal neoplasm were considered.
Figure 1: Multiple skin-colored verrucous nodules in both nostrils

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Histopathology of the nodule revealed two cup-shaped invaginations which were filled with keratinous material with hypergranulosis and infundibular hyperplasia in the epidermis [Figure 2]. Lower portion was occupied by numerous villae showing elongated dermal papillae lined by a single layer of basal cells. Grains with suprabasal acantholysis was also seen [Figure 3]. Underlying dermis showed sparse superficial perivascular lymphohistiocytic infiltrate. Thus, the case was diagnosed as WD.
Figure 2: Cup-shaped invagination with infundibular hyperplasia and in lower portion occupied by numerous villae (H and E, ×4)

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Figure 3: Suprabasal acantholysis with grains and villae (H and E, ×20)

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WD is a benign follicular adnexal neoplasm, characterized by a solitary papule or nodule with an umbilicated or pore-like center.[1] They have a predilection for the scalp, head, and neck in middle-aged persons or elderly.[2]

The etiology is unknown, but a few etiopathogenic factors were postulated including trauma, ultraviolet radiation, tobacco, and viral infections.[3],[4] The most important histopathologic differential diagnoses of multiple WD are Darier's disease, Grover's disease, hypertrophic actinic keratosis, and multiple squamous cell carcinomas. The diagnosis of multiple WD is established based on its characteristic clinical and histopathological features.[3],[4]

WD lesions show mainly three different architectural patterns, namely, cup-shaped, cystic, and nodular, the former being the most frequent. [3,4] The striking histological features of WD are a cup-shaped epidermal invagination filled with keratotic debris, grains, corps ronds, and villi formation with suprabasal acantholytic cells.[3]

Surgical excision is the most effective method for removing the WD lesion. Recurrence is rare. Malignant transformation has not been reported.[4]

WD occurring on the nasal mucosa is an extremely rare condition that, to the best of our knowledge, it is the first case in the Indian population. Histopathology proved to be valuable in confirming this diagnosis. This case is described for the rarity of multiple WD occurring on the nasal mucosa. We presented this exceptional entity to avoid misdiagnosis with other entities.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kaddu S, Dong H, Mayer G, Kerl H, Cerroni L. Warty dyskeratoma – Follicular dyskeratoma: Analysis of clinicopathologic features of a distinctive follicular adnexal neoplasm. J Am Acad Dermatol 2002;47:423-8.  Back to cited text no. 1
    
2.
Ugras N, Adim SB, Kilicoglu M, Baskan EB. Multiple warty dyskeratomas: Case report. Iran J Public Health 2014;43:1145-7.  Back to cited text no. 2
    
3.
Rambhia KD, Makhecha MB. A case of warty dyskeratoma on an unusual location. Indian Dermatol Online J 2019;10:343-5.  Back to cited text no. 3
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4.
Martorell-Calatayud A, Sanmartin-Jimenez O, Traves V, Guillen C. Numerous umbilicated papules on the trunk: Multiple warty dyskeratoma. Am J Dermatopathol 2012;34:674-5.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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