Pagetoid Dyskeratosis in Dermatopathology

Abstract

Pagetoid dyskeratosis (PD) is an incidental pathologic finding that appears in several skin conditions. In an attempt to better understand PD and its incidence in dermatopathology, the authors have analyzed all skin biopsies performed over the period of 1 year in our Department of Dermatology and examined their clinical and dermatopathological variables. The criteria used for a keratinocyte to be considered a PD cell were: (1) a size larger than normal, (2) the presence of pycnotic nucleus, (3) a clear halo surrounding the nucleus, and (4) a pale eosinophilic cytoplasm. A total of 3565 biopsies were analyzed, PD cells being found in 80 cases (2.24%). Melanocytic nevi were the commonest skin lesions in which PD was observed, followed by soft fibromas, angiofibromas, and acrochordons. Most lesions were located on the head, neck, and trunk. Most cases displayed fewer than 15 PD cells per field. PD cells were normally located in the mid epidermis (frequently in clusters). The biopsies usually revealed indirect signs of rubbing, although PD cells were also found in places where rubbing was unlikely. Here, the authors report the largest series of PD analyzed to date, expanding our understanding of this striking pathological observation.

Peculiar Histopathologic Feature of an Erythematous/Morbilliform Eruption in a COVID-19–Positive Patient

“…Microscopically, pagetoid dyskeratosis consists of large round epithelial keratinocytes with pyknotic nuclei and perinuclear halos of washed-out cytoplasm without atypia or mitoses. 14 However, these cells present individually or in small groups extending upward in the epidermis, whereas the vacuolated cells in our case extend regularly over the entire length of the lesion showing some areas of dysmaturation and mitoses with formation of "ghost cells." Finally, the vacuolar, clear changes of keratinocytes could be reminiscent of the ones seen in nutrient deficiency-related dermatoses such as pellagra or acquired zinc deficiency.…”

Pagetoid Dyskeratosis of the Hand With Parallel Ridge Pattern on Dermoscopy and Expression of Bcl-10 by Immunohistochemistry

“…8 The mechanism of discoloration is believed to be related to altered refraction of light through the cytoplasmic contacts of the PD cells. 1 Pagetoid dyskeratotic cells show features of an altered premature cornification. 9 These cells mature into orthohyperkeratotic squames in the stratum corneum.…”

Pagetoid Dyskeratosis of the Male Genitalia: Case Report and Review

“…The clinical presentation of pagetoid dyskeratosis is variable. It is typically an incidental finding in other primary skin lesions that have been biopsied (Table 1 ) [ 1 , 4 - 5 ]. Hence, the morphology of the lesion-containing pagetoid dyskeratosis corresponds to that lesion’s primary diagnosis.…”

“…They can present individually or in groups often extending upwards in the epidermis. Atypia and mitoses are usually absent [ 4 ].…”