Proliferative actinic keratosis

Abstract

Histological findings included elongation of rete ridges and variably dilated follicular structures containing many eosinophils, neutrophils, and their debris ( fig. 1c). These inflammatory cells occasionally disrupted the follicles and invaded into the adjacent acanthotic epidermis. A direct immunofluorescence study exhibited the intercellular deposition of IgG, C3c and C3d, but not IgA or IgM, in the epidermis. An indirect immunofluorescence study using the patient's serum demonstrated intercellular deposition of IgG at 1 : 160. He had circulating antibodies to desmoglein 3 (137 index; normal, < 10), but not desmoglein 1, as assessed by enzyme-linked immunosorbent assay. Thus, the skin eruption was diagnosed as pemphigus vegetans. The presence of scrotal tongue as well as bullous and heavily verrucous skin lesion favoured the Neumann type. 2 The patient was treated with prednisolone, 20 mg daily, which flattened the verrucous lesions with pigmented sequelae and was gradually tapered to 5 mg daily. Four months after starting of the therapy, he had an episode of acute abdominal pain and was admitted to a hospital. Endoscopic and roentgenological examinations revealed that he had gastric cancer, Borrmann type I ( fig. 1d), which was histologically diagnosed as poorly differentiated adenocarcinoma. He received partial gastrectomy, but the skin eruption and scrotal tongue continued at a low level with prednisolone, 7.5 mg daily. Two months later, metastatic lesions were found in the liver. The patient died of multiple organopathy 4 months after the operation. Autopsy was not performed.The coexistence of pemphigus vegetans and internal neoplasms has been rarely reported in the literature. [3][4][5] The simultaneous occurrence of pemphigus vegetans and gastric cancer suggests that they were closely associated with each other in our patient. Even after surgical removal of gastric cancer, the remaining metastatic lesions in the liver seems to render pemphigus lesions persistent. Our patient had scrotal tongue, which is seen in nearly a half of patients with the Neumann type. 3 Scrotal tongue coexists with internal malignancies in not only pemphigus vegetans but also other disorders such as acquired hypertrichosis lanuginosa. 6 Therefore, it is considered that pemphigus vegetans, gastric cancer/liver metastasis, and scrotal tongue were causally related. It should be noted that pemphigus vegetans may be a dermadrome for internal malignancies. References1 Lever WF. Pemphigus and Pemphigoid. Charles C Thomas, Springfield, IL, 1965: 41-45. 2 Premalatha S, Jakakumar S, Yesdian P, Thambiah AS. Cerebriform tongue-A clinical sign in pemphigus vegetans. Br J Dermatol 1981; 104: 587-591. 3 Bastiaens MT, Zwan NV, Verschueren GL, Stoof TJ, Niepoer C. Three cases of pemphigus vegetans: induction by enalapril association with internal malignancy. Int J Dermatol 1994; 33: 168-171. 4 Serwin AB, Bokiniec E, Chodynicka B. Pemphigus vegetans in a patient with lung cancer. Dermatol Online J 2005; 11: 13. 5 Ogawa H, Sakuma M, Morioka S et ...

Histopathological subtyping of actinic keratosis and it's coexistence with nonmelanotic skin cancers in Gaziantep and Malatya regions

“…AK'lar ilk defa 1996 yılında DSÖ'nün deri tümörleri sınıflamasında prekanseröz nitelikte iyi huylu epidermal tümörler içerisine sokulmuştur ve bazı alt gruplara ayrılmaktadır 2,11 . Bu alt grupların biyolojik davranışlarında farklılık olup olmadığının araştırılması, karsinoma ilerlemelerinin tespiti ve tedavilerinin planlanmasında önemli rol oynamaktadır 3,7,[12][13][14] . Literatürde alt grupların sayısında bir konsensus olmadığı gibi tiplerinin isimlendirmelerinde ve morfolojik özelliklerinin tanımlanmasında da bir konsensus bulunmamaktadır.…”

“…'nın 15 çalışmasında PAK ve HAK'ların SHK ile birlikteliği sık olarak bildirilmişken 13 çalışmamızda PAK olgularının %17,6'sının BHK ile birliktelik gösterdiği %76'sının ise herhangi bir tümörle birlikteliğinin bulunmadığını ve sadece % 2,94'ünün SHK ile birliktelik gösterdiğini tespit ettik. AK'ların maligniteye dönüşüm oranları farklı serilerde %0,25-20 arasında bildirilmiştir 13,15 . Birden fazla lezyonu olan olgularda maligniteye dönüşüm oranı; %0,1-10 arasındadır 2 .…”

“…Çalışmamızda lezyonların %63'ünde (n=73) non-melanotik deri kanseri ile birliktelik görüldü. Bu tümörler tiplendirildiğinde ise; literatürün aksine 13,15 en sık (%19) BHK ile birliktelik ikinci sıklıkta (%13) ise SHK ile birliktelik görüldü. Ülkemizde AK'lar ile ilgili yayınlanmış kısıtlı çalışmalar var ve çoğunluğu AK lezyonlarının yaş, cins ve yerleşim yerleri ile klinik özellikleri ve tedavilerine yönelik çalışmalar şeklindedir 16,17 .…”

Actinic keratosis: an occupational and environmental disorder

“…An AK is often better appreciated by palpation than by visualization. Most commonly, it has a rough, scaly texture that resembles fine sandpaper 14,15,35,36 . Size usually ranges from 1 to 3 mm in diameter but can reach several centimetres.…”

“…Size usually ranges from 1 to 3 mm in diameter but can reach several centimetres. In some cases, an AK can be proliferative, enlarging up to 4 cm in diameter and persists despite standard therapy presumably due to the difficulty in defining its margins 36 . AKs are solitary or multiple and usually seen on sun‐exposed skin of persons with accumulated years of prior solar exposure.…”