Cases for Diagnosis
Pigmented Papule With a Starburst Pattern on Dermoscopy
Pápula pigmentada con patrón dermatoscópico en estallido de estrellas
L.M. Nieto-Benito
, A.M. Rosell-Díaz, J.A. Avilés-Izquierdo
Corresponding author
Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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B (H&E, x20) - C (H&E, x40): a mayor detalle, nidos constituidos por queratinocitos eosinófilos, sin datos de atipia y marcadamente pigmentados, en ausencia de tapones córneos, con necrosis en masa y focos de diferenciación de células cuticulares. D: tinción inmunohistoquímica con HMB45 (x20): negatividad para dicho marcador, a pesar de la presencia intensa de pigmento.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L.M. Nieto-Benito, A.M. Rosell-Díaz, J.A. Avilés-Izquierdo" "autores" => array:3 [ 0 => array:2 [ "nombre" => "L.M." "apellidos" => "Nieto-Benito" ] 1 => array:2 [ "nombre" => "A.M." "apellidos" => "Rosell-Díaz" ] 2 => array:2 [ "nombre" => "J.A." "apellidos" => "Avilés-Izquierdo" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731021003082?idApp=UINPBA000044" "url" => "/00017310/0000011300000003/v2_202212210529/S0001731021003082/v2_202212210529/es/main.assets" ] "asociados" => array:1 [ 0 => array:19 [ "pii" => "S0001731021003082" "issn" => "00017310" "doi" => "10.1016/j.ad.2020.03.020" "estado" => "S300" "fechaPublicacion" => "2022-03-01" "aid" => "2741" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2022;113:301-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Casos para el diagnóstico</span>" "titulo" => "Pápula pigmentada con patrón dermatoscópico en estallido de estrellas" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "301" "paginaFinal" => "302" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Pigmented Papule With a Starburst Pattern on Dermoscopy" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 639 "Ancho" => 850 "Tamanyo" => 202290 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A (H&E, x10): acantosis epidérmica, con presencia de nidos de queratinocitos eosinófilos en su espesor, sin afectación ni extensión a dermis ni tejido celular subcutáneo subyacente. B (H&E, x20) - C (H&E, x40): a mayor detalle, nidos constituidos por queratinocitos eosinófilos, sin datos de atipia y marcadamente pigmentados, en ausencia de tapones córneos, con necrosis en masa y focos de diferenciación de células cuticulares. D: tinción inmunohistoquímica con HMB45 (x20): negatividad para dicho marcador, a pesar de la presencia intensa de pigmento.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L.M. Nieto-Benito, A.M. Rosell-Díaz, J.A. Avilés-Izquierdo" "autores" => array:3 [ 0 => array:2 [ "nombre" => "L.M." "apellidos" => "Nieto-Benito" ] 1 => array:2 [ "nombre" => "A.M." "apellidos" => "Rosell-Díaz" ] 2 => array:2 [ "nombre" => "J.A." "apellidos" => "Avilés-Izquierdo" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731021003082?idApp=UINPBA000044" "url" => "/00017310/0000011300000003/v2_202212210529/S0001731021003082/v2_202212210529/es/main.assets" ] ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Cases for Diagnosis</span>" "titulo" => " Pigmented Papule With a Starburst Pattern on Dermoscopy" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "T301" "paginaFinal" => "T302" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L.M. Nieto-Benito, A.M. Rosell-Díaz, J.A. Avilés-Izquierdo" "autores" => array:3 [ 0 => array:4 [ "nombre" => "L.M." "apellidos" => "Nieto-Benito" "email" => array:1 [ 0 => "lula.m.nieto@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A.M." "apellidos" => "Rosell-Díaz" ] 2 => array:2 [ "nombre" => "J.A." "apellidos" => "Avilés-Izquierdo" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pápula pigmentada con patrón dermatoscópico en estallido de estrellas" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 750 "Ancho" => 502 "Tamanyo" => 47171 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 27-year-old woman, with no relevant medical or surgical history, consulted for an intensely pigmented papule that was located on the right leg, had appeared several years earlier, and had recently grown larger.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed a high phototype and a dark brownish black papule (8<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>9<span class="elsevierStyleHsp" style=""></span>mm) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) on the lateral aspect of the right leg, lying on the border between a hypopigmented macule and normal skin. Dermoscopy revealed a central component with intense whitish blue–gray pigmentation, and the presence of evenly distributed dark-brown-to-black dots and globules in the periphery (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Biopsy of the excised lesion showed an acanthotic epidermis, the entire thickness of which contained markedly pigmented eosinophilic keratinocytes without atypia, no corneal plugs, mass necrosis and foci of differentiating cuticular cells, without involvement of or extension to the underlying dermis or signs of dysplasia or malignancy. Immunohistochemistry showed isolated cells positive for MelanA and HMB45 (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis?</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Pigmented hidroacanthoma simplex poroma.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Comment</span><p id="par0030" class="elsevierStylePara elsevierViewall">Poromas are a group of benign adnexal tumors that show terminal ductal differentiation of the sweat glands. Although historically this type of tumor has been considered to be of eccrine origin, there are probably similar numbers of eccrine and apocrine poromas.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> These usually manifest as solitary papules, plaques, or nodules that can appear in any location, although they show a preference for acral areas (palms and soles) and the scalp and, in the case of hidroacanthoma simplex, the extremities and trunk.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> They usually have a highly vascularized stroma, which lends a characteristic reddish pink color, although they can also be pigmented, as in the present case.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Definitive diagnosis is histological. Poromas are made up of 2 cell types: poroid cells, with a rounded basophilic nucleus and scarce cytoplasm, similar to the cells of the peripheral row of the distal portion of the duct; and larger, cuticular cells with scarce eosinophilic cytoplasm that resemble the luminal cells of the eccrine ducts.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> Depending on the architectural pattern, communication with the epidermis, and the presence or absence of solid and/or cystic components, 4 types of poromas can be distinguished: hidroacanthoma simplex, classic poroma, dermal duct tumor, and poroid hidradenoma. The degree of ductal differentiation varies, and therefore higher magnification can reveal the presence of sweat ducts inside the poroma, or dilation of the sweat ducts to form cystic spaces. Hidroacanthoma is limited to the epidermis, lacks communication with the dermis and tumor projections that exert pressure on the dermis (as occurs in the case of poroma), and has scant accompanying stroma.</p><p id="par0040" class="elsevierStylePara elsevierViewall">It is characterized by abrupt demarcation between the lesion and the normal keratinocytes of the epidermis, which are more basophilic. This feature, and the absence of horny plugs, allows differentiation of hidroacanthoma from clonal seborrheic keratosis, which is the main differential diagnosis.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2–4</span></a> Because this is a benign adnexal tumor, treatment is optional, and surgical removal is the treatment of choice.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Shiiya et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> analyzed 4 cases of hidroacanthoma simplex and identified the presence of blood cells and fine black dots, fine annular scales, and the absence of glomerular vessels as characteristic findings of nonpigmented hidroacanthoma that are useful for differentiation from Bowen disease and seborrheic keratosis. In their study, Chessa et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> examined 26 histologically confirmed poromas, including 9 cases of hidroacanthoma simplex (4 nonpigmented and 5 pigmented). The pigmented lesions consisted of macules or slightly raised plaques, dermoscopic analysis of which revealed the presence of pseudo-reticulum, milium cysts, and comedone-like structures. None of the previously published dermoscopic descriptions of hidroacanthoma simplex reflect the features described in the present case.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In adnexal tumors, although dermoscopy can help orient the diagnosis,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> histopathology is essential for definitive diagnosis.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Comment" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 750 "Ancho" => 502 "Tamanyo" => 47171 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 502 "Ancho" => 750 "Tamanyo" => 61955 ] ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 639 "Ancho" => 850 "Tamanyo" => 202290 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Acanthotic epidermis, the entire thickness of which contains nests of eosinophilic keratinocytes, without involvement of or extension to the dermis or underlying subcutaneous cellular tissue. Hematoxylin-eosin (H–E), original magnification ×10. B and C, Higher magnification images showing nests of markedly pigmented eosinophilic keratinocytes, without signs of atypia, absence of horny plugs, and mass necrosis and foci of differentiating cuticle cells (H–E, original magnification ×20 [B] and ×40 [C]). D, Image showing negative staining for HMB45 (original magnification ×20), despite the presence of intense pigmentation.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eccrine or apocrine poroma? Six poromas with divergent adnexal differentiation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.D. Harvell" 1 => "R.L. Kerschmann" 2 => "P.E. LeBoit" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00000372-199602000-00001" "Revista" => array:6 [ "tituloSerie" => "Am J Dermatopathol" "fecha" => "1996" "volumen" => "18" "paginaInicial" => "1" "paginaFinal" => "9" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8721584" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of hidroacanthoma simplex" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "X. Lu" 1 => "M. Wu" 2 => "J. Chen" 3 => "J. Wu" 4 => "Y. Gu" 5 => "L. 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Kimura" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/1346-8138.13421" "Revista" => array:6 [ "tituloSerie" => "J Dermatol" "fecha" => "2017" "volumen" => "44" "paginaInicial" => "327" "paginaFinal" => "334" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27177596" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermoscopic features of hidroacanthoma simplex: usefulness in distinguishing it from Bowen's disease and seborrheic keratosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Shiiya" 1 => "H. Hata" 2 => "Y. Inamura" 3 => "K. Imafuku" 4 => "S. Kitamura" 5 => "H. Fujita" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/1346-8138.12945" "Revista" => array:6 [ "tituloSerie" => "J Dermatol" "fecha" => "2015" "volumen" => "42" "paginaInicial" => "1002" "paginaFinal" => "1005" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25989988" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermoscopic-histopathological correlation of eccrine poroma: an observational study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.A. Chessa" 1 => "A. Patrizi" 2 => "C. Baraldi" 3 => "P.A. Fanti" 4 => "A. Barinasi" 5 => "S. Vaccari" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5826/dpc.0904a07" "Revista" => array:6 [ "tituloSerie" => "Dermatol Pract Concept" "fecha" => "2019" "volumen" => "9" "paginaInicial" => "283" "paginaFinal" => "291" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31723462" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermoscopic features and patterns of poromas: a multicenter observational case-control study conducted by the International Dermoscopy Society" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. Marchetti" 1 => "M.L. Marino" 2 => "P. Virmani" 3 => "S.W. Dusza" 4 => "A.A. Marghoob" 5 => "G. Nazzaro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jvd.14729" "Revista" => array:5 [ "tituloSerie" => "J Eur Acad Dermtol Venereol" "fecha" => "2018" "volumen" => "32" "paginaInicial" => "1263" "paginaFinal" => "1271" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00017310/0000011300000003/v2_202212210529/S0001731022001314/v2_202212210529/en/main.assets" "Apartado" => array:4 [ "identificador" => "93538" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Casos para el diagnóstico / Cases for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/00017310/0000011300000003/v2_202212210529/S0001731022001314/v2_202212210529/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731022001314?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 18 | 13 | 31 |
| 2024 October | 123 | 64 | 187 |
| 2024 September | 160 | 46 | 206 |
| 2024 August | 129 | 64 | 193 |
| 2024 July | 97 | 60 | 157 |
| 2024 June | 104 | 57 | 161 |
| 2024 May | 80 | 47 | 127 |
| 2024 April | 80 | 32 | 112 |
| 2024 March | 81 | 40 | 121 |
| 2024 February | 64 | 33 | 97 |
| 2024 January | 61 | 35 | 96 |
| 2023 December | 59 | 18 | 77 |
| 2023 November | 89 | 38 | 127 |
| 2023 October | 78 | 33 | 111 |
| 2023 September | 73 | 30 | 103 |
| 2023 August | 55 | 22 | 77 |
| 2023 July | 58 | 31 | 89 |
| 2023 June | 65 | 23 | 88 |
| 2023 May | 53 | 31 | 84 |
| 2023 April | 45 | 24 | 69 |
| 2023 March | 54 | 34 | 88 |
| 2023 February | 39 | 26 | 65 |
| 2023 January | 58 | 46 | 104 |
| 2022 December | 59 | 49 | 108 |
| 2022 November | 65 | 42 | 107 |
| 2022 October | 64 | 42 | 106 |
| 2022 September | 93 | 55 | 148 |
| 2022 August | 71 | 60 | 131 |
| 2022 July | 66 | 48 | 114 |
| 2022 June | 48 | 39 | 87 |
| 2022 May | 128 | 52 | 180 |
| 2022 April | 56 | 32 | 88 |
| 2022 March | 64 | 49 | 113 |
| 2022 February | 24 | 37 | 61 |
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