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    "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&#44; with no relevant medical or surgical history&#44; consulted for an intensely pigmented papule that was located on the right leg&#44; had appeared several years earlier&#44; and had recently grown larger&#46;</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 &#40;8<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>9<span class="elsevierStyleHsp" style=""></span>mm&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; on the lateral aspect of the right leg&#44; lying on the border between a hypopigmented macule and normal skin&#46; Dermoscopy revealed a central component with intense whitish blue&#8211;gray pigmentation&#44; and the presence of evenly distributed dark-brown-to-black dots and globules in the periphery &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</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&#44; the entire thickness of which contained markedly pigmented eosinophilic keratinocytes without atypia&#44; no corneal plugs&#44; mass necrosis and foci of differentiating cuticular cells&#44; without involvement of or extension to the underlying dermis or signs of dysplasia or malignancy&#46; Immunohistochemistry showed isolated cells positive for MelanA and HMB45 &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis&#63;</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&#46;</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&#46; Although historically this type of tumor has been considered to be of eccrine origin&#44; there are probably similar numbers of eccrine and apocrine poromas&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> These usually manifest as solitary papules&#44; plaques&#44; or nodules that can appear in any location&#44; although they show a preference for acral areas &#40;palms and soles&#41; and the scalp and&#44; in the case of hidroacanthoma simplex&#44; the extremities and trunk&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> They usually have a highly vascularized stroma&#44; which lends a characteristic reddish pink color&#44; although they can also be pigmented&#44; as in the present case&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Definitive diagnosis is histological&#46; Poromas are made up of 2 cell types&#58; poroid cells&#44; with a rounded basophilic nucleus and scarce cytoplasm&#44; similar to the cells of the peripheral row of the distal portion of the duct&#59; and larger&#44; cuticular cells with scarce eosinophilic cytoplasm that resemble the luminal cells of the eccrine ducts&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> Depending on the architectural pattern&#44; communication with the epidermis&#44; and the presence or absence of solid and&#47;or cystic components&#44; 4 types of poromas can be distinguished&#58; hidroacanthoma simplex&#44; classic poroma&#44; dermal duct tumor&#44; and poroid hidradenoma&#46; The degree of ductal differentiation varies&#44; and therefore higher magnification can reveal the presence of sweat ducts inside the poroma&#44; or dilation of the sweat ducts to form cystic spaces&#46; Hidroacanthoma is limited to the epidermis&#44; lacks communication with the dermis and tumor projections that exert pressure on the dermis &#40;as occurs in the case of poroma&#41;&#44; and has scant accompanying stroma&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">It is characterized by abrupt demarcation between the lesion and the normal keratinocytes of the epidermis&#44; which are more basophilic&#46; This feature&#44; and the absence of horny plugs&#44; allows differentiation of hidroacanthoma from clonal seborrheic keratosis&#44; which is the main differential diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2&#8211;4</span></a> Because this is a benign adnexal tumor&#44; treatment is optional&#44; and surgical removal is the treatment of choice&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Shiiya et al&#46;<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&#44; fine annular scales&#44; and the absence of glomerular vessels as characteristic findings of nonpigmented hidroacanthoma that are useful for differentiation from Bowen disease and seborrheic keratosis&#46; In their study&#44; Chessa et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> examined 26 histologically confirmed poromas&#44; including 9 cases of hidroacanthoma simplex &#40;4 nonpigmented and 5 pigmented&#41;&#46; The pigmented lesions consisted of macules or slightly raised plaques&#44; dermoscopic analysis of which revealed the presence of pseudo-reticulum&#44; milium cysts&#44; and comedone-like structures&#46; None of the previously published dermoscopic descriptions of hidroacanthoma simplex reflect the features described in the present case&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In adnexal tumors&#44; although dermoscopy can help orient the diagnosis&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> histopathology is essential for definitive diagnosis&#46;</p></span></span>"
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Cases for Diagnosis
Pigmented Papule With a Starburst Pattern on Dermoscopy
Pápula pigmentada con patrón dermatoscópico en estallido de estrellas
L.M. Nieto-Benito
Autor para correspondencia
lula.m.nieto@gmail.com

Corresponding author.
, A.M. Rosell-Díaz, J.A. Avilés-Izquierdo
Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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      "es" => array:1 [
        "titulo" => "P&#225;pula pigmentada con patr&#243;n dermatosc&#243;pico en estallido de estrellas"
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    "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&#44; with no relevant medical or surgical history&#44; consulted for an intensely pigmented papule that was located on the right leg&#44; had appeared several years earlier&#44; and had recently grown larger&#46;</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 &#40;8<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>9<span class="elsevierStyleHsp" style=""></span>mm&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; on the lateral aspect of the right leg&#44; lying on the border between a hypopigmented macule and normal skin&#46; Dermoscopy revealed a central component with intense whitish blue&#8211;gray pigmentation&#44; and the presence of evenly distributed dark-brown-to-black dots and globules in the periphery &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</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&#44; the entire thickness of which contained markedly pigmented eosinophilic keratinocytes without atypia&#44; no corneal plugs&#44; mass necrosis and foci of differentiating cuticular cells&#44; without involvement of or extension to the underlying dermis or signs of dysplasia or malignancy&#46; Immunohistochemistry showed isolated cells positive for MelanA and HMB45 &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis&#63;</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&#46;</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&#46; Although historically this type of tumor has been considered to be of eccrine origin&#44; there are probably similar numbers of eccrine and apocrine poromas&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> These usually manifest as solitary papules&#44; plaques&#44; or nodules that can appear in any location&#44; although they show a preference for acral areas &#40;palms and soles&#41; and the scalp and&#44; in the case of hidroacanthoma simplex&#44; the extremities and trunk&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> They usually have a highly vascularized stroma&#44; which lends a characteristic reddish pink color&#44; although they can also be pigmented&#44; as in the present case&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Definitive diagnosis is histological&#46; Poromas are made up of 2 cell types&#58; poroid cells&#44; with a rounded basophilic nucleus and scarce cytoplasm&#44; similar to the cells of the peripheral row of the distal portion of the duct&#59; and larger&#44; cuticular cells with scarce eosinophilic cytoplasm that resemble the luminal cells of the eccrine ducts&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> Depending on the architectural pattern&#44; communication with the epidermis&#44; and the presence or absence of solid and&#47;or cystic components&#44; 4 types of poromas can be distinguished&#58; hidroacanthoma simplex&#44; classic poroma&#44; dermal duct tumor&#44; and poroid hidradenoma&#46; The degree of ductal differentiation varies&#44; and therefore higher magnification can reveal the presence of sweat ducts inside the poroma&#44; or dilation of the sweat ducts to form cystic spaces&#46; Hidroacanthoma is limited to the epidermis&#44; lacks communication with the dermis and tumor projections that exert pressure on the dermis &#40;as occurs in the case of poroma&#41;&#44; and has scant accompanying stroma&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">It is characterized by abrupt demarcation between the lesion and the normal keratinocytes of the epidermis&#44; which are more basophilic&#46; This feature&#44; and the absence of horny plugs&#44; allows differentiation of hidroacanthoma from clonal seborrheic keratosis&#44; which is the main differential diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2&#8211;4</span></a> Because this is a benign adnexal tumor&#44; treatment is optional&#44; and surgical removal is the treatment of choice&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Shiiya et al&#46;<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&#44; fine annular scales&#44; and the absence of glomerular vessels as characteristic findings of nonpigmented hidroacanthoma that are useful for differentiation from Bowen disease and seborrheic keratosis&#46; In their study&#44; Chessa et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> examined 26 histologically confirmed poromas&#44; including 9 cases of hidroacanthoma simplex &#40;4 nonpigmented and 5 pigmented&#41;&#46; The pigmented lesions consisted of macules or slightly raised plaques&#44; dermoscopic analysis of which revealed the presence of pseudo-reticulum&#44; milium cysts&#44; and comedone-like structures&#46; None of the previously published dermoscopic descriptions of hidroacanthoma simplex reflect the features described in the present case&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In adnexal tumors&#44; although dermoscopy can help orient the diagnosis&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> histopathology is essential for definitive diagnosis&#46;</p></span></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#44; Acanthotic epidermis&#44; the entire thickness of which contains nests of eosinophilic keratinocytes&#44; without involvement of or extension to the dermis or underlying subcutaneous cellular tissue&#46; Hematoxylin-eosin &#40;H&#8211;E&#41;&#44; original magnification &#215;10&#46; B and C&#44; Higher magnification images showing nests of markedly pigmented eosinophilic keratinocytes&#44; without signs of atypia&#44; absence of horny plugs&#44; and mass necrosis and foci of differentiating cuticle cells &#40;H&#8211;E&#44; original magnification &#215;20 &#91;B&#93; and &#215;40 &#91;C&#93;&#41;&#46; D&#44; Image showing negative staining for HMB45 &#40;original magnification &#215;20&#41;&#44; despite the presence of intense pigmentation&#46;</p>"
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