Cases for Diagnosis
Long-Standing Solitary Nasal Papule
Pápula solitaria nasal de larga evolución
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"apellidos" => "Delgado Portela" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario de Móstoles, Móstoles, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Anatomía Patológica, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pápula solitaria nasal de larga evolución" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 608 "Ancho" => 751 "Tamanyo" => 46114 ] ] ] ] "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 47-year-old woman with no past history of interest visited our department with a paranasal papule on the left side of the nose, which had appeared more than 15 years earlier. The lesion had grown in recent months and was itchy.</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 papule measuring 4<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleHsp" style=""></span>mm, with a whitish central region and slightly erythematous edges (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Nonpolarized light contact dermatoscopy revealed a lesion with telangiectasis, linear vessels (upper region) and peripheral polymorphic vessels on a yellowish-pink background, with a central milky-white spherical area, with no ulceration (<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">The excisional biopsy showed epidermal invagination with proliferation of papillary elements, which presented a double layer of epithelial cells. The stroma of these papillae revealed an inflammatory infiltrate with abundant plasma cells (<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">Syringocystadenoma papilliferum (SCAP).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Comment</span><p id="par0030" class="elsevierStylePara elsevierViewall">SCAP is a rare benign adnexal tumor derived from the sweat glands. It is present from birth in half of cases and appears during puberty in between 15% and 30% of cases. It may occur de novo in cases of sebaceous nevus, although it may also be associated with many benign and malignant lesions, such as basal cell carcinoma, common warts, and different adnexal tumors. Clinical presentation is variable and nonspecific, and 3 forms are known: nodular, plaque and linear. It generally presents as a solitary papillomatous or verrucous, and sometimes erosive, nodule or plaque of variable size, on the head or neck, but may appear in other locations. It sometimes presents a small fistula with a clear, bloody, foul-smelling exudate. Diagnosis is histologic and characteristic, with numerous cystic invaginations connected to the epidermis and extending into the dermis. They are formed by papillary branches of different sizes, covered by a double-layer epithelium, with cuboidal basal cells and columnar apical cells that may show secretion due to decapitation. A dense inflammatory infiltrate with plasma cells in the stroma is characteristic. The treatment of choice is complete surgical excision, as, although SCAP is benign, cases with metastasis and association with other malignant tumors have been described.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Few dermatoscopic descriptions of this disease exist. Most correspond to SCAP associated with sebaceous nevus, with 14 cases, and only 2 correspond to solitary SCAP. Bruno et al. first published the dermatoscopic findings of SCAP associated with sebaceous nevus, describing a varied vascular pattern (linear, horseshoe-shaped, and glomerular) on a pink-white background.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In another review of tumors over sebaceous nevus,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> the authors describe 9 SCAP, most of which show a symmetric lesion with exophytic papillary structures, erosions, scabs, ulceration, and different vessels (hairpin, polymorphous and comma-shaped); in another SCAP, also over sebaceous nevus,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> the authors described a yellowish-white lesion with polymorphous vessels and a peripheral ring with hairpin vessels. Those authors speculate that the vascular structures may be related to manipulation or trauma. Recently, in 3 other lesions, the main findings were pinkish-white exophytic papillary structures and polymorphous vessels.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In the cases of SCAP without sebaceous nevus, one lesion showed milky-white amorphous spherical structures (corresponding histologically to tumor luminal cells) and peripheral telangiectasia,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and another showed milky-red papillomatous projections with central ulceration and yellowish areas within the ulcerated areas (secretion sites) and polymorphous vessels.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> It thus appears that the pinkish-white exophytic papillary structures and polymorphous and linear vessels are key to diagnosing SCAP, but is appears that milky-white spherical structures, as in our case, may also be key. The role of dermatoscopy in diagnosing adnexal tumors is not currently well known and histopathology provides the 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 "fechaRecibido" => "2018-06-13" "fechaAceptado" => "2018-07-02" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García-Arpa M, Lozano-Masdemont B, Flores-Terry MÁ, Delgado Portela M. Pápula solitaria nasal de larga evolución. Actas Dermosifiliogr. 2019;110:857–858.</p>" ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 569 "Ancho" => 751 "Tamanyo" => 60567 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 608 "Ancho" => 751 "Tamanyo" => 46114 ] ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 365 "Ancho" => 951 "Tamanyo" => 129365 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0100" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin–eosin: A), ×20. B), ×400.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermoscopic aspects of syringocystadenoma papilliferum associated with nevus sebaceus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.B. Bruno" 1 => "F.N. Cordeiro" 2 => "E. Soares Fdo" 3 => "G.H. Takano" 4 => "L.S. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 14 | 12 | 26 |
| 2024 Octubre | 72 | 48 | 120 |
| 2024 Septiembre | 80 | 22 | 102 |
| 2024 Agosto | 98 | 53 | 151 |
| 2024 Julio | 80 | 26 | 106 |
| 2024 Junio | 88 | 45 | 133 |
| 2024 Mayo | 78 | 33 | 111 |
| 2024 Abril | 82 | 23 | 105 |
| 2024 Marzo | 68 | 22 | 90 |
| 2024 Febrero | 64 | 33 | 97 |
| 2024 Enero | 59 | 30 | 89 |
| 2023 Diciembre | 46 | 19 | 65 |
| 2023 Noviembre | 73 | 37 | 110 |
| 2023 Octubre | 62 | 20 | 82 |
| 2023 Septiembre | 53 | 28 | 81 |
| 2023 Agosto | 51 | 19 | 70 |
| 2023 Julio | 57 | 34 | 91 |
| 2023 Junio | 65 | 19 | 84 |
| 2023 Mayo | 75 | 20 | 95 |
| 2023 Abril | 73 | 24 | 97 |
| 2023 Marzo | 77 | 24 | 101 |
| 2023 Febrero | 68 | 24 | 92 |
| 2023 Enero | 55 | 35 | 90 |
| 2022 Diciembre | 100 | 43 | 143 |
| 2022 Noviembre | 75 | 44 | 119 |
| 2022 Octubre | 69 | 22 | 91 |
| 2022 Septiembre | 60 | 36 | 96 |
| 2022 Agosto | 50 | 36 | 86 |
| 2022 Julio | 42 | 38 | 80 |
| 2022 Junio | 32 | 24 | 56 |
| 2022 Mayo | 61 | 37 | 98 |
| 2022 Abril | 62 | 38 | 100 |
| 2022 Marzo | 80 | 45 | 125 |
| 2022 Febrero | 97 | 30 | 127 |
| 2022 Enero | 110 | 50 | 160 |
| 2021 Diciembre | 69 | 47 | 116 |
| 2021 Noviembre | 60 | 40 | 100 |
| 2021 Octubre | 89 | 52 | 141 |
| 2021 Septiembre | 46 | 42 | 88 |
| 2021 Agosto | 50 | 31 | 81 |
| 2021 Julio | 28 | 23 | 51 |
| 2021 Junio | 30 | 22 | 52 |
| 2021 Mayo | 38 | 38 | 76 |
| 2021 Abril | 89 | 82 | 171 |
| 2021 Marzo | 74 | 28 | 102 |
| 2021 Febrero | 49 | 23 | 72 |
| 2021 Enero | 42 | 15 | 57 |
| 2020 Diciembre | 25 | 24 | 49 |
| 2020 Noviembre | 31 | 18 | 49 |
| 2020 Octubre | 33 | 11 | 44 |
| 2020 Septiembre | 31 | 14 | 45 |
| 2020 Agosto | 47 | 18 | 65 |
| 2020 Julio | 60 | 13 | 73 |
| 2020 Junio | 24 | 15 | 39 |
| 2020 Mayo | 34 | 20 | 54 |
| 2020 Abril | 21 | 13 | 34 |
| 2020 Marzo | 36 | 10 | 46 |
| 2020 Febrero | 8 | 5 | 13 |
| 2020 Enero | 1 | 2 | 3 |
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