Case for Diagnosis
Congenital Scalp Lesion
Una lesión congénita en el cuero cabelludo
J. Torre Castro
, M.D. Mendoza Cembranos, L. Requena Caballero
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Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, Spain
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(b) Dermoscopy revealing central pigmented dark brown-black atypical and irregular lesion with a blue-white veil in the center surrounded by erythema and scarce dotted vessels within the halo. (c) Histopathologic appearance of Meyerson phenomenon within a melanoma. Intraepidermal atypical, confluent melanocytic proliferation. Mild spongiosis, epidermal acantosis and chronic inflammatory cell infiltrate. (Hematoxylin-eosin stain; original magnification: ×20).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "X. Calderón-Castrat, A. Conde-Ferreirós, M. Yuste-Chaves, A. Santos-Briz" "autores" => array:4 [ 0 => array:2 [ "nombre" => "X." "apellidos" => "Calderón-Castrat" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Conde-Ferreirós" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Yuste-Chaves" ] 3 => array:2 [ "nombre" => "A." 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Torre Castro, M.D. Mendoza Cembranos, L. Requena Caballero" "autores" => array:3 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Torre Castro" "email" => array:1 [ 0 => "Juantorrecastro@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M.D." "apellidos" => "Mendoza Cembranos" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Requena Caballero" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Una lesión congénita en el cuero cabelludo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 672 "Ancho" => 1000 "Tamanyo" => 284792 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Histopathological features of the lesion. Hematoxylin-eosin, original magnification ×40 (A and C), ×100 (C), and ×200 (D).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case presentation</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 3-day-old newborn who was born at full term and had no past history of interest was evaluated for the presence of a congenital lesion on the vertex. Examination revealed a 9-mm, skin-colored pedunculated papule located on the midline (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Skin ultrasound was performed with an Esaote Gamma MyLab system with a variable frequency (10–22 MHz) probe. B-mode ultrasound revealed a well-defined hyperechoic dermoepidermal lesion that had a lobulated lower contour and did not affect the calvaria (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). Abundant vascularization was observed in color Doppler mode (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). In the absence of calvarial involvement and intracranial invasion, tangential excision of the lesion and electrocoagulation of the bed was performed to rule out malignancy and the presence of a vascular lesion.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Histology showed multiple sebaceous glands in the papillary dermis beneath a preserved epidermis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A). Examination of successive sections revealed a lesion composed of papillary structures connected to the follicular infundibulum (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B). These papillary structures were lined with a row of columnar epithelial cells that showed evidence of decapitation secretion at the luminal border, and the stroma of the papillae contained numerous plasma cells (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>C and D).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis?</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Syringocystadenoma papilliferum.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Comments</span><p id="par0030" class="elsevierStylePara elsevierViewall">A diagnosis of syringocystadenoma papilliferum was established. This is a benign adnexal hamartoma with follicular and apocrine differentiation.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Up to 50% of these lesions are congenital and can go unnoticed until adolescence, at which point hormonal stimulation promotes their growth and they tend to become more evident. During this growth phase they can ulcerate and bleed in response to trauma. The differential diagnosis of the congenital ulcerated form should include traumatic birth injury.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Between 70% and 90% of cases occur in the cervicocephalic region, although involvement of other areas has been described in pediatric patients.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Three clinical forms can be distinguished: papular (single papule or plaque on the scalp, most frequently associated with sebaceous nevus); linear (multiple umbilicated papules of similar size, most often in the cervical region); and nodular (the most common extracephalic subtype).</p><p id="par0035" class="elsevierStylePara elsevierViewall">Syringocystadenoma papilliferum is one of the lesions that most frequently develops from Jadassohn nevus; 75% of syringocystadenoma papilliferum cases arise from this nevus type. A review of the literature reveals that multiple benign and malignant neoplasms can develop from pre-existing Jadassohn nevus, including tricholemoma, trichoblastoma, sebaceoma, apocrine adenoma, basal cell carcinoma, squamous cell carcinoma, verrucous carcinoma, ductal carcinoma, and syringocystadenoma papilliferum.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The main peculiarity of our patient’s lesion was the papillary epithelial lining, which consisted of a single row of cells and exhibited discrete signs of decapitation secretion, as opposed to the classic double-row arrangement of epithelial cells showing evidence of decapitation secretion at the luminal border. This may be because the patient was a newborn, and therefore the lesion was in the initial stages of development and not highly differentiated.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In such cases ultrasound plays an important role as it can help establish the size and depth of the lesion, as well as its relationship with adjacent structures. In this specific case ultrasound allowed us to rule out cranial involvement.</p><p id="par0050" class="elsevierStylePara elsevierViewall">We have found no previous descriptions in the literature of the ultrasound pattern of syringocystadenoma papilliferum. A marked increase in vascularization is also observed in other benign adnexal proliferations. The correlation between this feature and the histopathological findings is unclear.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case presentation" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Diagnosis" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Comments" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of Interest" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Torre Castro J, Mendoza Cembranos MD, Requena Caballero L. Una lesión congénita en el cuero cabelludo. Actas Dermosifiliogr. 2021;112:257–258.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 481 "Ancho" => 750 "Tamanyo" => 58553 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1177 "Ancho" => 1000 "Tamanyo" => 117382 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 672 "Ancho" => 1000 "Tamanyo" => 284792 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Histopathological features of the lesion. Hematoxylin-eosin, original magnification ×40 (A and C), ×100 (C), and ×200 (D).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Syringocystadenocarcinoma papilliferum: a rare tumor with a favorable prognosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Peterson" 1 => "K. Tefft" 2 => "J. Blackmon" 3 => "A. Rajpara" 4 => "G. Fraga" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dermatol Online J." 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 12 | 8 | 20 |
| 2024 Octubre | 112 | 42 | 154 |
| 2024 Septiembre | 126 | 31 | 157 |
| 2024 Agosto | 148 | 60 | 208 |
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| 2024 Febrero | 117 | 33 | 150 |
| 2024 Enero | 109 | 36 | 145 |
| 2023 Diciembre | 80 | 29 | 109 |
| 2023 Noviembre | 120 | 27 | 147 |
| 2023 Octubre | 111 | 40 | 151 |
| 2023 Septiembre | 90 | 35 | 125 |
| 2023 Agosto | 96 | 19 | 115 |
| 2023 Julio | 98 | 41 | 139 |
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| 2023 Enero | 98 | 27 | 125 |
| 2022 Diciembre | 81 | 26 | 107 |
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| 2022 Septiembre | 44 | 35 | 79 |
| 2022 Agosto | 45 | 33 | 78 |
| 2022 Julio | 54 | 31 | 85 |
| 2022 Junio | 28 | 21 | 49 |
| 2022 Mayo | 57 | 42 | 99 |
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| 2022 Marzo | 40 | 52 | 92 |
| 2022 Febrero | 58 | 30 | 88 |
| 2022 Enero | 39 | 50 | 89 |
| 2021 Diciembre | 45 | 38 | 83 |
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| 2021 Octubre | 57 | 62 | 119 |
| 2021 Septiembre | 42 | 33 | 75 |
| 2021 Agosto | 46 | 31 | 77 |
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