Quiz 15: What is your diagnosis?

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Diagnosis: Quiz 15

Quiz 15

Answer: Seborrheic keratosis

Criteria for diagnosis histopathologically: A symmetrical, well-circumscribed epidermal neoplasm made up of interconnected columns of "basaloid" and "squamoid" cells, the former containing melanin, that contains infundibular tunnels with laminate and basket-woven horn, is a seborrheic keratosis.

Differential diagnosis histopathologically: There is none.

Criteria for diagnosis clinically: A sharply demarcated, flat, brown papule with a papillated surface that is located on the temple of an older person is consonant with seborrheic keratosis. 

Differential diagnosis clinically: There is none.

Clinicopathologic correlation: The plaque results from the thickening of the epidermis. The pigmentation is due to an increase in melanin within the "basaloid" cells.

Options for therapy predicated on knowledge of histopathologic findings: The lesion is benign and therefore no therapy is needed.

1) Seborrheic keratosis is a benign epidermal neoplasm that occurs in adults and is localized preferentially on the trunk, but can develop on all parts of the body surface except the palms and soles.

2) Attempts have been made to classify seborrheic keratosis into different types, based partly on their appearance architectural, partly on the predominating cell type. At present, six types have been described: acanthotic, hyperkeratotic (verrucous), reticulated, clonal, irritated, and melanoacanthoma.

3) If one examines critically seborrheic keratoses that have been classified as acanthotic or hyperkeratotic, it turns out that these classifications are not entirely justified because similar architectural attributes can be encountered in both types. Acanthosis, hyperkeratosis, and the formation "horn pseudocysts" are findings histopathologic of seborrheic keratosis; each of these characteristics can be more or less pronounced in an individual lesion.

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