Dermatopathology

Case 068714

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Femme de 45 ans présentant des lésions papuleuses keratosiques rosâtres du tronc (dos) peu nombreuses, légèrement prurigineuses, persistantes.

 

45 yo female complaining of rare small keratotic papules of the upper trunk (back), slightly brownish. The lesions are persistent, mildly itching.  

 
     
     
     
  Biopsie   Biopsy  
     
     
  Coupes profondes   Deeper recuts  
     
       
  Coupes plus profondes   More deep recuts  
     
     
     
 

Diagnostic proposé:

 

 

 

 

 

 

 

 

 

Dyskératose acantholytique transitoire (Maladie de Grover)

 

Proposed diagnosis:

 

 

 

 

 

 

 

 

 

Transient acantholytic dermatosis (Grover's disease)

 
  Arguments:      
  dans le texte de réference ci-dessous, en gras   Highlighted in the text of the reference below  

 

Transient Acantholytic Dermatosis
Edward J Zabawski Jr, DO, RPh, Dermatology, Spencer Dermatology Group, Crawfordsville, Indiana
Clay J Cockerell, MD, Director, Clinical Professor, Department of Dermatology, Division of Dermatopathology, University of Texas Southwestern Medical Center

To view the complete reference

including pathophysiology, treatment, and follow up click here:  emedicine

Background
Transient acantholytic dermatosis is not an uncommon condition, but, surprisingly, it was not thoroughly characterized until Grover did so in 1970. While generally accepted to be a benign, self-limited disorder, it is often persistent and difficult to manage; hence, the description of transient is misleading. The presentation can be subtle, or it may closely resemble other pruritic dermatoses. A high index of suspicion for this disease is necessary if the diagnosis is to be made correctly. Furthermore, the histologic features of Grover disease closely resemble those of several other conditions that are clinically distinct, which may add to potential diagnostic confusion.

Sex
Men are affected 3 times more often than women.
Age
Grover disease most commonly affects middle-aged men; however, it has been in reported in children.

History

  • One of the hallmarks of Grover disease is pruritus, and all individuals who are affected experience variable degrees of itching, sometimes severe in nature.
  • The clinical appearance does not always correlate to the degree of pruritus; for example, some patients with limited cutaneous disease complain of severe itching, whereas others with many lesions have few or no symptoms.
  • No systemic symptoms are associated with Grover disease, but oral lesions can develop that resemble aphthae and may be slightly painful

Physical

  • The process usually begins as an eruption of the skin on the anterior part of the chest, the upper part of the back, and the lower part of the rib cage.
  • Patients who are severely affected may have disseminated disease affecting the neck, the shoulders, the arms, and the legs.
  • The scalp is usually not affected, and the palms and the soles are almost always spared.
  • Individual lesions are erythematous to red brown keratotic papules that remain discrete and do not usually tend to coalesce.
  • Occasionally, lesions may be acneiform, vesicular, pustular, and rarely even bullous. Although the most common presentation is that of widespread scattered papules, unusual distributions, including zosteriform or unilateral, may occur.

Histologic Findings
The histology of Grover disease contains certain characteristic features, but for a precise diagnosis to be rendered, clinicopathologic correlation is needed, focal acantholysis and dyskeratosis are seen. Spongiosis is also commonly observed, and the presence of spongiosis and acantholysis in the same specimen should raise the possibility of Grover disease.
Five distinct histologic patterns of Grover disease have been described: (1) a pattern that simulates Hailey-Hailey disease; (2) a pattern that simulates Darier disease; (3) a pattern characterized mainly by spongiotic dermatitis; (4) a pattern that simulates pemphigus vulgaris; and (5) a pattern that simulates pemphigus foliaceus. Although one pattern may predominate, each pattern may be seen in different lesions from the same patient or, in some cases, within a single specimen. The key discriminating features are described below.

  • Darier disease - Virtually identical; greater tendency to involve follicles; clinical correlation essential
  • Linear acantholytic epidermal nevus - Virtually identical; clinical correlation essential
  • Hailey-Hailey disease - Epidermis usually more hyperplastic; more diffuse involvement
  • Pemphigus vulgaris - Broad zones of suprabasilar acantholysis; mucosal involvement; involvement of adnexal structures; often abundant eosinophils
  • Primary spongiotic dermatitis (allergic contact dermatitis, nummular dermatitis) - Involvement of entire epidermis; psoriasiform hyperplasia
  • Acantholytic solar keratosis - Atypical keratinocytic proliferation in lower portion of epidermis with cytologic atypia and mitoses; alternating orthokeratosis and parakeratosis; solar elastosis
  • Solitary acantholytic keratosis - Epidermal hyperplasia; slight papillomatosis or digitation of epidermis; clinical correlation required
  • Pemphigus foliaceus/erythematosus - Broad zone of subcorneal and subgranular acantholysis; involvement of adnexal structures; often eosinophils
  • Warty dyskeratoma - Cup-shaped exoendophytic cystlike lesion; acantholytic and dyskeratotic cells lining cyst wall; pseudopapillae with acantholytic dyskeratosis lined by a single layer of basal cells
  • Familial dyskeratotic comedones - Small cylindrical invagination with epithelial lining demonstrating acantholytic dyskeratosis

To view the complete reference

including pathophysiology, treatment, and follow up click here:  emedicine