What is your diagnosis?
Case for diagnosis. Verrucous plaque on the pubic region
Diego Henrique Morais Silva
, Anna Karoline Gouveia de Oliveira, Neusa Yuriko Sakai Valente, Thais do Amaral Carneiro Cunha
Corresponding author
Department of Dermatology, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil
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array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">What is your diagnosis?</span>" "titulo" => "Case for diagnosis. A pruritic eruption of keratotic papules over the face and neck" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "100" "paginaFinal" => "102" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 805 "Ancho" => 1750 "Tamanyo" => 223547 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Multiple skin-colored to erythematous to brownish, 1 − 2 mm papules, with a slightly keratotic center, sometimes coalescing into verrucous plaques; koebnerization is also present.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Maria Relvas, Joana Calvão, Inês Coutinho, José Carlos Cardoso" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Maria" "apellidos" => "Relvas" ] 1 => array:2 [ "nombre" => "Joana" "apellidos" => "Calvão" ] 2 => array:2 [ "nombre" => "Inês" "apellidos" => "Coutinho" ] 3 => array:2 [ "nombre" => "José Carlos" "apellidos" => "Cardoso" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275220303507" "doi" => "10.1016/j.abdp.2020.06.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275220303507?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620302993?idApp=UINPBA00008Z" "url" => "/03650596/0000009600000001/v3_202102051036/S0365059620302993/v3_202102051036/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">What is your diagnosis?</span>" "titulo" => "Case for diagnosis. Verrucous plaque on the pubic region" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "103" "paginaFinal" => "105" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Diego Henrique Morais Silva, Anna Karoline Gouveia de Oliveira, Neusa Yuriko Sakai Valente, Thais do Amaral Carneiro Cunha" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Diego Henrique Morais" "apellidos" => "Silva" "email" => array:1 [ 0 => "dhenriquems@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Anna Karoline" "apellidos" => "Gouveia de Oliveira" ] 2 => array:2 [ "nombre" => "Neusa Yuriko Sakai" "apellidos" => "Valente" ] 3 => array:2 [ "nombre" => "Thais" "apellidos" => "do Amaral Carneiro Cunha" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Dermatology, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "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" => 679 "Ancho" => 905 "Tamanyo" => 222291 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Detail of lobular proliferation with multivacuolated cells in the center and smaller, non vacuolated cells at the periphery (Hematoxylin & eosin, ×200).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Case report</span><p id="par0005" class="elsevierStylePara elsevierViewall">The authors describe the case of a 79-year-old woman, presenting a warty, erythematous, and painless plaque for two years on the pubic region (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). There were two similar lesions on the face. Dermoscopy showed yellow globules on a milky-red background. She had a personal history of ascending colon cancer 16 years ago, and papillary bladder carcinoma 24 years ago. Her mother died from colon cancer. The lesions were excised, and the histopathological analysis revealed a lobular neoplasia connected to the epidermis with numerous cells with multivacuolated cytoplasm and smaller, non vacuolated cells at the periphery of the lobules (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">What is your diagnosis?</span><p id="par0010" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">a)</span><p id="par0015" class="elsevierStylePara elsevierViewall">Amelanotic melanoma</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">b)</span><p id="par0020" class="elsevierStylePara elsevierViewall">Condyloma acuminatum</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">c)</span><p id="par0025" class="elsevierStylePara elsevierViewall">Squamous cell carcinoma</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">d)</span><p id="par0030" class="elsevierStylePara elsevierViewall">Sebaceous adenoma</p></li></ul></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">Based on clinical and histopathological findings, the authors reached the diagnosis of sebaceous adenoma in a patient with Muir-Torre syndrome (MTS). Sebaceous tumors are rare, most commonly located on the face and neck of the elderly.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> There are no specific findings at dermoscopy, although yellowish globules on a milky-red background are common findings in neoplasms with sebaceous differentiation.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> They are rarely multiple or found below the head, face, and neck; in these cases, the possibility of MTS increases.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The diagnosis of sebaceous neoplasia makes MTS screening imperative. This is a rare variant of Lynch syndrome, autosomal dominant, characterized by the occurrence of sebaceous gland tumors (adenoma, sebaceoma, or sebaceous carcinoma) associated with visceral neoplasia. Among the sebaceous tumors related to MTS, adenoma is the most common, histologically characterized by lobular proliferation with predominance of mature sebocytes in the center and a minority of basaloid germ cells at the periphery. Colon adenocarcinoma is the most common associated visceral neoplasia, especially when proximal to the splenic flexure (unlike sporadic cases), followed by tumors of the genitourinary tract.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The mutations responsible for the syndrome occur in the DNA repair genes: MLH1 (MutL Homolog 1), MSH2 (MutS Homolog 2), MSH6 (MutS Homolog 6), and PSM2 (postmeiotic segregation increased 2).<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> The repair genes encode proteins responsible for identifying and correcting errors during DNA replication. The loss of the expression of the product of these genes can be evidenced through immunohistochemistry, one of the tools used to confirm MTS. The most frequent mutations occur in the MSH2 gene, a finding observed in 90% of MTS patients.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The diagnosis of MTS is clinical, by finding sebaceous neoplasia and at least one visceral tumor without other contributing factors, such as radiotherapy or immunosuppression. Immunohistochemistry and molecular analysis are indicated in cases where there is no family or personal history of visceral neoplasms.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The authors report a case of sebaceous adenoma with unusual location in the pubic region in a patient with colon and bladder cancer. The importance of investigating systemic neoplasms associated with SMT and the monitoring of these patients and their families is emphasized.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Financial support</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Authors’ contributions</span><p id="par0060" class="elsevierStylePara elsevierViewall">Diego Henrique Morais Silva: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; intellectual participation in propaedeutic and/or therapeutic conduct of studied cases; critical review of the literature; critical review of the manuscript.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Anna Karoline Gouveia de Oliveira: Design and planning of the study; collection, analysis, and interpretation of data.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Neusa Yuriko Sakai Valente: Approval of the final version of the manuscript, effective participation in research orientation, intellectual participation in propaedeutic and/or therapeutic conduct of studied cases, critical review of the manuscript.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Thais do Amaral Carneiro Cunha: Approval of the final version of the manuscript, intellectual participation in propaedeutic and/or therapeutic conduct of studied cases.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1461405" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1331589" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Case report" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "What is your diagnosis?" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Financial support" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Authors’ contributions" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-03-04" "fechaAceptado" => "2020-07-05" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1331589" "palabras" => array:3 [ 0 => "Adenoma" 1 => "Muir-Torre syndrome" 2 => "Sebaceous glands" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Muir-Torre syndrome is a rare, autosomal dominant genodermatosis, characterized by sebaceous neoplasms and visceral carcinomas. The authors describe the case of a patient who, 16 years after the diagnosis of colon carcinoma, presented a verrucous plaque on the pubic region, histopathologically compatible with sebaceous adenoma. The need to investigate this syndrome is emphasized, especially in cases of sebaceous neoplasms located outside the head, face, and neck. Screening for neoplasms in these patients and their families is mandatory.</p></span>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Silva DHM, Oliveira AKG, Valente NYS, Cunha TAC. Case for diagnosis. Verrucous plaque on the pubic region. An Bras Dermatol. 2021;96:103–5.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 553 "Ancho" => 905 "Tamanyo" => 76712 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous verrucous plaque with yellowish structures in the pubic region.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 680 "Ancho" => 905 "Tamanyo" => 257609 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Panoramic view of dermal lobular proliferation composed predominantly of mature sebaceous cells (Hematoxylin & eosin, ×40).</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 679 "Ancho" => 905 "Tamanyo" => 222291 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Detail of lobular proliferation with multivacuolated cells in the center and smaller, non vacuolated cells at the periphery (Hematoxylin & eosin, ×200).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sebaceous lesions of the skin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Iacobelli" 1 => "N.T. Harvey" 2 => "B.A. Wood" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.pathol.2017.08.012" "Revista" => array:6 [ "tituloSerie" => "Pathology." "fecha" => "2017" "volumen" => "49" "paginaInicial" => "688" "paginaFinal" => "697" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29078997" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical, dermoscopic and reflectance confocal microscopy features of sebaceous neoplasms in Muir-Torre syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Moscarella" 1 => "G. Argenziano" 2 => "C. Longo" 3 => "C. Cota" 4 => "M. Ardigo" 5 => "V. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 21 | 8 | 29 |
| 2024 October | 105 | 78 | 183 |
| 2024 September | 122 | 109 | 231 |
| 2024 August | 156 | 105 | 261 |
| 2024 July | 115 | 133 | 248 |
| 2024 June | 99 | 62 | 161 |
| 2024 May | 78 | 72 | 150 |
| 2024 April | 105 | 86 | 191 |
| 2024 March | 90 | 67 | 157 |
| 2024 February | 90 | 73 | 163 |
| 2024 January | 53 | 43 | 96 |
| 2023 December | 59 | 58 | 117 |
| 2023 November | 60 | 71 | 131 |
| 2023 October | 60 | 82 | 142 |
| 2023 September | 64 | 70 | 134 |
| 2023 August | 41 | 33 | 74 |
| 2023 July | 57 | 29 | 86 |
| 2023 June | 52 | 49 | 101 |
| 2023 May | 57 | 15 | 72 |
| 2023 April | 31 | 23 | 54 |
| 2023 March | 57 | 47 | 104 |
| 2023 February | 37 | 24 | 61 |
| 2023 January | 33 | 34 | 67 |
| 2022 December | 38 | 20 | 58 |
| 2022 November | 61 | 44 | 105 |
| 2022 October | 62 | 51 | 113 |
| 2022 September | 48 | 64 | 112 |
| 2022 August | 34 | 49 | 83 |
| 2022 July | 36 | 52 | 88 |
| 2022 June | 45 | 52 | 97 |
| 2022 May | 36 | 50 | 86 |
| 2022 April | 40 | 47 | 87 |
| 2022 March | 38 | 72 | 110 |
| 2022 February | 37 | 72 | 109 |
| 2022 January | 69 | 91 | 160 |
| 2021 December | 35 | 61 | 96 |
| 2021 November | 48 | 68 | 116 |
| 2021 October | 63 | 81 | 144 |
| 2021 September | 46 | 64 | 110 |
| 2021 August | 57 | 59 | 116 |
| 2021 July | 46 | 60 | 106 |
| 2021 June | 34 | 95 | 129 |
| 2021 May | 76 | 119 | 195 |
| 2021 April | 165 | 231 | 396 |
| 2021 March | 175 | 88 | 263 |
| 2021 February | 73 | 25 | 98 |
| 2021 January | 37 | 21 | 58 |
| 2020 December | 16 | 10 | 26 |
| 2020 November | 1 | 2 | 3 |
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