Clinical Challenge: Asymptomatic Growth on the Neck - MPR

Clinical Challenge: Asymptomatic Growth on the Neck

Slideshow

  • Slide

A 62-year-old woman presents with a growth on her upper neck first noted several weeks ago. The lesion has increased in size but remains asymptomatic. The patient’s medical history is significant for multiple cutaneous neoplasms including basal cell carcinoma, spiradenoma, and trichofolliculoma. Examination reveals a 1.5cm nodule. Cervical and submandibular lymph nodes are nonpalpable.

Pseudoepitheliomatous hyperplasia is the result of exuberant tissue emanating from follicular infundibula.1 The condition may be triggered by chronic inflammation or an underlying neoplastic process.2 Pseudoepitheliomatous hyperplasia may also arise following application of a tattoo and on the tongue secondary to infection...

Submit your diagnosis to see full explanation.

Pseudoepitheliomatous hyperplasia is the result of exuberant tissue emanating from follicular infundibula.1 The condition may be triggered by chronic inflammation or an underlying neoplastic process.2 Pseudoepitheliomatous hyperplasia may also arise following application of a tattoo and on the tongue secondary to infection or malignancy.3,4 The condition is a benign reactive process that clinically may resemble neoplastic lesions such as keratoacanthomas. Definitive diagnosis is based on histopathologic examination that reveals invasion of the dermis by jagged epithelial strands with horn pearl formation. Histopathologic differential includes squamous cell carcinoma and verrucous carcinoma. Surgical excision is curative.

Stephen Schleicher, MD, is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College.

References

1. Grunwald MH, Lee JY, Ackerman AB. Pseudocarcinomatous hyperplasiaAm J Dermatopathol. 1988;10(2):95–103.

2. Zayour M, Lazova R. Pseudoepitheliomatous hyperplasia: a reviewAm J Dermatopathol. 2011;33(2):112–126.