Dermatoscopy of the Borst-Jadassohn phenomenon in hidroacanthoma simplex,

AnBrasDermatol.2020;95(1):95---97

Anais

Brasileiros

de

Dermatologia

IMAGES

IN

DERMATOLOGY

Dermatoscopy

of

the

Borst---Jadassohn

phenomenon

in

hidroacanthoma

simplex

夽,夽夽

Bruno

de

Castro

e

Souza

_,

_Maria

_Cláudia

_Alves

_Luce

_,

Thais

do

Amaral

Carneiro

Cunha

_,

_Neusa

_Yuriko

_Sakai

_Valente

a_{DepartmentofDermatology,HospitaldoServidorPúblicoEstadual,SãoPaulo,SP,Brazil}

b_{DepartmentofDermatology,InstitutodeAssistênciaMédicaaoServidoPúblicoEstadual,SãoPaulo,SP,Brazil}

c_{DermatologyResidencyProgram,InstitutodeAssistênciaMédicaaoServidoPúblicoEstadual,SãoPaulo,SP,Brazil}

Received30October2018;accepted13March2019 Availableonline18December2019

KEYWORDS

Dermoscopy; Dermatology; Poroma

Abstract The Borst---Jadassohnphenomenon isamorphological finding thatconsistsofthe presenceofwell-definednestsofcellslocatedinthespinystratumofanacanthoticepidermis. Oneoftheneoplasmswherethisphenomenonisfoundishidroacanthomasimplex.This neo-plasmisconsideredtheintraepidermalformoftheeccrineporoma.Despiteitsbenignnature, malignanttransformationsarereported.Thepresentarticlereportsacaseofhidroacanthoma simplexanddiscussesthedermoscopyofthisphenomenon.

©2019SociedadeBrasileira deDermatologia.PublishedbyElsevierEspa˜na,S.L.U.Thisisan openaccessarticleundertheCCBYlicense(http://creativecommons.org/licenses/by/4.0/).

Introduction

TheBorst---Jadassohnphenomenonis amorphological find-ing that consistsof the presence of well-defined nestsof cellslocatedinthespinystratumofanacanthotic epider-mis. Some neoplasms, whether malignantor benign, may presentthisphenomenon,likeasclonalseborrheickeratosis

夽 _{Howtocitethisarticle:SouzaBC,LuceMCA,CunhaTAC,Valente}

NYS. Dermatoscopy of the Borst---Jadassohn phenomenon in the hidroacanthomasimplex.AnBrasDermatol.2020;95:95---7.

夽夽_{StudyconductedattheHospitaldoServidorPúblicoEstadual,}

SP,Brazil.

∗_{Correspondingauthor.}

E-mail:brunocastro1990@hotmail.com(B.C.Souza).

(SK),clonalBowen’sdisease(BD),Paget’sdisease, porocar-cinoma,orhidroacanthomasimplex(HS).

The distinctionbetween these entities, both clinically andhistopathologically,issometimesachallenge.Thisfact canhave consequencessincetheapproachof each oneis different.The dermatoscopy of the Borst---Jadassohn phe-nomenonhasbeenlittlereported,thusitisworthwhileto describeitinHS.

Case

report

An88-year-oldmalepatientsoughttheDermatologyService complainingofanasymptomaticlesionintherightgluteal region,withanunknowntimeofevolution.

At the dermatological examination, a slightly elevated pink plaque with irregular borders was evident, but with https://doi.org/10.1016/j.abd.2019.03.004

0365-0596/©2019SociedadeBrasileiradeDermatologia.PublishedbyElsevierEspa˜na,S.L.U.ThisisanopenaccessarticleundertheCC BYlicense(http://creativecommons.org/licenses/by/4.0/).

96 SouzaBCetal.

Figure1 A slightlyelevatedpinkplaque withirregularbut evidentborders,withasmallareaofexulceration.

Figure2 Panoramicimageofthedermatoscopyshowing sev-eral round, brown, well-delimited structures surrounded by dottedvessels.Theexulceratedareacanbeseen.

a small area of exulceration (Fig. 1). Dermoscopy was abletoshow,besidestheexulceration,severalwell-defined brown, rounded structures, surrounded by dotted vessels

(Figs.2and3).

An incisional biopsy was performed with diagnostic hypotheses of seborrheic keratosis or Bowen’s disease. Histopathologyshowed basaloid clones without atypia, in themiddleofspinouscells (Fig.4).PossibilitiesofHSand clonalSKwereconsidered.Theexpressionof

carcinoembry-Figure3 Detailofthesamestructuresindermoscopy.

Figure4 Hematoxilin&eosin,(Hematoxilin&eosin,×200) ---well-circumscribedintraepithelialproliferationofroundedand basophiliccells.

onicantigen(CEA)andepithelialmembraneantigen(EMA) inthebasaloidcellsandintheductalstructurespresentin thesecells at the immunohistochemical examination indi-catedthediagnosisofHS.

Discussion

Intheearly20thcentury,BorstandJadassohnindependently describedneoplasmscharacterizedbywell-demarcatedcell nestslocatedintheepidermis.Believingthemtobea spe-cific type of tumor, the name intraepithelial epithelioma of Borst---Jadassohn was coined. From the morphological and immunohistochemical studies, the majority of the authorsnowadaysbelievethatthisentityrepresentsa mor-phological phenomenon, rather than being specific to a certain neoplasia. Therefore, it is preferred to designate it as the Borst---Jadassohn phenomenon (BJP). This phe-nomenonis characterizedasthe presenceof well-defined islands of epithelial cells, typical or atypical, within an acanthoticepidermis,andcanbeevidencedinsomebenign ormalignantconditions.1

DermatoscopyoftheBorst---Jadassohnphenomenoninhidroacanthomasimplex 97

Figure5 Fontana-Masson,(Fontana-Masson, ×200)---anest ofbasaloidcellswithaconsiderableamountofmelanin.This phenomenonisobservedindermoscopyasthebrownareas.

One of the neoplasms where BJP is found is the hidroacanthoma simplex. This neoplasm is considered the intraepidermal form of the eccrine poroma.2 _{Despite its} benign nature,malignant transformations are reportedin somecases,leadingtothediscussionregardingwhetherits earlyexcisionshouldbemandatory.3

Clinically,itisoftenmistakenforSK.Thisconfusionmay persistinhistopathologyandtheinitialdiagnosisofclonal SKisnotinfrequent.Thereisawell-circumscribed intraep-ithelialproliferation ofrounded andbasophilic cells, very similartowhatoccursinclonalSKthatpresentsBJP.Inthe immunohistochemistry,thepositivityforCEAandEMAinthe casesofHSaidinthedifferentiation.4

ShiiyaCetal.describedfourcasesofHSanddiscussed the maindermatoscopic changes, withthecentral aimof distinguishingitfromBowen’sdiseaseandSK.5_Theauthors concluded that findings of small black globules (75% of cases) and fine scales distributed annularly (100%) were characteristic.Inaddition,theabsenceofglomerular ves-sels would help in the differentiation of DB, since such vesselsfound in a group arehighly suggestive of the lat-ter.

In the case reported, dotted vessels distributed in circle around rounded brown structures were observed. They represent, in the correlation of dermatoscopy with histopathology,proliferationofvenulesneartheclonalcell blocks.Dottedvessels,wheninnon-melanocyticlesions,are non-specific,butthepatternfoundinthelesiondescribed may be peculiar.6 _{The rounded structures represent the} nests of melanocytic intraepidermal clonal cells, corre-spondingtoBJP.

Althoughhematoxylinandeosinstainingdidnotshowthe presenceofpigment,whentheFontana-Massonstainingwas used,agreatamountofmelaninwasobservedintheblocks (Fig.5).

In conclusion, the present study contributesto review conceptsofBJPtodescribethedermatoscopicalterations ofthisphenomenoninHS,oneofthemaintumorsinwhich itdevelops.

Financial

support

Nonedeclared.

Authors’

contribution

BrunodeCastro e Souza: Conception and planningof the study;compositionofthemanuscript;intellectual partici-pationin thepropaedeuticand/or therapeutic conductof thestudiedcases;criticalreviewoftheliterature.

MariaCláudiaAlvesLuce:Compositionofthemanuscript; criticalreviewoftheliterature.

Thais do Amaral Carneiro Cunha: Approval of the final versionof themanuscript;conceptionandplanningofthe study;intellectualparticipationinthepropaedeuticand/or therapeuticconductofthestudiedcases;criticalreviewof theliterature.

NeusaYuriko Sakai Valente: Participationin the design ofthestudy;intellectualparticipationinthepropaedeutic and/or therapeutic conduct of the studied cases; critical reviewoftheliterature;criticalreviewofthemanuscript.

Conflicts

of

interest

Nonedeclared.

References

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2.BattistellaM,LangbeinL,PeltreB,CribierB.From hidroacan-thoma simplex to poroid hidradenoma: clinicopathologic and immunohistochemicstudyofporoidneoplasmsandreappraisal oftheirhistogenesis.AmJDermatopathol.2010;32:459---68.

3.LeeJB,OhCK, JangHS,KimMB,JangBS,KwonKS.Acaseof porocarcinomafrompre-existinghidroacanthomasimplex:need of earlyexcision for hidroacanthomasimplex? Dermatol Surg. 2003;29:772---4.

4.Furlan KC, Kakizaki P,Chartuni JCN, Sittart JA, Valente NYS. Hidroacantoma simples:dermatoscopiaecriocirurgia.AnBras Dermatol.2017;92:256---8.

5.ShiiyaC,HataH,InamuraY, ImafukuK,KitamuraS,FujitaH, et al. Dermoscopic features ofhidroacanthoma simplex: use-fulnessindistinguishingitfromBowen’sdiseaseandseborrheic keratosis.JDermatol.2015;42:1002---5.

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