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CORRESPONDENCE
Year : 2018  |  Volume : 63  |  Issue : 2  |  Page : 190-192
Multiple eruptive clear cell acanthoma


Department of Dermatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China

Date of Web Publication6-Apr-2018

Correspondence Address:
Dr. Hong Fang
Department of Dermatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
People's Republic of China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_524_17

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How to cite this article:
Zhou S, Qiao J, Bai J, Wu Y, Jiang X, Pan Y, Xu L, Fang H. Multiple eruptive clear cell acanthoma. Indian J Dermatol 2018;63:190-2

How to cite this URL:
Zhou S, Qiao J, Bai J, Wu Y, Jiang X, Pan Y, Xu L, Fang H. Multiple eruptive clear cell acanthoma. Indian J Dermatol [serial online] 2018 [cited 2022 Jan 27];63:190-2. Available from: https://www.e-ijd.org/text.asp?2018/63/2/190/229448




Sir,

A 54-year-old Chinese woman presented to our department with multiple itchy erythematous to brown rounded sessile nodules and irregular plaques on the perineum. No abnormal symptoms were described by the patient, except pruritus. The lesions started 7 years back and gradually increased in number and size. There were more than 20 lesions with the long axis of individual lesions varying between 5 to 50 mm. The sessile nodules were rounded, rufous or brownish red, and sharply circumscribed with irregular shape, sometimes with a peripheral collarette scaling or slightly moist surface [Figure 1]. Moreover, red pinpoint dots on a whitish background were observed under dermoscopy [Figure 2]. Clinical examination did not reveal any systemic abnormality. There was no history of trauma or insect bite. Differential diagnoses included seborrheic keratosis, amelanotic melanoma, squamous cell carcinoma, Bowen's disease, eccrine poroma, guttate psoriasis, and clear cell hidradenoma. An incisional skin biopsy from a plaque on her left inguinal region was performed.
Figure 1: Multiple erythematous to brown and irregular sessile nodules on the perineum

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Figure 2: Dermoscopic appearance. Red pinpoint dots on a whitish background

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Histologically, the specimen revealed a psoriasiform pattern with papillomatosis. Acanthosis, hyperkeratosis, parakeratosis, and neutrophils in the epidermis and inflammatory cell infiltration and blood vessel dilation in the upper dermis were seen [Figure 3]a. Clear cell was noted in the epidermis, and no nuclear division was recognized [Figure 3]b. As for the immunohistochemical study, those clear cells showed abundant cytoplasmic glycogen by periodic acid-Schiff staining [Figure 4]a and [Figure 5]a. High molecular weight cytokeratins CK34βE12 [Figure 4]c and [Figure 5]b and CK5/6 [Figure 4]d were intensely positive in almost all keratinocytes. Epithelial membrane antigen [Figure 4]e was also positive, while CK20 and carcinoembryonic antigen [Figure 4]b, [Figure 4]f and [Figure 5]c] were negative in the keratinocytes. Taking together, a diagnosis of multiple clear cell acanthoma (CCA) was made.
Figure 3: Histopathological features showed acanthosis, hyperkeratosis, parakeratosis, and neutrophils in the epidermis and inflammatory cell infiltration and blood vessel dilation in the upper dermis. (a) Low magnification (H and E, ×40), (b) high magnification (H and E, ×200)

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Figure 4: Pictograph showing (a) abundant cytoplasmic glycogen by periodic acid-Schiff, (b) complete negative for CK20 in the epidermis, (c and d) intensely positive of CK34βE12 and CK5/6, respectively, in almost all keratinocytes, (e) positive stain for epithelial membrane antigen, (f) negative stain for carcinoembryonic antigen in tumor cells (IHC, ×100)

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Figure 5: Pictograph showing (a) abundant cytoplasmic glycogen by periodic acid–Schiff, (b and c) intensely positive of CK34βE12 and CK5/6, respectively, in almost all keratinocytes (IHC, ×200)

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CCA is widely accepted as a benign epidermal neoplasm of unknown etiology. Degos et al. were first to describe CCA in 1962,[1] so this entity is also called Degos acanthoma or pale cell acanthoma.[2] Usually, CCA presents as solitary, brownish-red papule or nodule that always occurs in the lower extremity, with a diameter <20 mm.[3] It grows quite slowly and maintains the same shape and size for years. About 98% of CCA patients are beyond 40 year old and more often around 60 year.[4] Multiple CCA is a rare form of this disease. The case is presented here because of this rare form of multiple lesions on the perineum. Under dermoscopy, lesions presented red dots, due to glomeruloid vessels in a serpiginous pattern, which provided a significant clue in the diagnosis of CCA. However, it still depends on a skin biopsy and its unique histopathological features to make a certain diagnosis. As for the treatment, electrofulguration, cryotherapy, curettage, carbon dioxide laser, surgical excision, topical 5-fluorouracil, and topical calcipotriol were included.[5] The lesions of our patient are multiple; we chose microwave treatment for those giant lesions combined with the use of topical calcipotriol for those small papules.[5] Now, the patient is still in the follow-up.

Acknowledgment

This work was supported by the National Natural Science Foundation of China (81271743).

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

This work was supported by the National Natural Science Foundation of China (81673045).

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Degos R, Delort J, Civatte J, Poiares Baptista A. Epidermal tumor with an unusual appearance: Clear cell acanthoma. Ann Dermatol Syphiligr (Paris) 1962;89:361-71.  Back to cited text no. 1
    
2.
Lin CY, Lee LY, Kuo TT. Malignant clear cell acanthoma: Report of a rare case of clear cell acanthoma-like tumor with malignant features. Am J Dermatopathol 2016;38:553-6.  Back to cited text no. 2
    
3.
Kasuga N, Kunisada M, Tanaka M, Nishigori C. Case of podoplanin-positive clear cell acanthoma. J Dermatol 2017;45:233-5.  Back to cited text no. 3
    
4.
Çetinözman F, Jansen P, Willemze R. Clear cell acanthoma on the dorsum of the hand. J Eur Acad Dermatol Venereol 2016;30:378-80.  Back to cited text no. 4
    
5.
Scanni G, Pellacani G. Topical calcipotriol as a new therapeutic option for the treatment of clear cell acanthoma. An Bras Dermatol 2014;89:803-5.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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