1. CASE 33 Alejandro García-Varona, MD Hospital El Bierzo

2. Initial Presentation and Management 34 year-old female No relevant individual or family medical history At her annual pap test screening visit, her doctor noted a single, asymptomatic, discrete, cystic (kind of papillary) lesion on her left labia majora, about 0,3 cm

3. Initial Presentation and Management She told the patient and performed a biopsy of the lesion We received an irregular, reddish, cutaneous fragment, 0,5 cm

8. DIAGNOSIS WARTY DYSKERATOMA

9. Warty Dyskeratoma Benign papulo-nodular lesion with an endophytic proliferation of squamous epithelium, often in relation to a foliculosebaceous unit and showing prominent acantholytic dyskeratosis Unknown etiology. Unrelated to HPV Typically involves head and neck. Oral, laryngeal and vulval location have been reported

10. Warty Dyskeratoma Solitary pink/brown papules, nodules or cysts with an umbilicated or pore-like centre or central keratin plug Between 1 and 10 mm

11. Jang EJ, et al. Ann Dermatol 2011;23:98-100

12. Warty Dyskeratoma Well-demarcated endophytic lesion Abundant keratin that forms a plug in the center Superficial keratinous debris contains conspicuous corps ronds Prominent acantholytic dyskeratosis Suprabasal clefting with villi formation Underlying dermis with lymphocytic infiltrate

13. Warty Dyskeratoma Common mitotic figures Three variants: – Cup-shaped – Cystic – Nodular Epidermal collarette present Connection to folliculosebaceous structure is commonly demonstrable

14. Warty Dyskeratoma DD with comedonal Darier disease (similar histology, differentiated on clinical grounds)

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