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Pathology of Warty


"A cup shaped, well circumsribed skin

lesion with acantholytic and dyskeratotic cells"

Dr Sampurna Roy MD




Syn: Focal Acantholytic Dyskeratosis

Warty dyskeratoma is a rare, benign tumour.

Graham and Helwig first described warty dyskeratoma as isolated Darier's disease in 1954. It was called warty dyskeratoma by Szymanski in 1957.

According to some authors, majority of these lesions display overall histopathologic features consistent with a follicular adnexal neoplasm.

On the basis of this finding, the term follicular dyskeratoma has been suggested.

These are rare usually solitary lesions with an umbilicated center.

Age:  Usually occur in middle aged or elderly patients.

Site: Located on the head and neck regionand rarely in the oral region.

Predisposing factor : Viral infection, smoking, autoimmunity, and ultraviolet light

Differential diagnosis:  Darier’s disease, acantholytic squamous cell carcinoma, and keratoacanthoma.

Microscopic features:

Histology reveals cup shaped, well circumsribed lesion characterized by suprabasilar clefting, acantholysis, dyskeratosis and keratinous plug.

Villi protrude into the lacuna. 

Villi are dermal papillae lined by basal cells and contain inflammatory cells and dilated blood vessels.

A cup shaped invagination is filled with a keratinous plug. Suprabasal clefting  is present.

There is suprabasal clefting with numerous acantholytic and dyskeratotic cells within the lacuna. Protruding into the lacuna are villi, which are dermal papillae covered by a layer of basal cells.

High power view showing suprabasilar clefting with numerous acantholytic and dyskeratotic cells within the lacuna. Corps ronds and grains are well developed in this skin lesion.


Note: Acantholytic dyskeratosis is a histopathologic pattern defined by a hyperkeratotic and parakeratotic epidermis with intraepidermal clefts containing acantholytic and dyskeratotic keratinocytes.

These features may be present in :

Warty dyskeratoma ; Darier disease ; Grover disease ; Hailey Hailey disease ; Acantholytic and dyskeratotic epidermal nevus, Focal acantholytic dyskeratosis ; Acantholytic solar keratosis ; Vulval and anal acantholytic dyskeratosis.


Further reading

Warty dyskeratoma/focal acantholytic dyskeratosis--an update on a rare oral lesion.

Multiple warty dyskeratomas: case report.

Warty dyskeratoma involving two adjoining follicles.

Warty dyskeratoma—“follicular dyskeratoma”: Analysis of clinicopathologic features of a distinctive follicular adnexal neoplasm

Multiple warty dyskeratomas of the scalp

Multiple warty dyskeratomas on the scalp.

Warty dyskeratoma: a benign cutaneous tumor resembling Darier's disease microscopically

Warty dyskeratoma or "follicular dykeratoma": a clinicopathologic features of a new entity.

Warty dyskeratoma--"follicular dyskeratoma": analysis of clinicopathologic features of a distinctive follicular adnexal neoplasm.





Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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