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Acquired Perforating Osteoma Cutis.

Kim BK, Ahn SK - Ann Dermatol (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea.

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Dear Editor: Osteoma cutis is a rare, benign condition characterized by dermal or subcutaneous bone formation that presents as stony hard nodules... Although the mechanism of bone formation remains unclear, it is speculated that resident fibroblasts or nests of pleuripotent mesenchymal cells differentiate into osteoblasts to form bone tissue... She reported that the lesion thickened and oozed fluid for 2 years... Laboratory test results for thyroid and parathyroid hormone were within normal limits... Mammography revealed solitary calcification at the same site, which was interpreted as a phlebolith... Perforating osteoma cutis is a very rare condition; few cases have been reported... Several potential mechanisms of perforation have been described: (a) transepidermal elimination, which is a dermal-induced epidermal reaction to eliminate foreign bodies, degenerated connective tissue or keratin, calcium deposits, and/or ectopic tissue; (b) the pressure effect from underlying tissue; (c) simple upward growth of underlying tissue; and (d) superficial inflammation caused by external trauma, leading to the degeneration and perforation of the epidermis... Calcification occurred much later, and calcium-containing ectopic bone tissue induced transepidermal elimination... In addition, the pressure effect and simple upward growth of bony nodules might have facilitated epidermal perforation... In the present case, the presence of clustered osseous tissue with surrounding dermal inflammatory cells supports the idea that the lesion was secondary to trauma... Surgical removal is commonly performed to treat osteoma cutis... Our patient was successfully treated with excision, and no recurrence has been noted during 6 months of follow-up.

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(A) A central well-demarcated keratotic plug in the epidermis, granulomatous inflammation and fibrosis in the dermis (H&E, ×40). Inset: the calcified plug was composed of osteoblasts, osteoclasts, and osteocytes (H&E, ×400). (B) Bony nodules (arrow) with inflammatory cell infiltration (H&E, ×200). Inset: a bony spicule (asterisk) perforates the epidermis (H&E, ×400). (C) Von Kossa staining revealed calcium deposition in the center of the lesion (von Kossa, ×100).
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Figure 2: (A) A central well-demarcated keratotic plug in the epidermis, granulomatous inflammation and fibrosis in the dermis (H&E, ×40). Inset: the calcified plug was composed of osteoblasts, osteoclasts, and osteocytes (H&E, ×400). (B) Bony nodules (arrow) with inflammatory cell infiltration (H&E, ×200). Inset: a bony spicule (asterisk) perforates the epidermis (H&E, ×400). (C) Von Kossa staining revealed calcium deposition in the center of the lesion (von Kossa, ×100).

Mentions: A 40-year-old woman with diabetes mellitus had a solitary 1×0.5-cm erythematous nodule and central keratotic crater on her left breast for 20 years (Fig. 1). She reported that the lesion thickened and oozed fluid for 2 years. Laboratory test results for thyroid and parathyroid hormone were within normal limits. Mammography revealed solitary calcification at the same site, which was interpreted as a phlebolith. Excisional biopsy was performed for diagnosis and removal. The specimen had a central keratotic plug comprising osseous tissue with surrounding inflammatory cells (Fig. 2A) and bony nodules perforating the overlying epidermis (Fig. 2B). Von Kossa staining showed calcium deposition (Fig. 2C). On the basis of these findings, we diagnosed the patient with acquired perforating osteoma cutis.


Acquired Perforating Osteoma Cutis.

Kim BK, Ahn SK - Ann Dermatol (2015)

(A) A central well-demarcated keratotic plug in the epidermis, granulomatous inflammation and fibrosis in the dermis (H&E, ×40). Inset: the calcified plug was composed of osteoblasts, osteoclasts, and osteocytes (H&E, ×400). (B) Bony nodules (arrow) with inflammatory cell infiltration (H&E, ×200). Inset: a bony spicule (asterisk) perforates the epidermis (H&E, ×400). (C) Von Kossa staining revealed calcium deposition in the center of the lesion (von Kossa, ×100).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4530160&req=5

Figure 2: (A) A central well-demarcated keratotic plug in the epidermis, granulomatous inflammation and fibrosis in the dermis (H&E, ×40). Inset: the calcified plug was composed of osteoblasts, osteoclasts, and osteocytes (H&E, ×400). (B) Bony nodules (arrow) with inflammatory cell infiltration (H&E, ×200). Inset: a bony spicule (asterisk) perforates the epidermis (H&E, ×400). (C) Von Kossa staining revealed calcium deposition in the center of the lesion (von Kossa, ×100).
Mentions: A 40-year-old woman with diabetes mellitus had a solitary 1×0.5-cm erythematous nodule and central keratotic crater on her left breast for 20 years (Fig. 1). She reported that the lesion thickened and oozed fluid for 2 years. Laboratory test results for thyroid and parathyroid hormone were within normal limits. Mammography revealed solitary calcification at the same site, which was interpreted as a phlebolith. Excisional biopsy was performed for diagnosis and removal. The specimen had a central keratotic plug comprising osseous tissue with surrounding inflammatory cells (Fig. 2A) and bony nodules perforating the overlying epidermis (Fig. 2B). Von Kossa staining showed calcium deposition (Fig. 2C). On the basis of these findings, we diagnosed the patient with acquired perforating osteoma cutis.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Dear Editor: Osteoma cutis is a rare, benign condition characterized by dermal or subcutaneous bone formation that presents as stony hard nodules... Although the mechanism of bone formation remains unclear, it is speculated that resident fibroblasts or nests of pleuripotent mesenchymal cells differentiate into osteoblasts to form bone tissue... She reported that the lesion thickened and oozed fluid for 2 years... Laboratory test results for thyroid and parathyroid hormone were within normal limits... Mammography revealed solitary calcification at the same site, which was interpreted as a phlebolith... Perforating osteoma cutis is a very rare condition; few cases have been reported... Several potential mechanisms of perforation have been described: (a) transepidermal elimination, which is a dermal-induced epidermal reaction to eliminate foreign bodies, degenerated connective tissue or keratin, calcium deposits, and/or ectopic tissue; (b) the pressure effect from underlying tissue; (c) simple upward growth of underlying tissue; and (d) superficial inflammation caused by external trauma, leading to the degeneration and perforation of the epidermis... Calcification occurred much later, and calcium-containing ectopic bone tissue induced transepidermal elimination... In addition, the pressure effect and simple upward growth of bony nodules might have facilitated epidermal perforation... In the present case, the presence of clustered osseous tissue with surrounding dermal inflammatory cells supports the idea that the lesion was secondary to trauma... Surgical removal is commonly performed to treat osteoma cutis... Our patient was successfully treated with excision, and no recurrence has been noted during 6 months of follow-up.

No MeSH data available.


Related in: MedlinePlus