Case Number : Case 1754 - 16 February - Dr Arti Bakshi Posted By: Guest

To mark my favourite middle daughter, Jenny's 25th Birthday, Dr Arti Bakshi has a great case for you all.

Geoff Cross - DermpathPRO Projects

many happy returns to Jenny!  If I'd known, i would have put in something much nicer than these warty bits of skin!! 

I thought this is a warty lesion with papillomatosis, acanthosis, epidermolytic hyperkeratosis and foci of SCAP. So as there is a combination of lesions I thought of naevus sebaceous. 

The location is atypical, but my diagnosis is also Nevus sebaceous with Syringocystadenoma papilliferum.

This is an exophytic epidermal proliferation with papillated  structures and columns of hyperkeratotic mass associated with    cystic invaginations typical of syringocystoadenoma papilliferum.How about an "apocrine acrosyringeal keratosis associated with syringocystoadenoma papilliferum?

https://www.ncbi.nlm.nih.gov/pubmed/?term=Yamamoto M[Author]&cauthor=true&cauthor_uid=10735969

Happy BD to Jenny :-))

SCP 

back ground apocrine acrosyringeal keratosis is a lovely suggestion by Vincenzo :-)

Site is unusual, but I agree with my colleagues. This is a nevus sebaceus of Jadassohn with verrucous acanthosis of the epidermis and postpubertal development of syringocystadenoma papilliferum.

Yes, I went for SCAP too with verrucous acanthosis and raised possibility of Naevus Sebaceous. Agree, site is ODD!!

Kazakov mentions this as a specific variant of SCAP (pg 65) ie. Viral wart like changes in SCAP or Verrucous SCAP and many of these are associated with naevus sebaceous. Apparently the surface epidermal changes not just mimic a vral wart but HPV DNA has been detected by PCR and ISH in some lesions leading to reports of condyloma acuminatum in association with SCAP. https://www.ncbi.nlm.nih.gov/pubmed/7864300.

Vincenzo's suggestion is also interesting and probably represents the same spectrum.