عنوان

Evaluation of clinical and pathological features of Inverted Follicular Keratosis in patients referring to Razi hospital from 1395 to 1399,بررسی ویژگیهای بالینی و پاتولوژیک Keratosis Follicular Inverted در بیماران مراجعه کننده به بیمارستان رازی طی سال های 1395 تا 1399

شماره

98983P

زبان متن نوشتاري يا گفتاري و مانند آن

انگلیسی

عنوان اصلي

Evaluation of clinical and pathological features of Inverted Follicular Keratosis in patients referring to Razi hospital from 1395 to 1399

عنوان اصلي

بررسی ویژگیهای بالینی و پاتولوژیک Keratosis Follicular Inverted در بیماران مراجعه کننده به بیمارستان رازی طی سال های 1395 تا 1399

نام عام مواد

[Dissertation]

نام نخستين پديدآور

Farah Maqbool

نام نخستين پديدآور

فرح مقبول

نام ناشر، پخش کننده و غيره

Tehran University of Medical Sciences, Medicine school

تاریخ نشرو بخش و غیره

2023

نام خاص و کميت اثر

74p

جزئيات پايان نامه و نوع درجه آن

Doctor Of Medicine(MD)

زمان اعطا مدرک

1401/12/02

امتياز متن

18

متن يادداشت

Introduction : Inverted follicular keratosis is a rare benign tumor of the follicular infundibulum, usually symmetric, invaginated proliferation of mature squamous cells that may be exophytic or endophytic. It is characterized histologically by the presence of prominent, stereotyped, closely apposed, concentric, laminated whorls of squamous cells with centripetal maturation, the so-called squamous eddies.Clinically, inverted follicular keratosis is usually a solitary lesion less than 1 cm in diameter, typically affecting white middle-aged persons of either sex,usually men. It is a lesion that almost always occurs on hairy skin. The lesion can vary from smooth and papular to verrucous, from skin colored to pigmented, and from orthokeratotic to hyperkeratotic. .The clinical differential diagnosis includes verruca vulgaris, seborrheic keratosis, SCC and a variety of other papules or keratoses. Histoligically 4 growth patterns have been observed,which include a wart-like variant, Keratoacanthoma-like pattern , Solid nodular and cystic. Characteristic histological appearance observed across all lesions includes central squamous cells and more peripheral basaloid cells , forming squamous eddies. Most of the lesions are treated by surgical excision. Its a cross-sectional study in which all the patients with the diagnosis of inverted follicular keratosis who had referred to Razi hospital from 1395 to 1399 will be evaluated based on clinical and pathological features and the results will be presented in tables, graphs and charts.Result: We analyzed 56 patients with inverted follicular keratosis in this study to determine the demographic data, clinical information, Pathological characteristics and the type of treatment received by the patients who were had referred to Razi Hospital from 1395 to 1399 and analyzed 32 different variables to draw conclusions.The demographic data that we assessed from the present study concluded that the mean age was 50.71 ± 19.76. The minimum age of the subjects was 10 years old and the maximum age was 82 years old.Also, it was more common in male (73.2%) than in female gender . Size of the lesion varied between 0.3 to 3 cm . The mean size was 1.01 cm with a standard deviation of 0.55.We found out that 23 patients (41.1%) out of 47 patients whose information about the type of lesion was recorded were of papule type. Also , for 5.4% of the patients, the lesion was ulcer type.Papule > nodule > plaque > verroceous , ulcer. Likewise , majority of the patients had their lesion located on face (57.1%) whereas only 1 patient was seen to have his lesion present on his neck.Face > scalp > lower extremity > upper extremity > trunk Furthermore, majority of the patients (95%) had a single lesion whereas only 3 patients (5%) had multiples lesions.Moreover, for the majority of patients,duration of lesion has been noticed to be below 3months. Only 10 patients have had their lesion for more than a year. Minimum duration of lesion was 1 months (9.8%) and the max duration was 4 years (2.4%).Also, 48 patients (85.7%) did not have any underlying disease.Out of56 patients, information regarding treatment provided was only recorded for 34 patients, all of whom had undergone complete excision.The pathological characteristics assessed were as follows : Exoendophytic component ,Parakeratosis, Hyperkeratosis, Squamous eddies, Mitosis, Nuclear atypia, Keratin plug,Pappilomatosis, Dyskeratotic cell, Coarse keratohyalin granules , endophytic predominant,exophytic predominant, Acantholysis, Dermal inflammation type of cell, Marginal buttress formation, Cystic structure, Hypogranulosis , Dermal ecstatic vessel, Melanin pigment. We found that : exoendophytic pathological characteristic was present in (50%) of patients, approximately( 37.5 %) presented with endophytic predominance , 79% presented with parakaratosis, (41.1% )presented with hyperkeratosis,( 80% )of the patients had squamous eddies, (72%) of the patients did not show mitosis, (29%) of the patients had nuclear atypia, (25% )presented with keratin plug, (35.7 %) had pappilomatosis,( 62.5% ) had dyskeratotic cell as one ofits pathological characteristic,( 33.9% ) presented with coarse kerato hyaline granules , approximately( 86% )did not have acantholysis, (98.2%) did not have marginal buttress formation , only (5%) showed cystic structure, (34 %) of patients have been reported to have hypergranulosis, 50% of the patients were seen to have presence of dermal ecstatic vessels,( 23.2%) had melanin pigment as one of their pathological characteristic.( 26.8%) patients did not have any dermal inflammation. The most common type of cell found in dermal inflammationwaslymphocytes(53.6).theleastcommoncellswere lymphohistiocyte (1.8), mixed cell (1.8), plasma cells (1.8).The association of the only pathological feature that is,keratin plug and location of lesion seems significant based on statistical view. But no significant relationship was seen between duration of lesion and pathological characteristics The most frequent location of lesion in both genders was related to face. (22.6% females and 77.4% in males) moreover, lesions on trunk and upper extremity were reported in males (4-5%respectively). also only one lesion was reported on neck which was present in a female (p<0.05) It is mostly found in age of over 50 years old and mostly present on face (71%) on face,followed by age group 30 to 50 years(22.6% ) and then patients below 30 years (6.5%). Therefore it can be said that the number of lesions seen in patients has increased with increase in age especially in lower extremity, upper extremity. Only one lesion was observed on neck which was seen in a patient below 30 years old. Moreover, for age group 30 to 50 years ,their lesions were present on face and lower extremity. Furthermore, truncal location was related to age group below 30 years. (p<0.05). With regard to duration of lesion and gender, majority of the lesions in both males and females lasted for less than 3 months. (28.6 % females and 71.4% males) Moreover, only 1 female has had her lesion for 6 to 12 months . (p=0.67) Furthermore, for patients below 30 years old, most of their lesions (60%)lasted for 6-12 months such that none of their lesion existed for more than a year . moreover, 4 patients (40%), from the age group 30 -50 years had their lesion lasted for more than a year. Also, patients above 50 years had most of their lesions for less than 3 months. (71.4%) ( p<0.05).Conclusion: In this descriptive review, we presented information related to demographic,clinical and pathological features of IFK patients.IFK was more common in males than in females and was prevalent in patients above 50 years old. Size of the lesions varied between 0.3 to 3cm with a mean size of 1.01cm.The most common type of lesion was papule followed by nodule and the least common type was ulcer .Moreover majority of the patients had a single lesion lasting for less than 3 months which was mostly located on face followed by scalp and lower extremity. Most of our patients did not mention any underlying disease and had undergone complete excision as their treatment for IFK.The commonly associated pathological abnormalities were squamous eddies, parakeratosis,dyskeratotic cell,dermal ecstatic vessels and the lesion’s endoexophytic predominance. The most common type of cell found in dermal inflammation was lymphocytes and the least ones were lymphohistiocyte , mixed cell and plasma cells.on evaluating the relationship between location of lesion and pathological features, the association of keratin plug and pathological features seems significant . but no significant relationship was found between duration of lesion and pathological features. Most of the lesions were present on face in both the genders.lesions on trunk and upper extremity were seen only in males. the number of lesions seen in patients has increased with increasing age especially in lower extremity,upper extremity .Furthermore , duration of lesion was less in older patients compared to younger patients.

متن يادداشت

Introduction : Inverted follicular keratosis is a rare benign tumor of the follicular infundibulum, usually symmetric, invaginated proliferation of mature squamous cells that may be exophytic or endophytic. It is characterized histologically by the presence of prominent, stereotyped, closely apposed, concentric, laminated whorls of squamous cells with centripetal maturation, the so-called squamous eddies.Clinically, inverted follicular keratosis is usually a solitary lesion less than 1 cm in diameter, typically affecting white middle-aged persons of either sex,usually men. It is a lesion that almost always occurs on hairy skin. The lesion can vary from smooth and papular to verrucous, from skin colored to pigmented, and from orthokeratotic to hyperkeratotic. .The clinical differential diagnosis includes verruca vulgaris, seborrheic keratosis, SCC and a variety of other papules or keratoses. Histoligically 4 growth patterns have been observed,which include a wart-like variant, Keratoacanthoma-like pattern , So