Indian Journal of Dermatology
  Publication of IADVL, WB
  Official organ of AADV
Indexed with Science Citation Index (E) , Web of Science and PubMed
 
Users online: 8607  
Home About  Editorial Board  Current Issue Archives Online Early Coming Soon Guidelines Subscriptions  e-Alerts    Login  
    Small font sizeDefault font sizeIncrease font size Print this page Email this page


 
Table of Contents 
QUIZ
Year : 2014  |  Volume : 59  |  Issue : 6  |  Page : 627
Asymptomatic black papule over abdomen


1 Department of Dermatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
2 Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Date of Web Publication30-Oct-2014

Correspondence Address:
Dr. Laxmisha Chandrashekar
Department of Dermatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry - 605 006
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.143560

Rights and Permissions



How to cite this article:
Singh N, Chandrashekar L, Behera B, Thappa DM, Kar R. Asymptomatic black papule over abdomen. Indian J Dermatol 2014;59:627

How to cite this URL:
Singh N, Chandrashekar L, Behera B, Thappa DM, Kar R. Asymptomatic black papule over abdomen. Indian J Dermatol [serial online] 2014 [cited 2020 Aug 15];59:627. Available from: http://www.e-ijd.org/text.asp?2014/59/6/627/143560


A 36-year-old lady presented with an asymptomatic large pore containing black material over the right side of the abdomen of 6 months duration. Examination revealed a single papule with a central pore containing black keratotic material over the right side of the abdomen [Figure 1]a. On trying to extract the keratotic material, a black plug came out [Figure 1]b and the pore became more prominent. It was then excised and sent for histopathological examination. There was no other mucocutaneous abnormality and systemic examination was non-contributory. Histopathological examination of the lesion revealed dilated infundibulum lined by outer root sheath epithelium with infundibular keratinization and keratohyaline granules [Figure 2], [Figure 3] and [Figure 4].
Figure 1: (a) Enlarged solitary comedo containing black keratotic material. (b) Black plug that came out, on comedo extraction

Click here to view
Figure 2: Dilated infundibulum lined by outer root sheath epithelium (H and E, ×40)

Click here to view
Figure 3: An irregular dilated cystic cavity lined by hyperplastic epithelial present in dermis (H and E, ×40)

Click here to view
Figure 4: Infundibular keratinization and keratohyalin granules (H and E, ×100)

Click here to view



   Question Top


What is your diagnosis?


   Answer Top


Diagnosis: Dilated pore of Winer.


   Discussion Top


Dr. Louis H Winer first reported dilated pore in 1954 and hence the name "dilated pore of Winer". [1] It usually presents on the head and neck region of elderly with a solitary keratin filled comedolike lesion. [2] The clinical differential diagnosis includes giant comedo and pilar sheath acanthoma. Dermoscopy of a case of dilated pore of Winer has been described as pinkish white nodule with regularly arranged vessels at the periphery. [3]

On histopathology, the dilated pore has markedly dilated follicular infundibulum lined by outer root sheath epithelium of hair. [4] This histopathological appearance of dilated pore of Winer is said to resemble "a glass of red wine". [5] There are also multiple finger-like short acanthotic projections extending from the infundibulum radiating into the surrounding dermis, sometimes even into subcutaneous tissue. [4] Pilar sheath acanthoma and trichofolliculoma are close histopathological mimics of dilated pore. Pilar sheath acanthoma differs from dilated pore in having larger irregularly branching cystic cavity with radiating larger lobulated masses of cell into the dermis and subcutaneous tissue. Trichofolliculomas are characterized by abnormally large follicles with smaller radiating follicles (secondary follicles). Immunohistochemical study of dilated pore using monoclonal antibodies against involucrin and cytokeratin has shown differentiation towards the infundibulum and partly towards the isthmus. [6]

The exact etiopathogenesis of the dilated pore is not known. It is usually considered to be an adnexal tumor of follicular differentiation. [4] Though Resnik et al. had proposed that dilated pore is histologically a variant of nevus comedonicus, but both of these entities can be distinguished by clinical and histopathological features. [7] Nevus comedonicus presents as grouped papules, usually linear with central keratinous plugs resembling comedones, which may present at any time from birth to 15-year of age. Dilated pore usually presents in elderly but rarely, it may be difficult to clinically differentiate from solitary lesion of nevus comedonicus and then, histopathological differentiation is warranted. Nevus comedonicus on histopathological examination reveals dilated pilosebaceous follicles filled with keratin plugs. [4] The immunohistochemical findings further supports that dilated pore is an adnexal tumor with follicular differentiation towards the infundibulum and partly towards isthmus. [6]

Patients with dilated pore usually report repeated episodes of expressing a keratotic plug from the center of the lesion, which gets refilled again within several weeks. Surgical excision can be performed if desired. Recurrence has been reported and hence a deep excision is advisable. Rarely, dilated pore may be associated with basal cell carcinoma, squamous cell carcinoma or trichoblastoma. [2]

Learning Points

  • Dilated pore of Winer is an adnexal tumor of follicular differentiation
  • It usually presents on the head and neck region of elderly
  • It presents with a solitary keratin filled comedo-like lesion
  • On histopathology, it has markedly dilated follicular infundibulum lined by outer root sheath epithelium of hair resembling "a glass of red wine".




The names of the winners(first three correct entries) are:

  1. Keshavmurthy Adya, Bijapur, Karnataka
  2. Mrinal Gupta,Tanda, Himachal Pradesh
  3. Vishal Gupta, New Delhi




"Others who have sent correct answers are mentioned below:"



Riti Bhatia, Anisha Sethi , Resham Vasani, Bhushan S Madke, Anupam Das, Vinay K, Geeti Khullar, Urmi Khanna, Radhika. S, Zubin Mandlewala, , Shraddha Uprety, Anuradha Kakkanatt Babu, Suresh Kumar K, Manisha Thapa, S. Murugan, Sumit Gupta, Dipti Das, Poonam Puri, , Harsh Sharma , Neetu Bhari, Sweta Rambhia, MONICA CHAHAR, Poonam Puri, Priyanka M. Jain, Atul Jain, Banashree majumdar , Keerthi Subramaniam, C.Vijay Krishna, Kumara Lakshmanan, DIMPLE DODA, Nisha V. Parmar, Suneil Pravin Gandhi, Rangaraj m, L Divya, Surajit Gorai, , Tirthankar Gayen, Gopikrishnan Anjaneyan, Ankan Gupta, G.V.Seethalakshmi, Vivek mishra, S Pradeep Nair, Vikas.Yatagiri, Nilesh Katrodiya, Amanur Rahaman, Bhavesh Devani, , Preethi m cheriyan, sonali bhat, Mounika ala, Vishalakshi S. Pandit, Monali Pattnaik, Sarvesh Thatte, Konchok Dorjay


 
   References Top

1.
Winer LH. The dilated pore, a tricho-epithelioma. J Invest Dermatol 1954;23:181-8.  Back to cited text no. 1
    
2.
Calonje E. Tumors of skin appendages. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook's Textbook of Dermatology. 8 th ed. Oxford: Wiley-Blackwell; 2010. p. 53.3.  Back to cited text no. 2
    
3.
Moreira A, Menezes N, Guedes R, Tente D, Baptista A, Varela P. Dermoscopy of a dilated pore of Winer. Eur J Dermatol 2010;20:229.  Back to cited text no. 3
    
4.
James WD, Berger TG, Elston DM. Epidermal nevi, neoplasms, and cysts. In: James WD, Berger TG, Elston DM, editors. Andrews' Diseases of the Skin-Clinical Dermatology. 11 th ed. China: Saunders Elsevier; 2011. p. 620-74.  Back to cited text no. 4
    
5.
Sarma DP. Dilated pore of Winer, Dr Louis H Winer and Wine Glass. The Internet J Dermatol 2009;7 (2). DOI: 10.5580/15a9. Available from: http://www.archive.ispub.com. [Last accessed on 2013 July 29].  Back to cited text no. 5
    
6.
Morikawa T, Takizawa H, Ohnishi T, Watanabe S. Dilated pore: A case report and an immunohistochemical study of cytokeratin expression. J Dermatol 2003;30:556-8.  Back to cited text no. 6
    
7.
Resnik KS, Kantor GR, Howe NR, Ditre CM. Dilated pore nevus. A histologic variant of nevus comedonicus. Am J Dermatopathol 1993;15:169-71.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

Top
Print this article  Email this article
 
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (2,010 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


   Question
   Question
   Question
   Answer
   Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed3363    
    Printed20    
    Emailed0    
    PDF Downloaded134    
    Comments [Add]    

Recommend this journal