Hypergranulotic dyscornification: 30 cases of a striking epithelial reaction pattern
Simon F. Roy MD  Christine J. Ko MD  Gilbert W. Moeckel MD, PhD  Jennifer M. McNiff MD
First published: 03 June 2019 https://doi.org/10.1111/cup.13522
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/cup.13522.
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ABSTRACT
BACKGROUND
Hypergranulotic dyscornification (HD) is a rarely reported histologic reaction pattern that may be observed in solitary benign keratoses.

OBJECTIVE AND METHODS
We retrospectively reviewed all cases described as displaying ‘hypergranulotic dyscornification’ at our institution between January 1st 1990 to September 1st 2018. We excluded cases that on retrospective review displayed changes of epidermolytic hyperkeratosis. We conducted electron microscopy (EM) of two lesions.

RESULTS
Thirty cases were identified in our search. Eleven patients were men and 19 were women. Their mean age was 56.9±21.2 years. In contrast to previous reports, we found that HD does not spare the head and neck area. The clinical impressions were frequently inflamed seborrheic keratosis, Bowen disease or inflamed verruca. The most distinctive histopathologic finding was the presence of a prominent granular layer with clumped perinuclear keratohyaline granules. Some cases had mounds of rounded, anucleate glassy eosinophilic corneocytes in the stratum corneum. We observed one case of incidental HD occurring in an epidermoid cyst. EM of HD showed dense perinuclear bands which appeared to match areas of positive staining by keratin immunohistochemistry, without evidence of pale cytoplasmic areas devoid of keratin filaments, characteristic of epidermolytic hyperkeratosis.

CONCLUSION
HD is a reproducible finding in some benign keratoses, likely due to abnormal keratinization. Awareness of this unique reaction pattern will help prevent misdiagnosis.