EPIDERMOLYTIC HYPERKERATOSIS (SOLITARY EPIDERMOLYTIC ACANTHOMA)
The pathology of epidermolytic hyperkeratosis is seen in a variety of unrelated clinical settings. These include congenital ichthyosiform erythroderma, some epidermal nevi, epidermolytic keratosis palmaris et plantaris, solitary epidermolytic acanthoma, disseminated epidermolytic acanthoma, and as an incidental finding without a  noticeable clinical lesion.

Cytoplasmic vacuolization is associated with hypergranulosis and the presence of moderately large eosinophilic granules within cytoplasm. The degree of severity of these components varies from case to case. The vacuolization spares the basal layer. Hyperkeratosis is seen in some cases but not in others. Hyperkeratosis is absent or minimal in the cases where epidermolytic 'hyperkeratosis' is an incidental finding.


A solitary lesion of unknown duration from the scrotum of a 67 year old male.
 
Composite low power view. Hyperkeratosis is prominent in this example.

 
Medium power view. Extreme cytoplasmic vacuolization is present in this case. The basal layer is spared.
Composite high power view. Hypergranulosis is prominent, and the basophilic keratohyaline granules vary in size. Clumps of intracytoplasmic eosinophilic material are present. Granules extend abnormally close to the basal layer.

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