Inverted Follicular Keratosis in External Auditory Canal: Case Report and Literature Review
Bruno Amaral Hay1,2, Juliana Cristina Mesti1,2, Juliana Mattos Baretta1,2, Lorena Cristina Gomes1,2, Ana Luiza Camargo1,2, Andreza Formiga1,2, Gilberto Da Fontoura Rey Bergonse2, Ana Paula Chornobay1,2, Rodrigo Marques Borburema*1,2, Leticia Boçon Rebeiko1,2
1 Centro de Estudos Otorrinolaringológicos Lauro Grein Filho, Curitiba/PR, Brasil
2Departamento de Otorrinolaringologia do Hospital da Cruz Vermelha Brasileira, Curitiba/PR, Brasil
Submission: August 13, 2018; Published: August 22, 2018
*Corresponding author: Rodrigo Marques Borburema, Rua Visconde do Rio Branco, 1102, Mercês, Curitiba-PR, Brazil, Tel: +5541992122503;
Email: [email protected]
How to cite this article: Bruno A H, Juliana C M, Juliana M B, Lorena C G, Ana L C, et al. Inverted Follicular Keratosis in External Auditory Canal: Case Report and
Literature Review. Glob J Oto, 2018; 17(2): 555959. DOI: 10.19080/GJO.2018.17.555959
Objective: we report a rare case of inverted follicular keratosis in external auditory canal. Method: case reports and review of the world literature concerning inverted follicular keratosis in external auditory canal.
Inverted follicular keratosis (IFK) appears as a firm, asymptomatic, pinkish-brown, usually small (less than 1cm in diameter) papule. It is located in the face region in about 85% of cases, especially in the chin and upper lip, other sites of the head and neck can also be affected. It reaches males more often thanfemales and they are usually middle-aged and elderly individuals[1,2]. Histologically it may be classified as a benign tumor of the infundibulum of the hair follicle, although the cause of the onset of this lesion has not yet been fully elucidated. It is characterized by large lobules that extend to the dermis, composedof basaloid cells in the periphery and squamous keratinized cells towards the center with scaly swirls . Some authors postulate that it may be related to viral warts or seborrheic keratosis, others believe that it is an independent entity [5,6,7]. In one study, no inverted follicular keratosis was found in the human papilloma virus, militating against a relationship with viral warts. Dermatoscopy is not enough to establish the diagnosis and to differentiate it from other lesions related to more frequent pathologies, such as viral warts, seborrheic keratosis, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), being necessary the anatomopathological study for definitive diagnosis . The most common method used in the treatment of inverted follicular keratosis is complete surgical excision. After caution surgical excision, there is no evidence of invasive growth or metastasis.
A 35-year-old female patient was seen in the otorhynolaryngology department with sintomns of a longstanding otorrhea. Physical examination revealed a verrucous and bleeding lesion in an external auditory conduit with progressive growth for three years. The audiometry did not show hearing loss and the immitance tympanometry showed a type A tympanometry curve on the left side and type as on the right side. On the tomography, soft-tissue material was evidenced in the external auditory canal, causing partial obstruction of the right conduit (Figures 1&2). Middle ear, mastoid and left ear
without changes. The patient underwent surgical resection of
the lesion and the histopathological analysis of the fragments
revealed the diagnosis of inverted follicular keratosis (IFK).
The presentation of inverted follicular keratosis in the
external auditory canal (EAC) is extremely rare and therefore
often unknown.The pattern reversed in the EAC has a high risk
of erroneous interpretation as an invasive tumor dissemination,
making anatomical pathological analysis mandatory
fordifferentiation . The IKF has chromatic variants, having
relation with the melanin cellular content, being more common
brown and yellow colorations. Although expansive lesions in
EAC commonly cause conductive hearing loss [11,12], there
was no loss in this case. The tomographic study assisted in
the evaluation of the lesion and a complete surgical excision
of the lesion was performed. The development of secondary
degenerations are extremely rare but described in the literature
. The histopathological analysis differentiated it from other
pathologies. After the result, excision of the lesion - treatment
of choice for inverted follicular keratosis-had already been
performed . There was no need for another complementary
treatment because there is no evidence of malignancy.