International Journal of Dermatology, Vol. 33, No. I t , November 1994

CAMEO

FIBROEPITHELIAL PAPILLOMAOF THE UMBILICUS

JAVIER VICENTE, M.D.,

JAVIER VAZQUEZ-DOVAL, M.D., AND E M I L I O QUINTANILLA, M.D.

A 23-year-old man presented with a long history of psoria-sis. On physical examination, in addition to plaques of psori-asis, we discovered the presence of a tumor in the umbilicalregion. The lesion consisted of a pedicle, 1 cm long that wasjoined at one end to the skin of the umbilicus; on the otherend a moderately pigmented cauliflower-shaped tumorousgrowth, 2 cm in diameter was found (Fig. 1). The tumor wasasymptomatic and had never suppurated or become in-flamed. Its first appearance was not known precisely, al-though it had probably appeared during the first months oflife. Abdominal computerized tomography (CT) revealed nosignificant abnormalities. Extirpation was performed by sec-tion of the pedicle, and the ensuing wound was closed bydirect suture.

Histologic study showed a pedicled tumorous growth ofpolypoid appearance with multiple finger-shaped projec-tions from the pedicle and the free end (Fig. 2). The epider-mis was hyperplastic and irregular. Both the dermis of thedigltations and the pedicle consisted of expanded collagen,a lymphocytic inflammatory infiltrate, and dilated proliferat-ing vessels (Fig. 3). On the basis of the clinical and patho-logic manifestations, a fibroepithelial papilloma of theumbilicus was diagnosed.

DISCUSSION

Any form of dermatosis may produce skin disorders inthe umbilical region; however, the cutaneous tumorsthat occasionally occur as a result of embryologic dis-orders or the detachment of the umbilical cord are ofparticular interest. Furthermore, the scant attentionpaid to tumors in the literature of the subject leads usto assume that their occurrence is rare.

Among the benign tumors of the umbilicus, fibroep-ithelial papillomas are the second most frequent afterthe melanocytic tumors. These growths tend to befound in young adults, and probably arise in child-hood.* They are generally soft, pigmented exophyticlesions that vary in size from 2-3 mm to several cen-

From the Department of Dermatology, University Clinic ofNavarra, School of Medicine, Pamplona, Spain.

Address for correspondence: Javier Vazquez-Doval, M.D.,Departamento de Dermatologia, Clinica Universitaria deNavarra, P.O. Box 192, 31080 Pamplona, Spain.

Figure 1. Umbilicus with a fibroepithelial papilloma.

timeters and have an irregular surface.' The histologicfindings are similar to those obtained from our patient.They are extirpated because of inflammation.

Figure 2. Histologic image with multiple finger-shaped projections from the pedicle and the freeend. (magnification x 8)

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International Journal of DermatologyVol. 33, No. 11, November 1994

Figure 3. Irregular acanthosis and a dense inflammatory in-filtrate in the papillary dermis with dilated vascular prolifera-tion, (magnification x 40)

The differential diagnosis includes pyogenic granulo-ma, endometriosis, dermatofihroma, teratoma, keloid,desmoid tumor, and neurofibroma.^ Fihroepithelial pa-pilloma of the umhilicus may he a marker for the persis-

tence of the omphalomesenteric duct or theHistologically, intestinal or gastric mucosa and smoothmuscle may be present.

In our patient, the fibroepithelial papilloma of theumbilicus should be regarded as a benign tumor thatprobably arose from some anomaly in the detachmentof the cord stump. For some reason this was incom-plete, causing the persisting skin tag to proliferate andacquire the condylomatous appearance that character-izes this growth.^

REFERENCES

1. Steck WD, Helwig EB. Tumors of the umhilicus. Can-cer 1965; 18:907-915.

2. Powell FC, Su WPD. Dermatoses of the umhilicus. Int JDermatol 1988; 27:150-156.

3. Steck WD, Helwig EB. Cutaneous remnants of the om-phalomesenteric duct. Arch Dermatol 1964; 90:463-470.

4. Begg RC. The urachus—its anatomy, histology, and de-velopment. J Anat 1930; 64:170-183.

Dermoscopy

Light that enters the skin is mostly scattered, which scramble the polarization. Afraction of the light is also absorbed by pigment. According to Anderson; most of thelight passing the analyzing filter in this crossed-polarizer configuration is the result ofmultiple light-scattering events by interactions with collagen fibers in the dermis.

Examination of microscopic skin features on live human subjects is riddledwith challenges, not the least of which is the near impossibility of keeping sub-jects still enough to retain a focused still image at high magnifications. Micro-scopic movements are not a problem at the low magnifications typically employedin dermoscopy, which are typically no larger than 10 x. These so-called "derma-toscopes," for example, the skin viewing device available from Heine USA, Inc.(Cary, NC), are designed to be place in direct contact with the skin, to eliminateboth the need for focusing adjustments and any movement-induced aberrations.Hand-held video camera probes are also available, such as the DermaScope fromBio-Rad, Inc. (Hercules, CA) and the "Scopeman" from Moritex, Inc. (SanDiego, CA). Both the dermatoscopes and video probes contain an integrated lightsource to supply sufficient localized illumination.

Clinical examination and diagnosis are still largely conducted without any op-tical aids. As a result, the diagnostic value of higher magnification intravital mi-croscopy remains to be demonstrated. Such capabilities do, however, open upexciting opportunities for investigative dermatology, and bring at least the expec-tation of finding microanatomical indicators of diagnostic value. From DorogiPL, Jackson EM. In vivo microscopy of human skin using polarized light. ] Toxi-col Cut Ocular Toxicol 1994; 13:97-107.

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