PMC3687166_01
Keloid on the right ear lobe
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F1
The swelling was firm, non-tender, dumbell-shaped, measuring 3 cm in diameter, present medial to the inferior part of the helix [Figure 1].
(a) H and E section showing hyperorthokeratinized stratified squamous epithelium with collagen spanning full thickness of the dermis (x100), (b) Epidermal changes seen are flattening of epithelium, hyperorthokeratosis, hypergranulosis, and spongiosis, regular palisading basal cell organization with prominent vacuolar changes (x200), (c) Dermal changes seen are abnormally large, dense, broad, glassy, and eosinophilic, focally fragmented collagen arranged haphazardly (x400)
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F2
A final diagnosis of Keloid was given [Figure 2].
(a) Van Gieson's stained section showing yellow colored epidermis and thick collagen bundles in dermis showing red color (x40), (b) Under polarized microscopy collagen bundles showing thick reddish orange birefringence (x200)
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F3
Under polarized light, collagen bundles showed reddish to orange birefringence indicating thick fibers [Figure 3].
(a) Keloid collagen showed positivity for alpha-SMA, which is expressed in myofibroblasts, blood vessels and fine collagen, giving an appearance of "Tram track." (x200/x100), (b) Keloid collagen showed scattered diffuse staining of S-100 (x200), (c) Keloid collagen showed desmin negativity (x100)
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F4
Scattered diffuse staining of S-100 was seen and expression of desmin was negative [Figure 4].