PMC5362840_01
The ears at first presentation, also showing spontaneous haemorrhage: (a) right pinna; (b) left pinna
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Both ear canals were obstructed and covered with reddish-to-dark-brown verrucous and necrotic tissue (Figure 1).
Histopathology of the tissue easily removed by gentle manipulation. (a) At a low magnification degenerative changes, such as necrosis and vacuolar and hydropic degeneration, are seen, but there are areas of slight or no degeneration that allow observation of pathological findings. Severe papillomatous hyperplasia is seen in the epidermis, and the external root sheaths of hair follicles are preserved. Haematoxylin and eosin, bar = 500 mum. (b) At a higher magnification, the epidermis shows parakeratotic hyperkeratosis, with infiltrating cells that are mainly neutrophils and lymphocytes. Apoptotic keratinocytes are also observed (arrows). Haematoxylin and eosin, bar = 50 mum
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The epidermis and the outer root sheaths of the hair follicles showed marked papillomatous hyperplasia (Figure 2a). A number of pyknotic and hypereosinophilic keratinocytes (apoptotic cells) were observed in the non-degenerated areas (Figure 2b).
Histopathology of the biopsy specimen obtained with endoscopic forceps. (a) Marked hyperplasia of the hair follicles (asterisk) accompanied by epidermal parakeratosis and erosion. Haematoxylin and eosin stain, bar = 100 mum. (b) At a higher magnification, keratinocytes with swollen pale eosinophilic cytoplasm and vesicular nuclei (pyknosis) are seen (arrows). Bar = 20 mum
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Repeat skin biopsy was performed as before, with pathological findings the same as described previously, further supporting a diagnosis of PNOE (Figure 3).