Dilated Pore of Winer; What’s That!

INTRODUCTION

Winer’s dilated pore (WDP) or dilated pore of Winer (DPOW) is a rare benign appendageal adnexal tumour characterised by dilated follicular pore filled with keratinous material. DPOW typically presents as massive comedone mostly affecting face, neck, upper trunk and genitalia, commonly found in males. Multiple lesions have been observed on rare occasions.^[1] Here, we present a case report of a 55-year-old female with a giant comedone-like papular lesion over the mons pubis.

CASE REPORT

A 55-year-old female presented with complaint of single, asymptomatic non-tender swelling over mons pubis for 3 months. Onset was insidious and gradually progressive over 3 months. Physical examination showed a single large hyperpigmented dilated pore over mons pubis surrounded by a similar dilated pore with its opening at a 1’O clock position [Figure 1]. No discharge, tenderness or surrounding lymphadenopathy was found. A massive central keratinous plug was present which entirely filled the pore. Surgical excision was done as shown in [Figure 1]. Excised specimen on histopathological examination showed dilated follicular infundibulum extending into the dermis filled with keratin material lined by epithelium [Figure 2].

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Figure 1:

Dilated pore of Winer at the mons pubis at presentation and after excision showing complete healing.

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Figure 2:

Histopathological image showing dilated follicular infundibulum extending into the dermis filled with keratin material lined by epithelium. (H&E, ×4).

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DISCUSSION

DPOW was first described in 1954 by Winer.^[2] It occurs as a small solitary papule centred by a follicular pore on the face, neck or back, mimicking a giant comedone, presenting in the 4–5^th decade. It occurs more frequently in men and is also seen more commonly in whites. It could be multiple or be agminated with a linear distribution (dilated pore nevus).^[3] It presents as an asymptomatic, enlarged solitary comedone without any perilesional inflammation or induration.^[4] Histopathologically, it is characterised by a markedly dilated follicular infundibulum extending deeply into the dermis. The cavity is filled with lamellar keratin material lined by epithelium that is atrophic near the ostium and acanthotic at the deeper portion of the invagination. Radiating epithelial projections push into the surrounding dermis at regular intervals. These projections do not contain keratin cysts, ducts or hair shafts.^[3] A clinical diagnosis of a DPOW is due to its classical presentation. Histopathologic analysis might be carried out when the diagnosis is unclear.^[5] Klovekorn et al. divided the benign neoplasm into four types that is, funnel-shaped, balloon-shaped, multi-lobular with cystic compartments and a superficial type.

Dermoscopic characterisation can help in asserting the clinical diagnosis or when other follicular disorders have to be differentiated.^[4] Dermoscopy although not done in our case shows bluish-black central homogenous non-descriptive area of keratin plug with grey-white halo around the central pore.^[6] The surrounding skin is usually normal. Other differentials can be a large comedone, which is a dilated infundibular cavity filled with lamellar orthokeratosis and limited by infundibular epithelium without elongated rete ridges.^[3]

CONCLUSION

The presence of DPOW around genitalia is unusual and rare, making the case intriguing, although there are case reports of it occurring over the vulva. Although surgical excision is the primary line of treatment for WDP, electrocautery could be used for treating the superficial variant of this entity. Simple comedone extractor can also be of help in treating small DPOWs.