Dyskeratotic cells are squamous cells that have keratinized too early or in the wrong place. Keratinization is the normal process by which squamous cells make and store a tough protein called keratin, but they are only supposed to do this once they reach the surface. A dyskeratotic cell makes keratin while it is still deep within the tissue, which changes how it looks under the microscope.
Dyskeratotic cells are a description of something the pathologist saw under the microscope, not a diagnosis on their own. They can appear in a wide range of situations, from harmless inflammatory or reactive changes to precancerous conditions and cancer. What they mean depends on the context in which they are found. This article explains what dyskeratotic cells look like, what they can indicate, and what to ask about after seeing this term on a report.
What do dyskeratotic cells look like under the microscope?
Under the microscope, a dyskeratotic cell is smaller and rounder than the normal squamous cells around it. Because it has filled with keratin early, its cytoplasm (the body of the cell) stains a bright pink, and its nucleus (the part that holds the cell’s DNA) becomes shrunken and dark. Pathologists usually see dyskeratotic cells scattered one at a time among normal cells, or gathered in small clusters. In many inflammatory skin conditions, these same cells are also called apoptotic (dying) cells, because premature keratinization is often a sign that the cell is dying.
Do dyskeratotic cells mean cancer?
On their own, dyskeratotic cells do not mean cancer. They are a microscopic finding that can appear in many different situations, including harmless reactive and inflammatory changes, as well as precancerous conditions and cancer. What the finding means depends entirely on the context: the other features the pathologist sees, where the sample came from, and the overall clinical picture. For this reason, a report that mentions dyskeratotic cells is interpreted together with the rest of the findings, and sometimes with additional testing, rather than as a diagnosis by itself.
What conditions are associated with dyskeratotic cells?
Dyskeratotic cells can be seen in precancerous, cancerous, infectious, and inflammatory conditions. Common examples include:
- Actinic keratosis (AK) — Actinic keratosis is a precancerous skin change caused by long-term sun exposure. Dyskeratotic cells may be present, and if left untreated, actinic keratosis can progress to squamous cell carcinoma of the skin.
- Bowen disease (squamous cell carcinoma in situ) — Bowen disease is an early form of skin cancer in which the abnormal cells are still confined to the surface layer. Dyskeratotic cells are a common feature.
- Squamous dysplasia — Squamous dysplasia is a precancerous change that can occur on mucosal surfaces such as the mouth, throat, and esophagus.
- Squamous cell carcinoma (SCC) — Dyskeratotic cells are frequently found in squamous cell carcinoma, a cancer that arises from squamous cells and can occur on the skin, lips, mouth, esophagus, and other surfaces.
- Viral infections — Certain viral infections, especially human papillomavirus (HPV), can produce dyskeratotic cells. Persistent infection with high-risk HPV types is a risk factor for cancers of the throat, cervix, and anus.
- Inflammatory skin conditions — Dyskeratotic cells can be seen in a number of inflammatory skin conditions, including lichen planus, pityriasis lichenoides, lichenoid keratoses, lichenoid drug reactions, graft-versus-host disease, erythema multiforme, drug eruptions, and connective tissue disorders such as lupus erythematosus.
- Mucous membrane pemphigoid — This autoimmune blistering disorder affects mucous membranes and can lead to erosions and scarring, with dyskeratotic cells sometimes present in the affected tissue.
Because dyskeratotic cells appear in so many different conditions, their presence in a tissue sample does not provide a diagnosis on its own. The pathologist combines this finding with the other microscopic features, the clinical history, and any additional testing to determine the underlying cause.
Questions to ask your doctor
- What condition were the dyskeratotic cells associated with in my sample?
- Do the dyskeratotic cells in my report point to a harmless, precancerous, or cancerous process?
- Was a specific diagnosis made, or is more testing needed to find the cause?
- Where was my tissue sample taken from, and does that location change what this finding means?
- If the cause is a precancerous condition, do I need treatment or monitoring?
- If the cause is an inflammatory or infectious condition, how is it treated?
- Will I need any follow-up biopsies or skin checks?
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