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Park L, Crasto D, Kubicki SL, Rivlin D. Trichoblastic Carcinoma in the Glabella Treated With Mohs Micrographic Surgery. Cureus 2024; 16:e63060. [PMID: 39050309 PMCID: PMC11268949 DOI: 10.7759/cureus.63060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
Trichoblastic carcinoma (TBC) is a rare adnexal neoplasm of follicular germ cell differentiation with the potential for local invasion and metastasis. Histologic features of trichoblastic carcinoma have significant overlap with trichoblastoma and basal cell carcinoma (BCC), making diagnosis difficult in some cases. Treatment strategies are not well defined and include surgical excision for localized tumors and systemic therapies for metastatic disease. We present a case of trichoblastic carcinoma clinically resembling a benign cyst that was ultimately treated with Mohs micrographic surgery (MMS).
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Affiliation(s)
- Lily Park
- Department of Dermatology, Larkin Community Hospital, Nova Southeastern University, South Miami, USA
| | - David Crasto
- Department of Dermatology, Larkin Community Hospital, Nova Southeastern University, South Miami, USA
| | - Shelby L Kubicki
- Department of Mohs Micrographic Surgery, Larkin Community Hospital, Nova Southeastern University, South Miami, USA
| | - Daniel Rivlin
- Department of Mohs Micrographic Surgery, Larkin Community Hospital, Nova Southeastern University, South Miami, USA
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Murray DW, Thiel RW, Phillips MA, Grider DJ. BerEP4-Negative Basal Cell Carcinoma: An Immunophenotype Not to Forget. Am J Dermatopathol 2024; 46:386-388. [PMID: 38457681 DOI: 10.1097/dad.0000000000002677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
ABSTRACT Basal cell carcinoma (BCC) is the most common cancer worldwide. Although not typically metastatic, BCC can be locally destructive. BerEP4 is an antibody against CD326, an epithelial cell adhesion molecule (EpCAM) that is expressed on epithelial progenitor cells and carcinomas. BerEP4 has been reported to have a 100% positive sensitivity in basal cell carcinomas, but a much lower sensitivity for a variety of other carcinomas, including clear cell renal cell carcinoma and metastatic renal cell carcinoma. A 74-year-old woman presented with a BerEP4-negative, but anti-renal cell antibody-positive BCC, and the stark clinical implications of misdiagnosis. This case stresses the importance of considering BerEP4-negative BCC, even when other abnormal features are present.
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Affiliation(s)
| | - Robert W Thiel
- Section of Dermatology, Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Mariana A Phillips
- Virginia Tech Carilion School of Medicine, Roanoke, VA
- Section of Dermatology, Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Douglas J Grider
- Section of Dermatology, Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA
- Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, VA; and
- Dominion Pathology Associates, Roanoke, VA
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de Vanssay de Blavous PM, Anketell P, Fernandez CP. A suspicious mole under the knee. Clin Exp Dermatol 2024; 49:655-657. [PMID: 38180105 DOI: 10.1093/ced/llae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/04/2023] [Accepted: 12/27/2023] [Indexed: 01/06/2024]
Abstract
This clinicopathological case describes a rare type of pigmented skin lesion. Pigmented trichoblastomas constitute an extremely rare type of benign primary neoplasm of the skin that can clinically resemble more common malignant neoplasms but present characteristic histological features.
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Nagose VB, Ingle SS, Chandak NO, Gondane SR. A Rare Cutaneous Malignancy: A Primary Cutaneous Carcinosarcoma with Adnexal Epithelial Component (Trichoblastic Carcinosarcoma) of Left Temporal Region. Indian J Dermatol 2024; 69:77-80. [PMID: 38572039 PMCID: PMC10986867 DOI: 10.4103/ijd.ijd_243_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Primary cutaneous carcinosarcoma (PCCS) is a rare cutaneous biphasic tumour with just 120 cases being reported till date. The epithelial component trichoblastic carcinoma/ malignant trichoblastoma (trichoblastic carcinosarcoma) is even rarer, so is the present case. An eighty years old male patient presented with a rapidly progressing ulceroproliferative nodular growth on the left temporal region. The incisional biopsy showed primary cutaneous carcinomasarcoma (PCCS). IHC showed epithelial and stromal component marked exclusively for pancytokeratin (AE1/AE3) CK5&6/ p40 and vimentin respectively. Both components were immunopositive for D2-40 and immunonegative for BerEP4/ S100/ Melan A/ MITF, thus final diagnosis given was Trichoblastic carcinosarcoma. Wide excision of the lesion with local rotation flap and skin grafting (thigh skin) was done. Patient remains disease free after four years also. Present case thus highlights the importance of HPE, IHC and early surgery for excellent prognosis of PCCS.
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Affiliation(s)
- Vaishali B. Nagose
- From the Department of Pathology, GMC, Sindhudurg, Maharashtra, India
- Department of Pathology, DUPMC, Jalgaon, Maharashtra, India
| | | | - Nilesh O. Chandak
- Department of Surgical Oncology, Consultant Surgical Oncologist, Chandak Cancer Hospital, Jalgaon, Maharashtra, India
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Toulemonde E, Chevret S, Battistella M, Neidhardt EM, Nardin C, Le Du F, Meyer N, Véron M, Gambotti L, Lamrani-Ghaouti A, Jamme P, Chaffaut C, De Pontville M, Saada-Bouzid E, Beylot-Barry M, Simon C, Jouary T, Marabelle A, Mortier L. Safety and efficacy of the anti-PD1 immunotherapy with nivolumab in trichoblastic carcinomas. Cancer Immunol Immunother 2023:10.1007/s00262-023-03449-9. [PMID: 37067554 DOI: 10.1007/s00262-023-03449-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 04/06/2023] [Indexed: 04/18/2023]
Abstract
Trichoblastic carcinoma is a rare malignant cutaneous adnexal tumor with a risk of local invasion and distant metastasis. As of today, there is no consensus for the treatment of locally advanced or metastatic trichoblastic carcinoma. "AcSé Nivolumab" is a multi-center Phase II basket clinical trial (NCT03012581) evaluating the safety and efficacy of nivolumab in several cohorts of rare, advanced cancers. Here we report the results of nivolumab in patients with trichoblastic carcinoma. Of the eleven patients enrolled in the study, five patients had been previously treated by sonic hedgehog inhibitors. The primary endpoint 12-week objective response rate was 9.1% (N = 1/11) with 1 partial response. Six patients who progressed under previous lines of treatment showed stable disease at 12 weeks, reflecting a good control of the disease with nivolumab. Furthermore, 54.5% of the patients (N = 6/11) had their disease under control at 6 months. The 1-year overall survival was 80%, and the median progression-free survival was 8.4 months (95%CI, 5.7 to NA). With 2 responders (2 complete responses), the best response rate to nivolumab at any time was 18.2% (95%CI, 2.3-51.8%). No new safety signals were identified, and adverse events observed herein were previously described and well known with nivolumab monotherapy. These results are promising, suggesting that nivolumab might be an option for patients with advanced trichoblastic carcinomas. Further studies on larger cohorts are necessary to confirm these results and define the role of nivolumab in the treatment of trichoblastic carcinomas.
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Affiliation(s)
- E Toulemonde
- Department of Dermatology, Claude Huriez Hospital, CHU de Lille, Lille, France.
| | - S Chevret
- Department of Biostatistics, Saint Louis Hospital, AP-HP, Paris, France
| | - M Battistella
- Department of Pathology, Saint Louis Hospital, AP-HP, Université Paris Cité, INSERM U976, Paris, France
- CARADERM Network, Lille, France
| | - E M Neidhardt
- Department of Oncology, Centre Léon Berard, Lyon, France
| | - C Nardin
- Department of Dermatology, CHU Besançon and INSERM 1098, Besançon, France
| | - F Le Du
- Department of Oncology, CLCC Eugène Marquis, Rennes, France
| | - N Meyer
- Department of Oncodermatology, IUC and CHU Toulouse, Toulouse, France
| | - M Véron
- Department of Dermatology, Claude Huriez Hospital, CHU de Lille, Lille, France
| | - L Gambotti
- Department of Clinical Research, Institut National Contre Le Cancer (INCa), Paris, France
| | | | - P Jamme
- Department of Dermatology, Claude Huriez Hospital, CHU de Lille, Lille, France
| | - C Chaffaut
- Department of Biostatistics, Saint Louis Hospital, AP-HP, Paris, France
| | - M De Pontville
- Department of Dermatology, CHU Caen, Caen, France
- CARADERM Network, Lille, France
| | - E Saada-Bouzid
- Department of Medical Oncology, Centre Antoine Lacassagne, Côte d'Azur University, Nice, France
| | - M Beylot-Barry
- Department of Dermatology, CHU Bordeaux, INSERM U1312, Bordeaux, France
- CARADERM Network, Lille, France
| | - C Simon
- Département R&D Unicancer, Paris, France
| | - T Jouary
- Department of Dermatology, François Mitterrand Hospital, Pau, France
- CARADERM Network, Lille, France
| | - A Marabelle
- Department of Therapeutic Innovations and Early Clinical Trials, INSERM U1015 & CIC1428, University of Paris Saclay, Gustave Roussy, Villejuif, France
| | - L Mortier
- Department of Dermatology, Claude Huriez Hospital, CARADERM and University of Lille, U1189 Inserm, 59000, Lille, France
- CARADERM Network, Lille, France
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Wierzbicka M, Kraiński P, Bartochowska A. Challenges in the diagnosis and treatment of the malignant adnexal neoplasms of the head and neck. Curr Opin Otolaryngol Head Neck Surg 2023; 31:134-145. [PMID: 36912226 DOI: 10.1097/moo.0000000000000872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
PURPOSE OF REVIEW The current review is to present the current knowledge regarding epidemiology, diagnostics, and management of malignant adnexal neoplasms (MANs). RECENT FINDINGS Immunotherapy and gene-related therapies are still being developed as the methods of salvage treatment in advanced and disseminated cases: CACNA1S, ATP2A1, RYR1, and MYLK3, as well as p53 or the JAK/STAT pathways, may be therapeutic targets; the efficiency of talimogene laherparepvec and nivolumab is assessed. SUMMARY MANs are rare tumors, but due to the aging of population their incidence is increasing. Their clinical presentation is unspecific, which makes the diagnosis challenging. Histopathological assessment is difficult even for experienced pathologists. Mohs micrographic surgery or wide local excision are recommended to treat primary lesions. Adjuvant radiotherapy may be beneficial in case of insufficient or positive surgical margins, in nodal metastases, in selected types of MANs like sebaceous, trichilemmal, and pilomatrix carcinomas, and as the induction treatment in large tumors located in medically fragile or cosmetically important regions. The role of chemotherapy is not well defined; however, it is recommended in distant metastases. Immunotherapy can improve the prognosis in advanced stage of the disease.
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Affiliation(s)
- Małgorzata Wierzbicka
- Department of Otolaryngology, Head and Neck Surgery, Poznań University of Medical Sciences
- Institute of Human Genetics, Polish Academy of Sciences
| | - Patryk Kraiński
- Department of Clinical Pathology and Immunology, Poznań University of Medical Sciences, Poznań, Poland
| | - Anna Bartochowska
- Department of Otolaryngology, Head and Neck Surgery, Poznań University of Medical Sciences
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