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Carr RA, Wiggins J, Slater DN. Follicular (Infundibular-Tricholemmal) Squamous Cell Carcinoma: A New WHO Entity. Clinicopathological Features in 103 Cases, Including Follow-Up and Implications for Patient Management. Am J Dermatopathol 2024; 46:416-432. [PMID: 38648027 DOI: 10.1097/dad.0000000000002713] [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: 04/25/2024]
Abstract
AIMS Cutaneous follicular (infundibular-tricholemmal) squamous cell carcinoma (FSCC) is a new World Health Organization entity. We present the largest series of published cases, summarizing clinical data, diagnostic criteria, differential diagnosis, and implications for patient management. METHODS Cases were identified from 2004 to 2011. Inclusion criteria included discrete attachment(s) of the tumor to the overlying epidermis via follicular infundibula, tricholemmal keratinization, and cellular pleomorphism. Keratoacanthoma and lesions with adjacent bowenoid epidermal dysplasia were excluded. RESULTS One hundred three cases of FSCC identified. 48.5% demonstrated completely circumscript borders ( in situ for practical purposes), 12.6% uncertain for invasion (overwhelmingly pushing borders), and only 38.8% as clearly invasive. Follicular mucin in acantholytic spaces within tumor epithelium was a distinctive finding in 57.2% of cases. Clinical data indicated predominance in elderly (median 78.5 years) men (70.4%), with preferential head and neck location (81.6%). Many were clinically suspected as squamous cell carcinoma (48.5%). However, a significant minority were clinically diagnosed as basal cell carcinoma (40.8%). This may reflect that FSCC commonly presented as a papule or nodule (51.3%). By contrast, keratoacanthoma was less frequently suggested (17.2%) and still fewer lesions were suspected to be actinic keratosis/Bowen's disease (13.6%). Follow-up in 82 cases (median 26.5 months, range 3-144) identified 5 (6.1%) local recurrences. There was no instance of metastasis in the subgroup of lesions with completely circumscript borders. Three of 45 (6.7%) patients, with follow-up, considered to have tumors with invasive pushing, and/or infiltrative borders developed lymph node metastases. CONCLUSIONS FSCC is identified as a common skin cancer, incorporating historical entities, such as infundibular carcinoma and tricholemmal carcinoma, with readily identifiable histologic features. Correct diagnosis has implications for patient management; a significant subgroup of lesions show completely circumscript borders that are considered in situ for practical purposes.
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Affiliation(s)
- Richard A Carr
- Department of Cellular Pathology, Warwick Hospital, Warwick, United Kingdom; and
| | - James Wiggins
- Department of Cellular Pathology, Warwick Hospital, Warwick, United Kingdom; and
| | - David N Slater
- Department of Histopathology, Royal Hallamshire Hospital, Sheffield, United Kingdom
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Puitandi S, Misra S, Biswas K, Biswas L, Banerjee U. Clinico-Pathological Profile of Basaloid Skin Tumors-Experience from a Tertiary Care Center of Eastern India. Indian J Surg Oncol 2023; 14:708-713. [PMID: 37900627 PMCID: PMC10611659 DOI: 10.1007/s13193-023-01752-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 04/19/2023] [Indexed: 10/31/2023] Open
Abstract
Basaloid tumors comprise a wide spectrum of benign and malignant tumors like basal cell carcinoma, seborrheic keratosis, pilomatricoma, basosquamous carcinoma, trichoblastoma, and cylindroma. Among them, basal cell carcinoma is the most common type which constitutes about 90% of all malignant skin tumor. This study was aimed at analyzing the clinico-pathological profile of basaloid skin tumors attending radiotherapy and surgery OPD of our institution and compares them with those of the reported literature from rest of the country as well as outside world. All cases of basaloid skin tumors presented at radiotherapy, surgery, and dermatology OPD between January 2020 and June 2021 with or without a histological diagnosis were evaluated. Those without a histological diagnosis underwent biopsy and categorized according to standard histological criteria. After histological confirmation, we collected demographic, clinical, and pathological data of the cases. Among 106 patients analyzed, 54.7% (58) cases were diagnosed as basal cell carcinoma followed by seborrheic keratosis (17.9%), pilomatricoma (13.2%), basosquamous carcinoma (9.4%), trichoblastoma (2.8%), and cylindroma (1.8%). Mean age of presentation was 57.03 (± 7.435) years, and head-neck region was the most common site of involvement for basal cell carcinoma. Twenty-two cases required immunohistochemical assessment for confirmation of diagnosis. To conclude, this study is one of its first from Eastern India and will act as a stepping stone for future studies concentrating on clinico-pathological profile, early diagnosis and treatment of basaloid skin tumors.
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Affiliation(s)
- Sampriti Puitandi
- Department of Pathology, Jalpaiguri Government Medical College and Hospital, Jalpaiguri, PIN-735101 West Bengal India
| | - Shiladitya Misra
- Department of Paediatric Medicine, Jalpaiguri Government Medical College and Hospital, Jalpaiguri, PIN-735101 West Bengal India
| | - Koustav Biswas
- Department of Radiotherapy, Nilratan Sircar Medical College and Hospital, AJC Bose Road, Kolkata-700014, West Bengal India
| | - Linkon Biswas
- Department of Radiotherapy, Nilratan Sircar Medical College and Hospital, AJC Bose Road, Kolkata-700014, West Bengal India
| | - Uma Banerjee
- Department of Pathology, Kolkata Medical College and Hospital, 88, College Street, West Bengal 700073 Kolkata, India
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Abstract
Ber-EP4 has been the traditional immunostain used for the detection of basaloid skin tumors. Recently, MOC-31 has shown be superior to Ber-EP4 in the detection of basosquamous basal cell carcinoma (BCC) and many centers are now using both Ber-EP4 and MOC-31 antibodies together to detect these lesions. The objective of this study was to compare the utility of using both Ber-EP4 and MOC-31 immunostains in the detection of basaloid skin tumors and to better characterize the previously unknown staining properties of MOC-31 in cutaneous lesions. To do this, 76 basaloid skin tumors stained with both Ber-EP4 and MOC-31 were obtained. Diagnoses included basosquamous BCC, Merkel cell carcinoma, adenoid cystic carcinoma, microcystic adnexal carcinoma, sebaceous carcinoma, trichoepithelioma, trichoblastoma, sebaceous adenoma, sebaceoma, and follicular induction overlying dermatofibroma. The distribution and intensity of Ber-EP4 and MOC-31 staining in these lesions was scored. These scores were analyzed using a truth table, χ test, and Pearson correlation tests. The overall mean and SD of the scores were also obtained. Overall, we found Ber-EP4 and MOC-31 to be statistically equivalent immunostains for the diagnosis of basaloid skin tumors. We recommend the use of only one of these antibodies and favor MOC-31 for the detection of basaloid skin tumors. We also describe MOC-31 staining properties in different cutaneous lesions.
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Pink Lobulated Scalp Tumor: Answer. Am J Dermatopathol 2019; 41:864. [PMID: 31633554 DOI: 10.1097/dad.0000000000001224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Orzechowska B, Pabijan J, Wiltowska-Zuber J, Zemła J, Lekka M. Fibroblasts change spreading capability and mechanical properties in a direct interaction with keratinocytes in conditions mimicking wound healing. J Biomech 2018; 74:134-142. [DOI: 10.1016/j.jbiomech.2018.04.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/18/2018] [Accepted: 04/19/2018] [Indexed: 01/10/2023]
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Distinct expression profile of stem cell markers, LGR5 and LGR6, in basaloid skin tumors. Virchows Arch 2017; 470:301-310. [DOI: 10.1007/s00428-016-2061-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 11/21/2016] [Accepted: 12/20/2016] [Indexed: 01/22/2023]
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Tellechea O, Cardoso JC, Reis JP, Ramos L, Gameiro AR, Coutinho I, Baptista AP. Benign follicular tumors. An Bras Dermatol 2016; 90:780-96; quiz 797-8. [PMID: 26734858 PMCID: PMC4689065 DOI: 10.1590/abd1806-4841.20154114] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 03/23/2015] [Indexed: 11/22/2022] Open
Abstract
Benign follicular tumors comprise a large and heterogeneous group of neoplasms that
share a common histogenesis and display morphological features resembling one or
several portions of the normal hair follicle, or recapitulate part of its
embryological development. Most cases present it as clinically nondescript single
lesions and essentially of dermatological relevance. Occasionally, however, these
lesions be multiple and represent a cutaneous marker of complex syndromes associated
with an increased risk of visceral neoplasms. In this article, the authors present
the microscopic structure of the normal hair follicle as a basis to understand the
type and level of differentiation of the various follicular tumors. The main
clinicopathological features and differential diagnosis of benign follicular tumors
are then discussed, including dilated pore of Winer, pilar sheath acanthoma,
trichoadenoma, trichilemmoma, infundibuloma, proliferating trichilemmal cyst/tumor,
trichoblastoma and its variants, pilomatricoma, trichodiscoma/fibrofolliculoma,
neurofollicular hamartoma and trichofolliculoma. In addition, the main syndromes
presenting with multiple follicular tumors are also discussed, namely Cowden,
Birt-Hogg-Dubé, Rombo and Bazex-Dupré-Christol syndromes, as well as multiple tumors
of follicular infundibulum (infundibulomatosis) and multiple trichoepitheliomas.
Although the diagnosis of follicular tumors relies on histological examination, we
highlight the importance of their knowledge for the clinician, especially when in
presence of patients with multiple lesions that may be the cutaneous marker of a
cancer-prone syndrome. The dermatologist is therefore in a privileged position to
recognize these lesions, which is extremely important to provide further propedeutic,
appropriate referral and genetic counseling for these patients.
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Affiliation(s)
- Oscar Tellechea
- Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | | | - José Pedro Reis
- Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Leonor Ramos
- Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | | | - Inês Coutinho
- Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
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Webb DV, Mentrikoski MJ, Verduin L, Brill LB, Wick MR. Basal cell carcinoma vs basaloid squamous cell carcinoma of the skin: an immunohistochemical reappraisal. Ann Diagn Pathol 2015; 19:70-5. [PMID: 25702956 DOI: 10.1016/j.anndiagpath.2015.01.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/12/2015] [Accepted: 01/16/2015] [Indexed: 12/15/2022]
Abstract
Typical cutaneous basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are morphologically dissimilar. It is well known, however, that poorly differentiated SCC may assume a basaloid phenotype, complicating the histologic distinction between these 2 neoplasms. Selected immunohistochemical stains have been used in the past to aid in that differential diagnosis. In the current study, additional markers were evaluated to determine whether they would be helpful in that regard. Twenty-nine cases of metatypical (squamoid) BCC (MBCC) and 25 examples of basaloid SCC (BSCC) were studied using the antibodies Ber-EP4 and MOC-31 as well as a plant lectin preparation from Ulex europaeus I (UEA-1). The resulting immunostains were interpreted independently by 3 pathologists, and the results showed that MBCCs demonstrated strong and diffuse staining for Ber-EP4 (25/29) and MOC-31 (29/29). In contrast, BSCCs tended to be only sporadically reactive for both markers (4/25 and 1/25 cases, respectively). Labeling for UEA-1 was observed in almost all BSCCs (24/25), but only 6 of 29 cases of MBCC showed limited, focal staining with that lectin. These data suggest that MOC-31 is a useful marker in the specified differential diagnosis, especially when used together with UEA-1.
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MESH Headings
- Antibodies, Monoclonal/chemistry
- Biomarkers, Tumor/chemistry
- Biomarkers, Tumor/metabolism
- Carcinoma, Basal Cell/diagnosis
- Carcinoma, Basal Cell/metabolism
- Carcinoma, Basal Cell/pathology
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/metabolism
- Carcinoma, Squamous Cell/pathology
- Diagnosis, Differential
- Humans
- Immunohistochemistry/methods
- Skin Neoplasms/diagnosis
- Skin Neoplasms/metabolism
- Skin Neoplasms/pathology
- Ulex/chemistry
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Affiliation(s)
- David V Webb
- Department of Pathology, University of Virginia Medical Center, Charlottesville, VA
| | - Mark J Mentrikoski
- Department of Pathology, University of Virginia Medical Center, Charlottesville, VA
| | - Lindsey Verduin
- Department of Pathology, University of Virginia Medical Center, Charlottesville, VA
| | - Louis B Brill
- Department of Pathology, University of Virginia Medical Center, Charlottesville, VA
| | - Mark R Wick
- Department of Pathology, University of Virginia Medical Center, Charlottesville, VA.
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Lichtenstein DA, Carr RA, Taibjee SM. Trichoepithelioma, not Basal cell carcinoma, in an 8-year-old child. Pediatr Dermatol 2013; 30:276-8. [PMID: 23461691 DOI: 10.1111/pde.12078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
| | - Richard A. Carr
- Department of Pathology; Warwick Hospital; Warwick; United Kingdom
| | - Saleem M. Taibjee
- Department of Dermatology; Birmingham Children's Hospital; Birmingham; United Kingdom
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Desmoplastic trichilemmoma of the facial region mimicking invasive carcinoma. J Maxillofac Oral Surg 2010; 10:71-3. [PMID: 22379325 DOI: 10.1007/s12663-010-0118-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Accepted: 10/15/2010] [Indexed: 12/27/2022] Open
Abstract
Trichilemmoma is a hamartomatous proliferation arising from cells of hair follicle. Its desmoplastic variant simulates an invasive carcinoma. In this tumor, the cell of origin seems to be located in the superficial level of the hair follicle just below the basement membrane at the sebaceous gland level. We present a similar case which presented with an asymptomatic nodular lesion in the region above the upper lip on left side. Fine needle aspiration cytology raised the cytological possibility of a malignancy for which the lesion was excised. On histopathology the lesion was diagnosed as desmoplastic trichilemmoma. The case highlights the difficulty encountered in differentiating a benign adnexal tumor from malignant lesion based on cytology alone. Moreover, the extensive desmoplasia on histopathology raises the suspicion of invasive malignancy which requires to be carefully excluded. The superficial features of trichilemmoma and lack of cellular atypia is a useful diagnostic clue in such a situation. Positivity of CD34 can also be used to differentiate from basal cell carcinomas. The case reported here had a solitary lesion, but follow up is required for development of more lesions or multiple hamartomas in other organs as a part of Cowden's disease.
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Defty CL, Segen J, Carter JJ, Ahmed I, Carr RA. Basaloid squamous cell carcinoma with 'monster' cells: a mimic of pleomorphic basal cell carcinoma. J Cutan Pathol 2010; 38:354-6. [PMID: 21039745 DOI: 10.1111/j.1600-0560.2010.01627.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Pleomorphic giant or 'monster' cells represent a well-recognized yet uncommon finding associated with basal cell carcinoma (BCC), usually of nodular type. We present a case of basaloid squamous cell carcinoma (basaloid SCC) with 'monster' cells that closely mimicked those described in pleomorphic nodular BCC. Clinically, the lesion presented as a fleshy, hyperkeratotic nodule in an 82-year-old woman. Histopathology revealed a basaloid lesion with lobulated borders and focal retraction artifact but a lack of prominent palisading or stromal mucin. There were areas of necrosis and small foci of keratinization. Striking bizarre monstrous pleomorphic nuclei were widely scattered throughout the lesion. Ber-EP4 immunohistochemistry proved to be negative and epithelial membrane antigen (EMA) expression was moderate to strong in 70% of the basaloid epithelium. Monster cells have not previously been highlighted in cutaneous SCC or in its uncommon cutaneous basaloid variant. The prognostic significance of monster cells is unknown but, given the relative paucity of keratinization in basaloid SCC, these lesions should probably be regarded as poorly differentiated. We have not previously encountered an SCC that so closely resembles nodular BCC with pleomorphic monster cells and believe that this is the first such report in the literature.
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Affiliation(s)
- Clare L Defty
- Department of Dermatology, University Hospitals of Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, UK
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Trichoblastoma of the Breast Detected by Screening Mammography: A Diagnostic Pitfall. Am J Surg Pathol 2010; 34:748-54. [DOI: 10.1097/pas.0b013e3181dadd49] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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