Follicular differentiation in basal cell carcinoma and the trend to designate benign or questionable lesions as malignant

The rate and pattern of bcl-2 and cytokeratin 15 expression in trichoepithelioma and nodular Basal cell carcinoma: a comparative study

Context:

Histopathological evaluations can differentiate between clinically resembling trichoepithelioma (TE) and basal cell carcinoma (BCC) unless the biopsy specimens are small or superficial. Previous studies used immunohistochemical evaluation for Bcl-2 and cytokeratin 15 (CK15), in attempts to differentiate between these two entities, with heterogeneous findings.

Aims:

This study intended to compare the rate and patterns of Bcl-2 and CK15 expressions between specimens of TE and nodular BCC.

Settings and Design:

Case-series including formalin-fixed, paraffin-embedded cutaneous biopsies.

Subjects and Methods:

Twenty-two BCC and 12 TE specimens were stained for Bcl-2 and CK15 and examined microscopically. The rate and patterns of expressions were compared between the two groups.

Statistical Analysis Used:

Statistical analysis was performed using the statistical software (SPSS version 16.0; SPSS Inc., Chicago, IL, USA), Pearson Chi-square, or Fisher's exact tests, wherever appropriate.

Results:

The two groups were comparable for the expression rate and patterns of Bcl-2 (86.4%: 5 central, 14 diffuse in BCC vs. 83.3%: 2 central, 8 diffuse in TE; P = 0.59 and 0.54 for rate and pattern, respectively). The rate of CK15 expression was significantly higher in TE specimens (66.7%: 4 central, 3 diffuse, 1 peripheral vs. 4.5%: 1 central; P < 0.001). The positive likelihood ratio in distinguishing the two neoplasms was 14.7 (95% confidence interval: 2.1-103.7).

Conclusions:

CK15 but not Bcl-2 staining may help in differentiating between BCC and TE even in BCCs with follicular differentiation.

Basal cell carcinomas in mice arise from hair follicle stem cells and multiple epithelial progenitor populations

Uncontrolled Hedgehog (Hh) signaling leads to the development of basal cell carcinoma (BCC), the most common human cancer, but the cell of origin for BCC is unclear. While Hh pathway dysregulation is common to essentially all BCCs, there exist multiple histological subtypes, including superficial and nodular variants, raising the possibility that morphologically distinct BCCs may arise from different cellular compartments in skin. Here we have shown that induction of a major mediator of Hh signaling, GLI2 activator (GLI2ΔN), selectively in stem cells of resting hair follicles in mice, induced nodular BCC development from a small subset of cells in the lower bulge and secondary hair germ compartments. Tumorigenesis was markedly accelerated when GLI2ΔN was induced in growing hair follicles. In contrast, induction of GLI2ΔN in epidermis led to the formation of superficial BCCs. Expression of GLI2ΔN at reduced levels in mice yielded lesions resembling basaloid follicular hamartomas, which have previously been linked to low-level Hh signaling in both mice and humans. Our data show that the cell of origin, tissue context (quiescent versus growing hair follicles), and level of oncogenic signaling can determine the phenotype of Hh/Gli-driven skin tumors, with high-level signaling required for development of superficial BCC-like tumors from interfollicular epidermis and nodular BCC-like tumors from hair follicle stem cells.

Bazex-Dupré-Christol syndrome: an ectodermal dysplasia with skin appendage neoplasms

Bazex-Dupré-Christol syndrome is a rare X-linked genodermatosis characterized by early-onset nonmelanoma skin cancers, atrophoderma follicularis, hypotrichosis, hypohidrosis, and multiple milia. Its molecular basis remains unknown and nosologic classification is debated. We report a 5-year-old child presenting sparse hair, reduced sweating, ice-pick skin depressions of the dorsum of hands, facial and limb milia, perianal skin hyperpigmentation, and hyperpigmented papules of the axillae and neck. His mother showed similar features but lacked hair involvement. Histologic examination of a skin papule obtained from the index case revealed features consistent with trichoepithelioma. Our findings indicate that trichoepitheliomas are an early sign of Bazex-Dupré-Christol syndrome and may guide the diagnosis even before the development of basal cell carcinomas. The high frequency of hypotrichosis, hypohidrosis and dry skin in Bazex-Dupré-Christol syndrome indicates that it may be better classified as an ectodermal dysplasia. Comparison with other conditions combining features of ectodermal dysplasia and proneness to skin tumors suggests the involvement of a common pathogenic pathway implicated in both skin development and cancer.

Expression of class II ?-tubulin in non-melanoma cutaneous tumors

BACKGROUND

Different combinations of beta-tubulin isotypes contribute to the diverse functions of microtubules (MTs). Class II beta-tubulin (class II tubulin) is up-regulated in differentiated keratinocytes. In contrast, the expression of class II tubulin in follicular differentiation and cutaneous tumors has not been studied.

METHODS

The immunohistochemical expression of class II tubulin was investigated in 117 cutaneous tumors: 30 squamous cell carcinomas (SCCs), seven keratoacanthomas (KAs), 57 basal cell carcinomas (BCCs), 23 trichoepitheliomas (TEs), and in the adjacent non-neoplastic skin.

RESULTS

Class II tubulin was expressed in the keratinocytes of the granular layer, melanocytes, hair cortical and cuticular cells, inner root sheath (IRS), companion layer (CL) of the outer root sheath (ORS), and mesenchymal cells with Schwannian or myogenic differentiation. Moreover, class II tubulin expression was increased in the areas of squamous or follicular differentiation in cutaneous tumors. On grading the follicular differentiation or myofibroblastic response with anti-class II tubulin, TE showed follicular differentiation more frequently (p < 0.001) with less of a myofibroblastic response (p = 0.001) than BCC.

CONCLUSIONS

Class II tubulin expression is closely related to squamous or follicular differentiation and may be helpful in distinguishing most SCCs from KAs and BCC from TE. However, it does not reliably distinguish well-differentiated, crateriform SCC from KA.

Molecular diagnosis of basal cell carcinoma and other basaloid cell neoplasms of the skin by the quantification of Gli1 transcript levels

BACKGROUND

Distinguishing basal cell carcinoma (BCC) from other benign and malignant skin tumors is sometimes a difficult task for the pathologists. Because the activation of hedgehog signals and the up-regulation of its critical transcriptional factor Gli1 are well documented in BCC, a molecular technique measuring Gli1 transcripts may aide the diagnosis.

METHODS

Gli1 transcript levels were measured by real-time quantitative reverse transcriptase polymerase chain reaction (RT-PCR) using RNA extracted from formalin-fixed, paraffin-embedded tissues of 68 cases of various skin tumors. Hematoxylin and eosin-stained pathology slides were independently reviewed by three expert dermatopathologists.

RESULTS

The histological diagnoses were unambiguous in 53 tumors. The tumors included BCC (21), squamous cell carcinoma (13), seborrheic keratoses (8), trichoepithelioma (5), eccrine poroma/porocarcinoma (4), and sebaceous epithelioma/carcinoma (2). In these unambiguous cases, all BCC and trichoepithelioma tumors showed high expression of Gli1mRNA, while the expression was virtually absent in other tumors. The diagnosis was discordant among three pathologists in the remaining 15 tumors. Histological diagnoses included BCC, BCC with sebaceous differentiation, sebaceoma/sebaceous epithelioma, trichoblastoma, trichoepithelioma, basaloid follicular harmartoma, basosquamous carcinoma, etc. Six of them showed high Gli1 transcript levels.

CONCLUSIONS

Quantification of Gli1 transcripts by RT-PCR is helpful in discriminating BCC and trichoepithelioma from other skin tumors.