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Laokulrath N, Lim SK, Lim HY, Gudi M, Tan PH. Case report: Metastatic ovarian mucinous carcinoma to the breast: diagnostic challenges and pitfalls. Front Oncol 2024; 14:1364011. [PMID: 38562166 PMCID: PMC10982378 DOI: 10.3389/fonc.2024.1364011] [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: 01/01/2024] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Metastases to the breast from extramammary sources are extremely rare, with the ovary, primarily high-grade serous carcinoma, being the most common origin. We report a case of breast metastases from advanced stage ovarian mucinous carcinoma in a 48-year-old female- a case hitherto unreported in the literature. The case is noteworthy for its atypical presentation marked by an areolar rash, clinically suggestive of Paget disease of the nipple. This unique clinical scenario, coupled with histopathological examination revealing in-situ-like carcinoma component, posed a diagnostic challenge in discerning the tumour origin. We emphasize the need for heightened awareness among pathologists to avoid misdiagnosing metastatic carcinomas as primary breast tumours, a potential pitfall with significant clinical implications.
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Affiliation(s)
- Natthawadee Laokulrath
- Department of Pathology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Pathology and Laboratory Medicine, Kandang Kerbau (KK) Women’s and Children’s Hospital, Singapore, Singapore
| | - Siew Kuan Lim
- Solis Breast Care and Surgery Centre, Singapore, Singapore
| | | | - Mihir Gudi
- Department of Pathology and Laboratory Medicine, Kandang Kerbau (KK) Women’s and Children’s Hospital, Singapore, Singapore
| | - Puay Hoon Tan
- Department of Pathology and Laboratory Medicine, Kandang Kerbau (KK) Women’s and Children’s Hospital, Singapore, Singapore
- Luma Medical Centre, Singapore, Singapore
- Parkway Laboratory Services Ltd, Singapore, Singapore
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Mitra A, Schulman JM. Expression of Ber-EP4 and CD34 can distinguish clear-cell basal cell carcinoma from trichilemmoma: A case series. Indian J Dermatol Venereol Leprol 2024; 90:118-120. [PMID: 37317725 DOI: 10.25259/ijdvl_468_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 03/05/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Anupam Mitra
- Department of Pathology, University of California Davis, Sacramento, United States
| | - Joshua M Schulman
- Department of Dermatology, Veteran Affairs Hospital Mather & University of California Davis, Mather, CA, United States
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Chaudet KM, Stagner AM, Nazarian RM. Use of Cytokeratin 17 in the Differentiation Between Desmoplastic Trichilemmoma and Cutaneous Basal Cell Carcinoma. Am J Dermatopathol 2022; 44:886-890. [PMID: 36197047 DOI: 10.1097/dad.0000000000002302] [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: 11/05/2022]
Abstract
ABSTRACT Desmoplastic trichilemmoma (DTL) is a variant of trichilemmoma characterized by a prominent desmoplastic stroma that may mimic invasive carcinoma. These lesions typically show features of a conventional trichilemmoma at the periphery, surrounding dense hyalinized stroma with entrapped cords of tumor cells. On a small or superficial biopsy, DTL may pose a diagnostic challenge in distinguishing this benign adnexal neoplasm from invasive carcinoma, particularly basal cell carcinoma (BCC). We aimed to investigate whether the immunohistochemical expression of cytokeratin 17 (CK17) would be useful in the differentiation between DTL and BCC. CK17 is expressed in normal adnexal structures and has been shown to demonstrate strong staining in BCCs. Expression of CK17 was examined in 23 cases of DTL and 23 BCCs. An immunoreactivity score was assigned using the percentage of tumor cells staining with scoring as follows: 0, complete negativity; 1, < 15% tumor cells staining; 2, 15%-84% tumor cells staining; and 3, >85% staining. All cases of BCC scored as 3, whereas 18% of DTL scored as 3. The mean percent staining for CK17 was significantly higher for BCCs (97% of tumor cells) than DTLs (57% of tumor cells); P < 0.001 in the unpaired t test. The pattern of CK17 staining may also help differentiate between cases scoring 3. All BCCs showed strong diffuse staining throughout, whereas for those cases of DTL with a score of 3, the peripheral basaloid rim in the tumor lobules did not stain. CK17 is a useful adjunct in distinguishing DTL from BCC in small or superficial biopsy specimens.
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Affiliation(s)
- Kristine M Chaudet
- Dermatopathology Unit, Department of Pathology, Massachusetts General Hospital, Boston, MA
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CD34 and BerEP4 Are Helpful to Distinguish Basaloid Tricholemmoma From Basal Cell Carcinoma. Am J Dermatopathol 2018; 40:561-566. [PMID: 29570129 DOI: 10.1097/dad.0000000000001117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Tricholemmoma, a benign follicular neoplasm with outer root sheath differentiation, typically comprises clear or pale cells, and when multiple is pathognomic of Cowden's syndrome. The tumor is probably underrecognized and in basaloid examples can be difficult to distinguish from basal cell carcinoma (BCC). We studied 55 tricholemmomas (including 15 basaloid cases) and compared immunohistochemical profile with nodular BCC from our archives. Basaloid and non-basaloid tricholemmomas had similar staining characteristics. BerEP4 was focally positive (range 10%-20%) in only 3/39 (7.7%) tricholemmomas compared with widespread positivity in BCC (90.8%, 139 of 151 cases with ≥50% tumor area stained). CD34 was expressed, usually focally (median 20%, range 10%-90%), in 52/53 (98.1%) tricholemmomas and was negative in all 21 BCCs stained. EMA staining lacked sensitivity or specificity in differentiating tricholemmoma from BCC. Five or more Merkel cells were found in 7/17 (40.1%) tricholemmomas and 1/23 (4.3%) nodular BCCs studied. In summary, immunohistochemistry is helpful in distinction between tricholemmoma, including difficult basaloid examples (BerEP4 negative or focal, CD34 positive) compared with BCC (BerEP4 widespread in most cases, CD34 negative). The presence of 5 or more Merkel cells is a relatively specific but not a particularly sensitive discriminator.
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Histopathologic pitfalls of Mohs micrographic surgery and a review of tumor histology. Wien Med Wochenschr 2016; 168:218-227. [PMID: 27832425 DOI: 10.1007/s10354-016-0528-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 10/18/2016] [Indexed: 01/15/2023]
Abstract
Mohs micrographic surgery is a specialized subset of staged surgical excisions with each subsequent stage being driven largely by the histologic findings of the previous stage. Therefore, it is imperative that histologic analysis is performed in an accurate manner. Frozen section and tissue flattening is a crucial step in Mohs surgery. Frozen sections introduce certain artifacts and these artifacts must be interpreted in the correct context. Basal and squamous cell carcinomas are the most common tumors encountered in Mohs micrographic surgery, and their histopathology is also associated with certain "pitfalls". Basal cell carcinoma should be distinguished from hair follicles, folliculocentric basaloid proliferations, poromas, nevus sebaceous, desmoplastic trichoepitheliomas, and spiradenomas, to name but a few histologic entities. Similarly, squamous cell carcinoma should be distinguished from hypertrophic actinic keratoses, pseudoepitheliomatous hyperplasia, sebaceous carcinoma, and microcystic adnexal carcinoma. In addition, there are numerous subtypes of basal cell and squamous carcinomas that the Mohs surgeon should be aware of due to differences in the biologic behavior of these tumors. This review presents a number of the common histologic pitfalls of Mohs micrographic surgery and a review of tumor histology.
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Torres-Gómez F, Fernández-Machín P, Neila-Iglesias J. Basal Cell Carcinoma With a Cylindromatous Phenotype. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2015.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Torres-Gómez FJ, Fernández-Machín P, Neila-Iglesias J. Basal Cell Carcinoma With a Cylindromatous Phenotype. ACTAS DERMO-SIFILIOGRAFICAS 2015; 107:165-7. [PMID: 26522236 DOI: 10.1016/j.ad.2015.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 08/10/2015] [Accepted: 09/06/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- F J Torres-Gómez
- Unidad de Anatomía Patológica, Área de Gestión Clínica de Biotecnología, Agencia Pública Sanitaria Bajo Guadalquivir, Sevilla, España.
| | - P Fernández-Machín
- Unidad de Anatomía Patológica, Área de Gestión Clínica de Biotecnología, Agencia Pública Sanitaria Bajo Guadalquivir, Sevilla, España
| | - J Neila-Iglesias
- Servicio de Dermatología, Agencia Pública Sanitaria Bajo Guadalquivir, Sevilla, España
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Chu SWW, Biswas A. Basal cell carcinomas showing histological features generally associated with cutaneous adnexal neoplasms. J Cutan Pathol 2015; 42:1049-1062. [PMID: 26264868 DOI: 10.1111/cup.12577] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 09/12/2014] [Accepted: 05/03/2015] [Indexed: 12/28/2022]
Abstract
Basal cell carcinoma (BCC) is the commonest malignant neoplasm in humans. Although a histopathological diagnosis of BCC is straightforward in the vast majority of cases, unusual histological variants can present a diagnostic challenge. A small proportion of BCCs show features which are generally associated with cutaneous adnexal neoplasms. Such changes may involve either the epithelium or the stroma and can mislead the pathologist particularly in small biopsies. Despite the growing evidence which speculate that BCC is a primitive follicular tumor, it is unusual to encounter tumors which actually show definitive signs of adnexal differentiation. This review aims to address this somewhat overlooked aspect of a very common tumor and offers practical guidance to distinguish them from adnexal neoplasms which they might mimic.
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Affiliation(s)
| | - Asok Biswas
- Department of Pathology, Western General Hospital, Edinburgh, UK
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Misago N, Toda S, Narisawa Y. CD34 expression in human hair follicles and tricholemmoma: a comprehensive study. J Cutan Pathol 2011; 38:609-15. [DOI: 10.1111/j.1600-0560.2011.01749.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sellheyer K. Basal cell carcinoma: cell of origin, cancer stem cell hypothesis and stem cell markers. Br J Dermatol 2011; 164:696-711. [PMID: 21128907 DOI: 10.1111/j.1365-2133.2010.10158.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cancer stem cells have recently been described in several high-grade neoplasms. It is still unclear if they also occur in cutaneous malignancies. Cancer stem cells are not identical with somatic stem cells. The presence of tumour stem cells in a neoplasm does not in itself equal that the tumour derives from a somatic stem cell. A cell originally lacking stem cell characteristics could also acquire those features during the course of carcinogenesis and then becomes the clonal founder cell of a tumour. Basal cell carcinoma (BCC) is the most common cutaneous malignancy. A plethora of various stem cell markers has been applied to study its cellular origin. Intriguingly, the anatomical origin of BCC is still uncertain. This review will discuss the various stem cell markers used in BCC and the cellular origin of this tumour, and touches briefly on the possibility of cancer stem cells in BCC. If BCC or other skin cancers harbour tumour stem cells, these cells could be specifically targeted, making use of specific cell surface molecules such as receptor proteins. Novel drugs directed against those receptor proteins could replace currently available shotgun approaches including imiquimod.
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Affiliation(s)
- K Sellheyer
- Department of Dermatology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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Spiradenoma and spiradenocylindroma with an adenomatous or atypical adenomatous component: a clinicopathological study of 6 cases. Am J Dermatopathol 2008; 30:436-41. [PMID: 18806484 DOI: 10.1097/dad.0b013e3181812729] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report 5 cases of spiradenoma and 1 case of spiradenocylindroma, which, in addition to areas of conventional growth, manifested an adenomatous component. This consisted of compactly situated, well-developed glands having small round lumens lined by inner pale to eosinophilic cells and surrounded by an outer well-formed peripheral layer of myoepithelial cells, which reacted with a variety of myoepithelial cell markers. In 1 case, apocrine secretion was evident in the glandular part of the lesion. In 4 of the 6 cases, the adenomatous component was a minor but significant portion of the tumors, but in 2 cases it was extensive, comprising approximately 20% of the tumor area. In 1 of these 2 cases, the luminal epithelium showed atypia including rare, atypical mitotic figures. In addition, there were foci of glands showing myoepithelial cell loss. As this alteration was limited and fairly well circumscribed within the tumor bulk, we regard it as an "atypical adenomatous component," but we cannot exclude the possibility that this may represent an incipient apocrine carcinoma, despite uneventful follow-up. Three cases also manifested clear cell areas. Immunohistochemical studies demonstrated that myoepithelial proliferation and overgrowth accounted for the clear cell change in some of the lesions.
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Jones M, Bresch M, Alvarez D, Böer A. Keloidal basal cell carcinoma: not a distinctive clinicopathological entity. Br J Dermatol 2008; 160:127-31. [PMID: 18795924 DOI: 10.1111/j.1365-2133.2008.08828.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Keloidal basal cell carcinoma (BCC) has been reported as a rare but distinctive variant of BCC. OBJECTIVES To determine the frequency of keloidal collagen in BCC and to correlate it with clinical, histopathological and immunohistochemical features. METHODS Over 12 months, all cases of BCC with thick sclerotic collagen were collected and studied for clinical diagnosis, site, histopathological features and immunohistochemistry (collagen I, III, IV, laminine) in comparison with five keloids. RESULTS Of 1011 BCCs seen, 18 showed thick sclerotic collagen. In two cases, these stained positive for collagen type IV or laminine, indicating basement membrane material. In 16 cases, sclerotic bundles stained positive for collagen type I but not for types III, IV, and laminine, as do keloids. The clinical diagnosis was BCC (13), squamous cell carcinoma (one) or keloid (one). Fourteen lesions came from the face, nine of them from the ear. Keloidal collagen was extensive in 10 lesions, including all from the ear. Histologically, tumours often had morphoeiform zones (14), necrosis en masse (eight) and ulceration (nine). CONCLUSIONS Keloidal collagen in BCC is not as rare as reported and consists of type I collagen, the same as in keloids. It does not characterize a distinctive clinicopathological entity but is found in different histological types of BCC with varying clinical appearance. Keloidal collagen in BCC is associated with morphoeiform features, ulceration and necrosis. Interestingly, extensive keloidal collagen is more often seen in BCC on the ear, a site prone to develop keloids.
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Affiliation(s)
- M Jones
- Department of Dermatology, Military Hospital of Tunis, Tunis, Tunisia
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Abstract
In this report, we present two cases of axillary lymph node metastatic breast carcinoma with features mimicking ductal carcinoma in situ (DCIS): one was of the comedo-like type and the other was suggestive of the micropapillary type. In the first case, the primary tumor presented DCIS of the comedo type; however, in the second case, the primary tumor consisted only of the invasive ductal component. Immunohistochemistry against smooth muscle actin, S100-protein, CK5/6, CD10, P63, and 34betaE12 did not identify myoepithelial cells either in DICS of the first primary tumor or in both metastases. These features probably do not represent the true DCISs, but only mimic them. This observation suggests that a proportion of "primary DCIS" may constitute an invasive pseudo-DCIS carcinoma, and immunohistochemical identification of myoepithelial cells may be helpful in such cases.
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Affiliation(s)
- Radzislaw Kordek
- Department of Pathology, Chair of Oncology, Medical University of Lodz, Ul Paderewskiego 4, 93-509 Lodz, Poland.
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Misago N, Satoh T, Narisawa Y. Basal cell carcinoma with tricholemmal (at the lower portion) differentiation within seborrheic keratosis. J Cutan Pathol 2003; 30:196-201. [PMID: 12641780 DOI: 10.1034/j.1600-0560.2003.00020.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Recent genetic investigations support the idea that basal cell carcinoma (BCC) is trichoblastic carcinoma. However, it is generally thought that clear cell basal cell carcinoma is a result of degeneration rather than tricholemmal differentiation. METHODS We report a case of BCC, with clear cell components, that developed within seborrheic keratosis, with histopathological and immunohistochemical findings. RESULTS The clear cell components in the present case showed the following four characteristics: (i) at the periphery of the aggregations, columnar clear cells were aligned in a palisade along a well-defined basement membrane; (ii) the nuclei of the columnar clear cells were at the pole opposite the basement membrane; (iii) the clear cells contained glycogen; (iv) in the aggregations with clear cell components, there was diffuse positive staining for cytokeratin 7 (CK7) (OV/TLR/30), but only the inner region stained positive for CK17. These four characteristics are comparable to those of the lower portion of normal outer root sheath. In addition, the BCC in the present case was partly composed of squamous cells that contained glycogen and were selectively positive for CK17 - features similar to those of squamous cells in normal outer root sheath. CONCLUSIONS Some clear cell BCCs are simply the result of degenerative change, but other clear cell BCCs may be the result of tricholemmal (at the lower portion) differentiation.
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Affiliation(s)
- Noriyuki Misago
- Division of Dermatology, Department of Internal Medicine, Saga Medical School, Saga, Japan.
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Haas N, Audring H, Sterry W. Carcinoma arising in a proliferating trichilemmal cyst expresses fetal and trichilemmal hair phenotype. Am J Dermatopathol 2002; 24:340-4. [PMID: 12142616 DOI: 10.1097/00000372-200208000-00011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Carcinomas that arise in a proliferating trichilemmal cyst (PTC) have been described under a variety of names. Monoclonal antibodies (mAbs) indicating follicular differentiation have become available and were used here in two rare tumors with uncommon biologic behavior. To further elucidate the histogenesis of carcinomas arising in a PTC, mAbs to hair follicle stem cells and to hair follicle differentiation-specific cytokeratins (mAbs to cytokeratin [CK] 7, CK8, CK18, and CK19 as well as mAbs to CD8/CK15 and CD34) were studied on paraffin-embedded sections of two cases of carcinoma arising in a PTC, one anaplastic carcinoma, and one poorly differentiated squamous cell carcinoma (SCC). For comparison, concurrent PTCs and trichilemmal cysts as well as four SCCs from controls were studied. The anaplastic carcinoma showed expression of CK7, indicating a fetal hair root phenotype, and expression of CD34, indicating trichilemmal differentiation. In contrast, the poorly differentiated SCCs as well as the control SCCs stained negative for most of the mAbs applied. Expression of fetal and trichilemmal hair follicle phenotypes suggests differentiation from hair stem cells and might explain differences in biologic behavior.
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Affiliation(s)
- Norbert Haas
- Department of Dermatology, Medical Faculty (Charité), Humboldt-University Berlin, Berlin, Germany.
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Illueca C, Monteagudo C, Revert A, Llombart-Bosch A. Diagnostic value of CD34 immunostaining in desmoplastic trichilemmoma. J Cutan Pathol 1998; 25:435-9. [PMID: 9826169 DOI: 10.1111/j.1600-0560.1998.tb01770.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Desmoplastic trichilemmoma (DT) is a variant of trichilemmoma, characterized by a central prominent desmoplastic component which may simulate invasive carcinoma. We have studied the morphologic and immunohistochemical features of seven cases of DT. Immunohistochemistry was performed on paraffin sections using monoclonal antibodies to CD34 (QBEND/10), vimentin and GCDFP-15. CD34 was also tested in seven cases of basal cell carcinoma (BCC), three with outer root sheath differentiation and four with morphea-form features, and five squamous cell carcinomas. Histologically, features of conventional trichilemmoma were seen at the periphery of the seven lesions. In contrast, at the center, the epithelial cells tended to cluster in narrow irregular cords and nests entrapped in a dense collagenous stroma. One case of DT coexisted with a BCC. In all cases of DT, epithelial tumor cells showed CD34 immunostaining. All cases of BCC, including the one contiguous to a DT, were CD34 negative. CD34 immunodetection in the epithelial cells of the pseudoinvasive component of DT may be of great value in the differential diagnosis with other desmoplastic tumors of the skin, and particularly with BCC.
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Affiliation(s)
- C Illueca
- Department of Pathology, Hospital Clinico Universitario, University of Valencia, Spain
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