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Kervarrec T, Lei KC, Sohier P, Macagno N, Jullie ML, Frouin E, Goto K, Taniguchi K, Hamard A, Taillandier A, Tallet A, Collin C, Sahin Y, Barry F, Taibjee S, Cokelaere K, Houben R, Schrama D, Nardin C, Aubin F, Doucet L, Pissaloux D, Tirode F, de la Fouchardière A, Balme B, Laurent-Roussel S, Becker JC, von Deimling A, Samimi M, Cribier B, Battistella M, Calonje E, Guyétant S. Wnt/beta-catenin activated non pilomatrical carcinoma of the skin: a case series. Mod Pathol 2024:100586. [PMID: 39094735 DOI: 10.1016/j.modpat.2024.100586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 07/08/2024] [Accepted: 07/22/2024] [Indexed: 08/04/2024]
Abstract
Among skin epithelial tumors, recurrent mutations in the APC/CTNNB1 genes resulting in activation of the Wnt/β-catenin pathway have been reported predominantly in neoplasms with matrical differentiation. In the present study, we describe the morphologic, immunohistochemical, and genetic features of 16 primary cutaneous carcinomas harboring mutations activating the Wnt/β-catenin pathway without evidence of matrical differentiation, as well as four combined tumors in which a similar Wnt/β-catenin activated carcinoma component was associated with Merkel cell carcinoma or pilomatrical carcinoma. Among the pure tumor cases, 6/16 patients were female with a median age of 80 years (range: 58-98). Tumors were located on the head and neck (n=7, 44%), upper limb (n=4, 25%), trunk (n=3, 18%), and leg (n=2, 13%). Metastatic spread was observed in 4 cases resulting in death from disease in one patient. Microscopically, all cases were poorly differentiated neoplasms infiltrating the dermis and/or subcutaneous tissue. In 13 cases, solid "squamoid" areas were associated with a basophilic component characterized by rosette/pseudoglandular formation resulting in a biphasic appearance. Three specimens consisted only of poorly differentiated carcinoma lacking rosette formation. Immunohistochemical studies showed frequent expression of EMA (100%), BerEP4 (100%), cytokeratin 7 (94%), chromogranin A (44%), synaptophysin (82%) and cytokeratin 20 (69%). Complete loss of Rb expression was observed in all but one case. Nuclear β-catenin and CDX2 expressions were detected in all cases. Recurrent pathogenic somatic mutations were observed in APC (60%), CTNNB1 (40%) and RB1 (n=47%). Global methylation analysis confirmed that cases with rosette formation constituted a homogenous tumor group distinct from established skin tumor entities (pilomatrical carcinoma, Merkel cell carcinoma and squamous cell carcinoma) while the 3 other cases lacking such morphologic features did not. In addition, we identified four combined neoplasms in which there was a component showing a similar poorly differentiated rosette forming carcinoma demonstrating Rb loss and beta-catenin activation associated with either Merkel cell carcinoma (n=3) or pilomatrical carcinoma (n=1). In conclusion, we describe a distinctive neoplasm, for which we propose the term "Wnt/β-catenin activated rosette-forming carcinoma", morphologically characterized by the association of rosette formation, squamous and/or neuroendocrine differentiation, diffuse CDX2 expression, Rb loss, and mutations in CTNNB1/APC genes.
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Affiliation(s)
- Thibault Kervarrec
- Department of Pathology, Université de Tours, Centre Hospitalier Universitaire de Tours, Tours, France; "Biologie des infections à polyomavirus" team, UMR INRA ISP 1282, Université de Tours, Tours, France; CARADERM Network.
| | - Kuan Cheok Lei
- Translational Skin Cancer Research, Department of Dermatology and German Cancer Consortium (DKTK), Partner Site Essen, University Medicine Essen, Essen; and Deutsches Krebsforschungszentrum (DKFZ); Heidelberg, Germany.
| | - Pierre Sohier
- Department of Dermatology, Université de Tours, Centre Hospitalier Universitaire de Tours, Tours, France; Faculté de Médecine, Université Paris Cité, Paris, France; Department of Pathology, Hôpital Cochin, AP-HP.Centre-Université Paris Cité, Paris, France.
| | - Nicolas Macagno
- CARADERM Network; Department of Pathology, Timone University Hospital, Marseille, France
| | - Marie-Laure Jullie
- CARADERM Network; Department of Pathology, Hopital Haut-Leveque, CHU de Bordeaux, Pessac, France
| | - Eric Frouin
- CARADERM Network; Department of Pathology, University hospital of Poitiers, Poitiers France; Department of Pathology, University hospital of Nimes, Nimes, France
| | - Keisuke Goto
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan; Department of Diagnostic Pathology, Shizuoka Cancer Center Hospital, Sunto, Japan; Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan; Department of Dermatology, Hyogo Cancer Center, Akashi, Japan
| | - Kohei Taniguchi
- Department of Pathology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Aymeric Hamard
- Department of Pathology, Université de Tours, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Antoine Taillandier
- Department of Pathology, Université de Tours, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Anne Tallet
- Platform of Somatic Tumor Molecular Genetics, Université de Tours, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Christine Collin
- Department of Pathology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yusuf Sahin
- Department of Pathology, University hospital of Poitiers, Poitiers France
| | - Fatoumata Barry
- Department of Pathology, University hospital of Poitiers, Poitiers France
| | - Saleem Taibjee
- Poundbury Cancer Institute, Dorchester, Dorset, United Kingdom
| | | | - Roland Houben
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, German Dermatology
| | - David Schrama
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, German Dermatology
| | - Charline Nardin
- Department, Inserm 1098, Université de Franche Comté, CHU Besançon, Besançon, France
| | - Francois Aubin
- Department, Inserm 1098, Université de Franche Comté, CHU Besançon, Besançon, France
| | - Laurent Doucet
- Department of Pathology, Université de Brest, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Daniel Pissaloux
- Department of Biopathology, Center Léon Bérard, Lyon, France; University of Lyon, Universite Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Lyon, France
| | - Franck Tirode
- Department of Biopathology, Center Léon Bérard, Lyon, France; University of Lyon, Universite Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Lyon, France
| | - Arnaud de la Fouchardière
- Department of Biopathology, Center Léon Bérard, Lyon, France; University of Lyon, Universite Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Lyon, France
| | - Brigitte Balme
- Dermatology Unit, Hospices Civils de Lyon, Univesrity Hospital Lyon Sud, Pierre Bénite, France
| | | | - Jürgen C Becker
- Translational Skin Cancer Research, Department of Dermatology and German Cancer Consortium (DKTK), Partner Site Essen, University Medicine Essen, Essen; and Deutsches Krebsforschungszentrum (DKFZ); Heidelberg, Germany; Department of Dermatology, University Clinic Essen, Essen, Germany
| | - Andreas von Deimling
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Mahtab Samimi
- "Biologie des infections à polyomavirus" team, UMR INRA ISP 1282, Université de Tours, Tours, France; Department of Dermatology, Université de Tours, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Bernard Cribier
- CARADERM Network; Dermatology Clinic, Hôpitaux Universitaires & Université de Strasbourg, Hôpital Civil, Strasbourg, France
| | - Maxime Battistella
- CARADERM Network; Department of Pathology, APHP Hôpital Saint Louis, Université Paris 7, Paris, France
| | - Eduardo Calonje
- Department of Dermatopathology, St John's Institute of Dermatology, St Thomas's Hospital, London, UK
| | - Serge Guyétant
- Department of Pathology, Université de Tours, Centre Hospitalier Universitaire de Tours, Tours, France; "Biologie des infections à polyomavirus" team, UMR INRA ISP 1282, Université de Tours, Tours, France
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Sugimoto A, Fujimoto M, Masuo Y, Nakagawa Y, Yamada Y, Kono F, Haga H. A Case of Biphenotypic Adnexal Carcinoma With Bowenoid and Basaloid Features: Focus on the Expression of SOX9 and Wnt Signaling Pathway Molecules, Including CDX2. Am J Dermatopathol 2023; 45:835-838. [PMID: 37883950 DOI: 10.1097/dad.0000000000002571] [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: 10/28/2023]
Abstract
ABSTRACT An 87-year-old woman presented with a pedunculated nodule of 1.2 × 1.2 × 0.6 cm on her left cheek. Microscopic examination of the lesion revealed bowenoid and rosette-like basaloid components, resembling Bowen disease and neuroendocrine carcinoma, respectively. Immunohistochemically, both components were positive for Wnt signaling pathway molecules-nuclear/cytoplasmic beta-catenin, lymphoid enhancer binding factor 1 (LEF1), and caudal type homeobox 2 (CDX2)-and the adnexal marker SRY-box transcription factor 9 (SOX9). Unlike neuroendocrine tumors and basal cell carcinomas, the basaloid component in the present case was negative for chromogranin A, INSM1, synaptophysin, and p40. Previously reported cases of similar CDX2-positive lesions were diagnosed as squamous cell carcinoma with enteric adenocarcinomatous differentiation and basaloid cutaneous carcinoma with a primitive cytomorphology. However, the lesion in the present case was simultaneously positive for SOX9, indicating adnexal differentiation. In particular, the expression of multiple Wnt signaling pathway molecules indicates follicular differentiation despite the absence of morphological follicular features, such as shadow cells. Moreover, shared immunopositivity for SOX9, CDX2, nuclear/cytoplasmic beta-catenin, and LEF1 by both bowenoid and basaloid components indicated that the bowenoid component did not represent Bowen disease but a part of the adnexal tumor, and that the basaloid component was not a tumor-to-tumor metastasis. After complete excision, no recurrence has been observed for 5 months. The findings of the present case expand the histological spectrum of cutaneous adnexal tumors with follicular immunophenotypic differentiation.
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Affiliation(s)
- Akihiko Sugimoto
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
- Department of Pathology, Shiga General Hospital, Shiga, Japan; and
| | - Masakazu Fujimoto
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Yumi Masuo
- Department of Dermatology, Shiga General Hospital, Shiga, Japan
| | - Yujin Nakagawa
- Department of Dermatology, Shiga General Hospital, Shiga, Japan
| | - Yosuke Yamada
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Fumihiko Kono
- Department of Pathology, Shiga General Hospital, Shiga, Japan; and
| | - Hironori Haga
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
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