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Carr RA, Mesiano D, Heffron C, Radonic T, Wiggins J, Tso S, Agrawal R, Cheung E, Slater DN, Nichols L, Craig P. Aberrant p16, p53 and Ki-67 immunohistochemistry staining patterns can distinguish solitary keratoacanthoma from cutaneous squamous cell carcinoma. Pathology 2023; 55:772-784. [PMID: 37573161 DOI: 10.1016/j.pathol.2023.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 06/16/2023] [Accepted: 07/09/2023] [Indexed: 08/14/2023]
Abstract
Keratoacanthoma (KA) is widely considered a benign, usually self-resolving, neoplasm distinct from cutaneous squamous cell carcinoma (cSCC), while some consider KA to be indistinguishable from cSCC. Published studies indicate utility for p16, p53, Ki-67 immunostaining and elastic van Gieson (EVG) in the assessment of KA and cSCC. We compared clinical features and staining patterns for p16, p53, Ki-67 and EVG in fully excised KA, cSCC with KA-like features (cSCC-KAL) and other cSCC (cSCC-OTHER). Significant differences between KA, cSCC-KAL and cSCC-OTHER were found for head and neck location (20%, 86%, 84%), and duration <5 months (95%, 63%, 36%). KA shows both a mosaic pattern for p16 (>25-90% of neoplasm area) and peripheral graded pattern for p53 (up to 50% moderate and strong nuclear staining) in 92% compared with 0% of cSCC-KAL and 0% of cSCC-OTHER. In contrast, a highly aberrant pattern (usually null) for one or both p16 and p53, was present in 0% of KA, 83.8% of cSCC-KAL and 90.9% of cSCC-OTHER. Abnormal distribution of Ki-67 beyond the peripheral 1-3 cells was uncommon in KA (4.2%) and common in cSCC-KAL (67.6%) and cSCC-OTHER (88.4%). Moderate to striking entrapment of elastic and collagen fibres was present in the majority of KA (84%), cSCC-KAL (81%) and cSCC-OTHER (65%). KA are clinically distinct neoplasms typically of short duration occurring preferentially outside the head and neck and generally lacking aberrations of p16, p53 and Ki-67, compared with cSCC that have high rates of aberrant or highly aberrant p16, p53 and Ki-67, but EVG lacked specificity.
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Affiliation(s)
- Richard A Carr
- Cellular Pathology, South Warwickshire NHS Foundation Trust, Warwick, UK.
| | - Domenico Mesiano
- Cellular Pathology, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - Cynthia Heffron
- Department of Pathology, Cork University Hospital, Cork, Ireland
| | - Teodora Radonic
- Department of Pathology, Amsterdam University Medical Center, Netherlands
| | - James Wiggins
- Cellular Pathology, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - Simon Tso
- Jephson Dermatology Centre, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - Rishi Agrawal
- Histopathology Department, New Cross Hospital, Wolverhampton, UK
| | - Elaine Cheung
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong
| | | | - Linda Nichols
- Department of Statistics, University of Warwick, Coventry, UK
| | - Paul Craig
- Department of Histopathology, Cheltenham General Hospital, Gloucestershire, UK
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2
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Mitsui Y, Ogawa K, Koga K, Goto K, Takai T, Anan T, Fukumoto T, Asada H. Trichilemmal cysts with proteinaceous material: A potential diagnostic pitfall. J Cutan Pathol 2022; 49:515-524. [PMID: 35166386 DOI: 10.1111/cup.14214] [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: 06/16/2021] [Revised: 01/08/2022] [Accepted: 02/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cysts of the skin are observed frequently and their diagnoses are generally straightforward. However, atypical cystic lesions for which differentiation is indistinct have been noted. METHODS We examined five cases of trichilemmal cyst with proteinaceous material (TCPM), which required differentiation from sweat duct/gland tumors. We investigated the histopathological findings of TCPMs and evaluated the immunohistochemical expression of cytokeratin (CK) 10, CK13, CK17, CK19, CD8, and CD117. Immunohistochemical analysis was performed on the five TCPMs, 10 trichilemmal cysts (TCs), five clear cell hidradenomas, five poroid hidradenomas, and cutaneous normal adnexa. RESULTS Apoptotic cells were present in the cyst wall with a small amount of keratin or calcification in the cavity of TCPMs. The TCPMs and TCs were negative for CK19 and CD117, whereas clear cell hidradenoma and poroid hidradenoma were positive for CK19 and CD117. The restricted positivity for CK10 was detected in the suprabasal layers of the cyst walls of TCPMs and TCs. The immunostaining patterns of TCPMs and TCs were similar to those of normal follicular isthmus. CONCLUSIONS The histopathological findings with characteristics of TCs and a panel of immunohistochemical antibodies including CD117, CK19, and CK10 contributed to a correct diagnosis of TCPM. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yasuhiro Mitsui
- Department of Dermatology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Kohei Ogawa
- Department of Dermatology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Kaori Koga
- Department of Pathology, Fukuoka University School of medicine, Fukuoka, Japan
| | - Keisuke Goto
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan.,Department of Pathology, Itabashi Central Clinical Laboratory, Tokyo, Japan.,Department of Anatomic Pathology, Tokyo Medical University, 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 Diagnostic Pathology, Osaka National Hospital, Osaka, Japan.,Department of Dermatology, Hyogo Cancer Center, Akashi, Japan
| | - Toshihiro Takai
- Department of Dermatology, Hyogo Cancer Center, Akashi, Japan
| | - Takashi Anan
- Sapporo Dermatopathology Institute, Sapporo, Japan
| | | | - Hideo Asada
- Department of Dermatology, Nara Medical University School of Medicine, Kashihara, Japan
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3
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Ogita A, Ansai SI. What Is a Solitary Keratoacanthoma? A Benign Follicular Neoplasm, Frequently Associated with Squamous Cell Carcinoma. Diagnostics (Basel) 2021; 11:diagnostics11101848. [PMID: 34679546 PMCID: PMC8535102 DOI: 10.3390/diagnostics11101848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 11/24/2022] Open
Abstract
We present histopathological criteria for diagnosing keratoacanthoma (KA). In KA, four histological stages are recognized, which are the early/proliferative stage, well-developed stage, regressing stage and regressed stage. In diagnosing KA, we emphasize that KA consists of the proliferation of enlarged pale pink cells with ground glass-like cytoplasm without nuclear atypia, other than crateriform architecture. KA sometimes exhibits malignant transformation within the lesions. We describe the characteristics of benign and malignant epithelial crateriform tumors that should be differentiated from KA. We also present the data of histopathological diagnosis of lesions clinically diagnosed as KA, its natural course and related lesions after partial biopsy, and incidence of crateriform epithelial neoplasms. Based on these data, we recommend complete excision of the lesion when KA is clinically suspected, especially when the lesion is located on a sun-exposed area of an elderly patient. If complete excision is impossible, partial excision of a sufficient specimen with intact architecture is required. In such a case, however, careful investigation after biopsy will be needed, even if the histopathological diagnosis is KA, because there is some possibility that a conventional SCC lesion remains in the residual tissue.
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Takayama E, Yoshioka A, Takai T, Goto K. A case of Muir-Torre syndrome with a keratoacanthoma and sebaceous neoplasms: Clinicopathological features and a speculation on the pathogenesis of cutaneous tumor type. J Dermatol 2021; 48:690-694. [PMID: 33523490 DOI: 10.1111/1346-8138.15772] [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: 10/03/2020] [Revised: 12/21/2020] [Accepted: 01/10/2021] [Indexed: 11/26/2022]
Abstract
Muir-Torre syndrome is a hereditary condition characterized by occurrence of sebaceous neoplasms or keratoacanthomas and visceral tumors. The most common mechanism for this syndrome is a constitutional defect in the mismatch repair genes. We report the case of a 67-year-old woman with a mutator L homologue 1 (MLH1) mutation. She had a history of endometrial and colorectal cancers. The patient presented with a typical keratoacanthoma on the right cheek and numerous sebaceous neoplasms on the face and trunk. Seven sebaceous adenomas and a low-grade sebaceous carcinoma were excised. Most sebaceous adenomas showed dermoscopic features such as some yellow comedo-like globules and curved vessels in creamy-white areas. Moreover, they revealed pathological features such as keratoacanthoma-like architecture and peritumoral or intratumoral lymphocytes. One of these sebaceous adenomas indicated histopathologically spontaneous regression and another was continuous with the hair follicle. Immunohistochemical staining for mismatch repair proteins revealed loss of expression for MLH1 and postmeiotic segregation increased 2 (PMS2) proteins in tumor cells nuclei in both keratoacanthoma and sebaceous adenoma. Nuclei in overhanging epithelial lips of the keratoacanthoma were also negative. These findings suggest that the type of Muir-Torre syndrome-related cutaneous tumor may have been affected by mismatch repair protein deficient sites in the pilosebaceous unit.
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Affiliation(s)
- Eriko Takayama
- Department of Dermatology, Konan Medical Center, Kobe, Japan
| | - Akiko Yoshioka
- Department of Dermatology, Konan Medical Center, Kobe, Japan
| | - Toshihiro Takai
- Department of Dermatology, Hyogo Cancer Center, Akashi, Japan
| | - Keisuke Goto
- Department of Dermatology, Hyogo Cancer Center, Akashi, Japan.,Department of Pathology, Itabashi Central Clinical Laboratory, Tokyo, Japan.,Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.,Department of Diagnostic Pathology, Shizuoka Cancer Center Hospital, Nagaizumi, Japan.,Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
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5
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Kossard S. Keratoacanthoma, committed stem cells and neoplastic aberrant infundibulogenesis integral to formulating a conceptual model for an infundibulocystic pathway to squamous cell carcinoma. J Cutan Pathol 2020; 48:184-191. [PMID: 32881028 PMCID: PMC7821248 DOI: 10.1111/cup.13861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/21/2020] [Accepted: 08/27/2020] [Indexed: 12/19/2022]
Abstract
Keratoacanthomas (KAs) are distinctive tumors that are defined by their clinical and histopathological features. Their relationship and distinction from squamous cell carcinoma (SCC), however, remain controversial. All cytogenic and immunohistochemical markers that have been applied in this quest have failed. A close relationship of KAs to hair follicles has been recognized. The descriptive term infundibulocystic or infundibular SCC was introduced to define a more broad-based pathway encompassing KAs. The follicular infundibulum roles in respect to neoplasia and wound healing are important elements in understanding the pathogenesis of KAs. Mouse models for KA have provided insights into the relationship of KA to follicles and SCCs. These advances and together with the diverse clinical and histopathological aspects of KA have contributed to the formulation of a conceptual pathway. The central element is that ultraviolet (UV)-mutated or activated committed infundibular stem cells are driven by the combination of a mutated oncogenic RAS pathway linked with the Wnt/beta-catenin pathway responsible for stem cell maintenance, hair follicle development, wound healing and driving KA proliferation and terminal keratinization. The existence and activation of this mutated pathway may form the basis of the paradoxical emergence of KAs and SCCs in patients receiving BRAF and PD-1 inhibitor therapy.
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Affiliation(s)
- Steven Kossard
- Kossard Dermatopathologists, Laverty Pathology, Macquarie Park, New South Wales, Australia
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6
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Kossard S, Amiri A. Onycholemmal variant of keratoacanthoma centrifugum marginatum as an expression of mutated committed stem cells in a conceptual pathway. Australas J Dermatol 2020; 61:e354-e357. [PMID: 32166739 DOI: 10.1111/ajd.13271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/13/2020] [Accepted: 02/17/2020] [Indexed: 01/08/2023]
Abstract
We describe a 43-year-old woman with a 10-year history of grossly hyperkeratotic nodules which progressively extended over the right ring finger. These involuted leaving pale, atrophic skin in their wake. At presentation, the advancing border had an arciform series of nodules in the pattern of keratoacanthoma centrifugum marginatum. The presence of filiform keratinisation that encased the nail plate, gross onychogryphotic masses of keratin on the ventral finger surface and a flat nail-like plate of keratin on the dorsal finger surface were distinctive features. Skin biopsy showed epidermal acanthosis, gross papillomatous cutaneous horn formation that had onycholemmal features. The pathology differed from keratoacanthoma and was not crateriform or infundibulocystic. Although HPV was not detected on immunohistochemistry, pathogenesis may still represent an HPV-related transfection of onycholemmal keratin committed stem cells producing an onycholemmal variant of keratoacanthoma centrifugum marginatum. A conceptual model linked to advances in follicular stem cell biology is formulated to explore this case.
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Affiliation(s)
- Steven Kossard
- Kossard Dermatopathologists, Laverty Pathology, Macquarie Park, New South Wales, Australia
| | - Alvand Amiri
- Newcastle Dermatology, Georgetown, New South Wales, Australia
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Nagarajan P. Differentiating keratoacanthoma from squamous cell carcinoma-In quest of the holy grail. J Cutan Pathol 2020; 47:418-420. [PMID: 31893469 DOI: 10.1111/cup.13640] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/20/2019] [Accepted: 12/27/2019] [Indexed: 12/15/2022]
Abstract
To distinguish keratoacanthomas from squamous cell carcinomas remains a diagnostic challenge in dermatopathology. Several immunohistochemical and cytogenetic markers have been evaluated; however, so far there has been no unequivocal evidence supporting practical application of any of these markers. Recent studies have evaluated the composition of tumor-associated immune infiltrate, in particular the number and distribution of CD123-positive plasmacytoid dendritic cells in making this distinction; but these cells also do not appear to be a consistent biomarker in distinguishing keratoacanthoma from squamous cell carcinoma.
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8
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Joshi S, De Angelis PM, Zucknick M, Schjølberg AR, Andersen SN, Clausen OPF. Role of the Wnt signaling pathway in keratoacanthoma. Cancer Rep (Hoboken) 2019; 3:e1219. [PMID: 32672002 DOI: 10.1002/cnr2.1219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Keratoacanthoma (KA) has a unique life cycle of rapid growth and spontaneous regression that shows similarities to the hair follicle cycle, which involves an active Wnt signaling during physiological regeneration. We analyzed the expression of the Wnt signaling proteins β-catenin, Lef1, Sox9, and Cyclin D1 in young and old human KAs to investigate a possible role for Wnt signaling in KAs. AIM To investigate the role of the Wnt/β-catenin signaling pathway in human KAs. METHODS AND RESULTS Formalin-fixed, paraffin-embedded tissue samples of 67 KAs were analyzed for protein expression using immunohistochemistry. The majority of KAs were positive for Sox9 and Cyclin D1 but not for nuclear-localized β-catenin or Lef-1. No significant differences in protein expressions were seen between young and old KAs. However, we found a significant association between Ki67 and Cyclin D1 proteins (P= .008). CONCLUSIONS The Wnt signaling pathway does not appear to play a significant role in the biogenesis of human KA. Sox9 overexpression may be indicative of inhibition of Wnt signaling. Sox-9 and Cyclin D1 are proliferation markers that are most likely transactivated by alternate signaling pathways.
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Affiliation(s)
- Sarita Joshi
- Department of Pathology, Rikshospitalet, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Department of Pathology, Akershus University Hospital, Lørenskog, Norway
| | - Paula M De Angelis
- Department of Pathology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Manuela Zucknick
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Aasa R Schjølberg
- Department of Pathology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Solveig Norheim Andersen
- Institute of Clinical Medicine, Department of Pathology, Akershus University Hospital, Lørenskog, Norway
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9
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Misago N, Ansai SI, Fukumoto T, Anan T, Nakao T. Keratoacanthoma en plaque/nodule: A brief report of the clinicopathological features of five cases. J Dermatol 2017; 44:803-807. [PMID: 28332728 DOI: 10.1111/1346-8138.13787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/06/2017] [Indexed: 11/28/2022]
Abstract
Keratoacanthoma (KA) is characterized by exoendophytic growth with a central keratin-filled crater, representing the crateriform architecture. We herein report five rare cases of KA without a central keratin-filled crater. These KA cases histopathologically showed that one or a few infundibular structures/isthmic lobules had their own open keratotic pores on the surface without a common merged keratotic plug/horn, clinically representing verrucous (keratotic) plaque/nodule, namely, "KA en plaque/nodule". KA rarely but on occasion does show verrucous plaque (or nodular) lesions without a central keratin-filled crater, as the notion that KA invariably shows crateriform architecture is nonsensical.
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Affiliation(s)
| | - Shin-Ichi Ansai
- Division of Dermatology and Dermatopathology, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Japan
| | | | - Takashi Anan
- Sapporo Dermatopathology Institute, Sapporo, Japan
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10
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Takai T. Advances in histopathological diagnosis of keratoacanthoma. J Dermatol 2017; 44:304-314. [DOI: 10.1111/1346-8138.13696] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 10/11/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Toshihiro Takai
- Department of Dermatology; Hyogo Cancer Center; Akashi Japan
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11
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Ogita A, Ansai SI, Misago N, Anan T, Fukumoto T, Saeki H. Clinicopathological study of crateriform verruca: Crateriform epithelial lesions histopathologically distinct from keratoacanthoma. J Dermatol 2016; 43:1154-1159. [DOI: 10.1111/1346-8138.13331] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/13/2016] [Indexed: 01/26/2023]
Affiliation(s)
- Azusa Ogita
- Division of Dermatology; Nippon Medical School Musashi Kosugi Hospital; Kawasaki Japan
| | - Shin-ichi Ansai
- Division of Dermatology; Nippon Medical School Musashi Kosugi Hospital; Kawasaki Japan
| | | | - Takashi Anan
- Sapporo Dermatopathology Institute; Sapporo Japan
| | | | - Hidehisa Saeki
- Department of Dermatology; Nippon Medical School; Tokyo Japan
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12
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Misago N. The distinction of keratoacanthoma from various types of squamous cell carcinoma with crateriform architecture. J Cutan Pathol 2016; 43:1234-1237. [DOI: 10.1111/cup.12803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 08/04/2016] [Indexed: 01/08/2023]
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13
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Ogita A, Ansai SI, Misago N, Anan T, Fukumoto T, Saeki H. Histopathological diagnosis of epithelial crateriform tumors: Keratoacanthoma and other epithelial crateriform tumors. J Dermatol 2016; 43:1321-1331. [DOI: 10.1111/1346-8138.13390] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 02/23/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Azusa Ogita
- Division of Dermatology; Nippon Medical School Musashi Kosugi Hospital; Kawasaki Japan
| | - Shin-ichi Ansai
- Division of Dermatology; Nippon Medical School Musashi Kosugi Hospital; Kawasaki Japan
| | | | - Takashi Anan
- Sapporo Dermatopathology Institute; Sapporo Japan
| | | | - Hidehisa Saeki
- Department of Dermatology; Nippon Medical School; Tokyo Japan
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14
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Goto K. Immunohistochemistry for CD117 (KIT) is effective in distinguishing cutaneous adnexal tumors with apocrine/eccrine or sebaceous differentiation from other epithelial tumors of the skin. J Cutan Pathol 2015; 42:480-8. [DOI: 10.1111/cup.12492] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 04/08/2015] [Accepted: 04/08/2015] [Indexed: 01/08/2023]
Affiliation(s)
- Keisuke Goto
- Department of Diagnostic Pathology; Kainan Hospital; Yatomi-city Aichi Japan
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15
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Misago N, Inoue T, Nagase K, Tsuruta N, Tara-Hashimoto A, Kimura H, Takahara K, Narita T, Narisawa Y. Crater/ulcerated form of infundibular squamous cell carcinoma: A possible distinct entity as a malignant (or high-grade) counterpart to keratoacanthoma. J Dermatol 2015; 42:667-73. [PMID: 25854192 DOI: 10.1111/1346-8138.12871] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 02/20/2015] [Indexed: 11/30/2022]
Abstract
Follicular squamous cell carcinoma (SCC) with infundibular differentiation includes the common and crater forms of infundibular SCC. We previously considered the crater/ulcerated infundibular SCC to be a progressive condition of the common form and histopathologically studied an additional five cases of the crater/ulcerated infundibular SCC, the results of which suggested the following characteristic histopathological features and possible developmental process in this type of SCC: (i) a considerable number of continuous hyperplastic follicular infundibula, which may develop at the beginning of the disease; (ii) hyperplastic infundibula exhibiting an abrupt or gradual transition to the SCC component, which frequently change relative to the neoplastic infundibular canal; and (iii) the presence of multiple sites of branching of the neoplastic infundibular canals and/or complete involvement of large cysts in the neoplastic process over the center of the lesion, resulting in ulceration. Based on these histopathological findings, we considered that crater/ulcerated infundibular SCC involve a considerable number of continuous follicular infundibula from the start, although some cases may develop from the common form. We also emphasize the possible aggressive biological behavior of the crater/ulcerated form. Keratoacanthoma (KA) is a unique, benign or borderline malignant neoplasm exhibiting follicular (infundibular/isthmic) differentiation characterized by the involvement of continuous follicular infundibula in multiples. From this standpoint, we consider that crater/ulcerated infundibular SCC is possibly related to KA in terms of histogenesis and is a malignant (or high-grade) counterpart of KA.
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Affiliation(s)
- Noriyuki Misago
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Takuya Inoue
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Kotaro Nagase
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Noriko Tsuruta
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Akiko Tara-Hashimoto
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Hiromi Kimura
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Kanako Takahara
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Tomomi Narita
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yutaka Narisawa
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
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Targeting the adnexal epithelium: an unusual case of syringometaplasia in a patient on vemurafenib. Am J Dermatopathol 2015; 37:e57-60. [PMID: 25839889 DOI: 10.1097/dad.0000000000000274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cutaneous adverse events (cAEs) are reported in 90% of all patients on selective BRAF inhibitors and contribute significantly to patient morbidity. Two weeks after initiating vemurafenib for metastatic melanoma, our patient developed a pruritic eruption with numerous, 1-2 mm pink hyperkeratotic follicular papules over his trunk and upper extremities. A biopsy demonstrated squamous metaplasia of the eccrine ducts with irregular hyperplasia of hair follicles sparing the interfollicular epidermis. Diffuse adnexal metaplasia is a novel and unusual cutaneous response to vemurafenib. The patient was started on acitretin 10 mg daily with improvement of the eruption after 4 weeks. We report an unusual cAE of vemurafenib selectively targeting the adnexal epithelium with relative sparing of the interfollicular epidermis. Interval improvement was noted after 4 weeks of acitretin, which is an effective therapeutic option for patients with cAEs involving squamous hyperplasia secondary to vemurafenib. Our case illustrates the particular sensitivity of the adnexal epithelium for vemurafenib-induced dysfunction in proliferation and differentiation, providing the basis for common cAEs observed on this medication.
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Wagner VP, Martins MD, Dillenburg CS, Meurer L, Castilho RM, Squarize CH. Histogenesis of keratoacanthoma: histochemical and immunohistochemical study. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:310-7. [DOI: 10.1016/j.oooo.2014.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 10/03/2014] [Accepted: 10/09/2014] [Indexed: 01/19/2023]
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18
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Takai T, Misago N, Murata Y. Natural course of keratoacanthoma and related lesions after partial biopsy: Clinical analysis of 66 lesions. J Dermatol 2015; 42:353-62. [DOI: 10.1111/1346-8138.12784] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 12/16/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Toshihiro Takai
- Department of Dermatology; Hyogo Cancer Center; Akashi Japan
| | - Noriyuki Misago
- Division of Dermatology; Department of Internal Medicine; Saga University; Saga Japan
| | - Yozo Murata
- Department of Dermatology; Hyogo Cancer Center; Akashi Japan
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Kossard S. The role of the follicular isthmus in the evolution of keratoacanthoma. J Cutan Pathol 2014; 42:299-300. [PMID: 25488378 DOI: 10.1111/cup.12430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 07/20/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Steven Kossard
- Department of Dermatopathology, Skin and Cancer Foundation Australia, Darlinghurst, Australia.
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Abstract
Recently we described skin tumors driven by skin-specific expression of Zmiz1 and here we define keratoacanthoma pathobiology in this mouse model. Similar to human keratoacanthoma development, we were able to segregate murine keratoacanthomas into three developmental phases: growth, maturation, and regression. These tumors had areas with cellular atypia, high mitotic rate, and minor local invasion in the growth phase, but with development they transitioned to maturation and regression phases with evidence of resolution. The early aggressive appearance could easily be misdiagnosed as a malignant change if the natural pathobiology was not well-defined in the model. To corroborate these findings in the Zmiz1 model, we examined squamous skin tumors from another tumor study in aging mice, and these tumors followed a similar biological progression. Lastly, we were able to evaluate the utility of the model to assess immune cell infiltration (F4/80, B220 Granzyme B, CD3 cells, arginase-1) in the regression phase; however, because inflammation was present at all phases of development, a more comprehensive approach will be needed in future investigations. Our study of keratoacanthomas in selected murine models suggests that these squamous tumors can appear histologically aggressive during early development, but with time will enter a regression phase indicating a benign biology. Importantly, studies of squamous skin tumor models should be cautious in tumor diagnosis as the early growth distinction between malignant versus benign based solely on histopathology may not be easily discerned without longitudinal studies to confirm the tumor pathobiology.
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Misago N, Takai T, Toda S, Narisawa Y. The histopathologic changes in keratoacanthoma depend on its stage. J Cutan Pathol 2014; 41:617-9. [DOI: 10.1111/cup.12350] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 11/19/2013] [Accepted: 12/28/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Noriyuki Misago
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine; Saga University; Saga Japan
| | - Toshihiro Takai
- Department of Dermatology; Hyogo Cancer Center; Akashi Japan
| | - Shuji Toda
- Department of Pathology, Faculty of Medicine; Saga University; Saga Japan
| | - Yutaka Narisawa
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine; Saga University; Saga Japan
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