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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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JAVOR S, MANDOLINI PL, GIANOTTI R. Trichilemmal tumor arising after the excision of the sebaceous cyst. Which comes first, the chicken or the egg? Ital J Dermatol Venerol 2022; 156:15-16. [DOI: 10.23736/s2784-8671.19.06213-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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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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Tarasen A, Carlson JA, Leonard MK, Merlino G, Kaetzel D, Slominski AT. Pigmented Epithelioid Melanocytoma (PEM)/Animal Type Melanoma (ATM): Quest for an Origin. Report of One Unusual Case Indicating Follicular Origin and Another Arising in an Intradermal Nevus. Int J Mol Sci 2017; 18:ijms18081769. [PMID: 28809777 PMCID: PMC5578158 DOI: 10.3390/ijms18081769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/08/2017] [Accepted: 08/10/2017] [Indexed: 12/30/2022] Open
Abstract
Pigmented epithelioid melanocytoma (PEM) is a tumor encompassing epithelioid blue nevus of Carney complex (EBN of CNC) and was previously termed animal-type melanoma. Histologically PEMs are heavily pigmented spindled and epithelioid dermal melanocytic tumors with infiltrative borders, however, their origin remains unclear. Stem cells for the epidermis and hair follicle are located in the bulge area of the hair follicle with the potential to differentiate into multiple lineages. Multiple cutaneous carcinomas, including follicular cutaneous squamous cell carcinoma (FSCC), are thought to arise from stem cells in the follicular bulge. We present two cases of PEM/ATM in a 63 year-old male on the scalp with follicular origin and a 72 year-old female on the upper back arising in an intradermal nevus. Biopsy of both cases revealed a proliferation of heavily pigmented dermal nests of melanocytes with atypia. The Case 1 tumor was in continuation with the outer root sheath of the hair follicle in the bulge region. Case 2 arose in an intradermal melanocytic nevus. Rare mitotic figures, including atypical mitotic figures, were identified in both cases. We present two cases of PEM, with histologic evidence suggesting two origins: one from the follicular bulb and one from an intradermal nevus.
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Affiliation(s)
- Ashley Tarasen
- Departments of Dermatology and Pathology, University of Alabama at Birmingham, Birmingham, AL 35201, USA.
| | - J Andrew Carlson
- Department of Dermatopathology, Albany Medical College, Albany, NY 12201, USA.
| | - M Kathryn Leonard
- Department of Biochemistry and Molecular Biology, Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Glenn Merlino
- Center for Cancer Research, National Cancer Institute, Bethesda, MD 21201, USA.
| | - David Kaetzel
- Department of Biochemistry and Molecular Biology, Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Andrzej T Slominski
- Departments of Dermatology and Pathology, University of Alabama at Birmingham, Birmingham, AL 35201, USA.
- Veterans Affairs Medical Center, Birmingham, AL 35201, USA.
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Sia PI, Figueira E, Allende A, Selva D. Malignant hair follicle tumors of the periorbital region: A review of literature and suggestion of a management guideline. Orbit 2016; 35:144-56. [PMID: 27171562 DOI: 10.1080/01676830.2016.1176048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Malignant hair follicle tumors are rare skin adnexal malignancies that have a predilection for the head and neck region. They can be categorized into a number of different subtypes. Histologically, they are distinct from their benign counterpart. To the best of our knowledge, there is no extensive review of these malignancies, especially in the periorbital region. We aim to provide a literature review and a guideline for management of these malignant tumors in the periorbital region. Database from Medline, PubMed, Embase, and Google Scholar were consulted. A total of 16 cases from the literature on hair follicle malignancies in the periorbital region were included in this review. The clinical presentations, diagnostic patterns, investigations used, and best management approach of these tumors are discussed. The American Joint Committee on Cancer (AJCC) 7(th) edition carcinoma of the eyelid staging system was used to describe their behaviors. We recommend wide excision surgery and a close follow-up for these tumors. Tumors presenting with a late stage require work-up for distant metastasis and consideration for exenteration procedures. The role of radiotherapy and chemotherapy in this context is still uncertain.
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Affiliation(s)
- Paul Ikgan Sia
- a South Australian Institute of Ophthalmology and Discipline of Ophthalmology & Visual Sciences , University of Adelaide , Adelaide , Australia
| | - Edwin Figueira
- a South Australian Institute of Ophthalmology and Discipline of Ophthalmology & Visual Sciences , University of Adelaide , Adelaide , Australia
| | - Alexandra Allende
- b Douglass Hanly Moir Pathology , Sydney , New South Wales , Australia
| | - Dinesh Selva
- a South Australian Institute of Ophthalmology and Discipline of Ophthalmology & Visual Sciences , University of Adelaide , Adelaide , Australia
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Misago N, Toda S, Nakao T. Focus of tricholemmal differentiation (tricholemmal carcinoma) within Bowen's disease/carcinoma. J Dermatol 2015; 43:439-42. [DOI: 10.1111/1346-8138.13098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 08/05/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Noriyuki Misago
- Division of Dermatology; Nakao Clinic; Saga University; Saga Japan
| | - Shuji Toda
- Department of Pathology; Faculty of Medicine; Saga University; Saga Japan
| | - Tomokazu Nakao
- Division of Dermatology; Nakao Clinic; Saga University; Saga Japan
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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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Carr RA, Taibjee SM, Turnbull N, Attili S. Follicular squamous cell carcinoma is an under-recognised common skin tumour. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.mpdhp.2014.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Shendrik I, Crowson AN, Magro CM. Follicular cutaneous squamous cell carcinoma: an under-recognized neoplasm arising from hair appendage structures. Br J Dermatol 2014; 169:384-8. [PMID: 23574514 DOI: 10.1111/bjd.12374] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cutaneous squamous cell carcinoma (SCC) with no demonstrable point of epidermal origin is problematic as it raises consideration of metastatic SCC histologically. There are rare case reports and series of SCC arising from the wall of hair follicle structures. Such lesions have been termed follicular SCC (FSCC). OBJECTIVES To investigate the clinicopathological features of FSCC. METHODS We prospectively collected cases of follicular SCC over a 5-year period. Follicular SCC is defined as a cutaneous SCC deriving from a pre-existing hair follicle structure. Lesions were considered to represent 'hybrid' SCCs if an interfollicular epidermal origin was also demonstrated; SCCs with > 50% of the origin from interfollicular epidermis were excluded. Histological features and clinical information were evaluated. RESULTS We identified 61 cases of follicular SCC arising in 60 patients from a database of 5212 cutaneous SCCs encountered over the same time period by the same authors. There were 49 pure follicular SCCs and 12 hybrid lesions. The male to female ratio was 44 : 16; the mean age was 74 years (range 44-93). Follicular SCC represents 1·2% of all primary SCCs. Biopsies of such lesions, if the appendage structure of origin is not represented, are histologically indistinguishable from metastatic SCC. CONCLUSIONS Recognition of this under-reported form of SCC is essential if an inappropriate diagnosis of metastatic SCC, with potentially harmful and inappropriate therapy and investigation, is to be avoided.
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Affiliation(s)
- I Shendrik
- University of Oklahoma and Regional Medical Laboratory, Tulsa, OK, USA.
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Misago N, Takai T, Toda S, Narisawa Y. The changes in the expression levels of follicular markers in keratoacanthoma depend on the stage: keratoacanthoma is a follicular neoplasm exhibiting infundibular/isthmic differentiation without expression of CK15. J Cutan Pathol 2014; 41:437-46. [PMID: 24666173 DOI: 10.1111/cup.12317] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 11/19/2013] [Accepted: 12/28/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although the precise etiology of keratoacanthoma (KA) is unknown, KA is generally assumed to differentiate toward hair follicles based on previous studies of experimental carcinogenesis. METHODS We performed a comprehensive immunohistochemical study of various follicular markers in all stages of KA. A total of 67 tumors, including 16 early or proliferative stage lesions, 43 well-developed stage lesions, five regressing stage lesions and three regressed stage lesions, were subjected to the analysis. RESULTS CK15 (clone C8/144B), CK19 and CD34 were not expressed at any stage. CK1, CK10, CK16, CK17, CK15 (clone LHK15) and calretinin showed dynamic changes in their expression in KA depending on the stage. CONCLUSIONS KA is a follicular neoplasm with infundibular/isthmic (upper segmental region of hair follicles) differentiation. It is considered that early or proliferative stage tumors show keratin-filled invaginations with infundibular differentiation and gradual isthmic differentiation. Well-developed examples of KA generally show isthmic differentiation in the whole lesions. The regressed stage KAs lose the features of this type of follicular differentiation and show epidermal characteristics. No expression of CK15 (clone C8/144B) was observed in KAs, although this finding is insufficient to completely rule out the correlation between the regression of KA and the hair follicle cycle.
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Affiliation(s)
- Noriyuki Misago
- Division of Dermatology, Department of Internal Medicine, Saga University, Saga, Japan
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Wilkie MD, Munir N, Roland NJ, Lancaster J. Trichilemmal carcinoma: an unusual presentation of a rare cutaneous lesion. BMJ Case Rep 2013; 2013:bcr-2012-008369. [PMID: 23605822 DOI: 10.1136/bcr-2012-008369] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Trichilemmal carcinoma (TC) is a rare cutaneous neoplasm which is derived from adnexal keratinocytes, is histologically invasive, contains cytologically atypical clear cell neoplasm and is in continuity with the epidermis and/or follicular epithelium. However, the diagnostic criteria and even the existence of TC have been contentious. We report the case of a 92-year-old woman with TC of the head and neck region who presented with an unusually long history. She was treated successfully with wide local excision. Important aspects in presentation, differential diagnosis, including histopathological features and management are discussed.
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Affiliation(s)
- Mark David Wilkie
- Department of Otorhinolaryngology Head & Neck Surgery, University Hospital Aintree, Liverpool, UK.
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