1
|
Rybski KJ, Zengin HB, Smoller BR. TRPS1: A Marker of Follicular Differentiation. Dermatopathology (Basel) 2023; 10:173-183. [PMID: 37366800 DOI: 10.3390/dermatopathology10020025] [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: 04/19/2023] [Revised: 06/05/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023] Open
Abstract
The trichorhinophalangeal syndrome type 1 (TRPS1) immunohistochemical (IHC) stain has increased in use in recent years as a marker for breast carcinomas. The TRPS1 gene is involved in various tissues, including the growth and differentiation of hair follicles. This article seeks to evaluate the IHC expression of TRPS1 in cutaneous neoplasms with follicular differentiation, such as trichoblastoma (TB), trichoepithelioma (TE), and basal cell carcinoma (BCC). IHC studies were performed on 13 TBs, 15 TEs, and 15 BCCs with an antibody against TRPS1. The study found a variable staining expression of TRPS1 in the tumor nests of TB, TE, and BCC. BCCs were distinct in that none of the BCCs demonstrated intermediate or high positivity, while TBs and TEs showed intermediate-to-high positivity in 5/13 (38%) and 3/15 (20%) of cases, respectively. We observed a distinct staining pattern among the mesenchymal cells of TB and TE. We found that TRPS1 highlighted perifollicular mesenchymal cells adjacent to the nests of TB and TE tumor cells. This staining pattern was absent in BCCs, where only scattered stromal cells were positive for TRPS1. Papillary mesenchymal bodies were also highlighted by TRPS1 in TB and TE. TRPS1 stained various parts of the normal hair follicle, including the nuclei of cells in the germinal matrix, outer root sheaths, and hair papillae. TRPS1 may be a useful IHC marker for follicular differentiation.
Collapse
Affiliation(s)
- Kristin J Rybski
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Hatice B Zengin
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Bruce R Smoller
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA
| |
Collapse
|
2
|
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.
Collapse
Affiliation(s)
- Kristine M Chaudet
- Dermatopathology Unit, Department of Pathology, Massachusetts General Hospital, Boston, MA
| | | | | |
Collapse
|
3
|
Kuo YW, Lin JC, Tsai WH. Development of seven secondary neoplasms in a nevus sebaceous: a case report and literature review. Arch Craniofac Surg 2022; 23:83-88. [PMID: 35350087 PMCID: PMC9081419 DOI: 10.7181/acfs.2022.00101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/16/2022] [Indexed: 11/24/2022] Open
Abstract
Nevus sebaceous of Jadassohn is a congenital cutaneous hamartoma with epidermal, sebaceous, follicular, and apocrine structures that usually appears at birth or in early childhood. It has the potential to generate a variety of secondary neoplasms of different lineages, and the risk increases with patient age. Although multiple neoplasms may occasionally arise within the same lesion, the coexistence of more than five secondary tumors is extremely rare. Here we report a case of seven secondary tumors including syringocystadenoma papilliferum, desmoplastic trichilemmoma, sebaceoma, trichoblastoma, pigmented trichoblastoma, sebaceous adenoma, and tumor of follicular infundibulum arising within a nevus sebaceous. The complete diagnosis relies on the histopathological analysis of multipoint biopsies and delicate pathological sections.
Collapse
Affiliation(s)
- Yi-Wen Kuo
- Department of Dermatology, E-Da Cancer Hospital, Kaohsiung, Taiwan.,School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Jung-Chia Lin
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wei-Hsuan Tsai
- International Aesthetic Medical Center, E-Da Dachang Hospital, Kaohsiung, Taiwan
| |
Collapse
|
4
|
Putri CA, Mudhar HS, Meeney A, Tan JHY. Eyelid skin trichilemmoma and underlying local malignancy: is an aggressive treatment necessary? BMJ Open Ophthalmol 2020; 5:e000513. [PMID: 32617416 PMCID: PMC7319780 DOI: 10.1136/bmjophth-2020-000513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/29/2020] [Accepted: 06/08/2020] [Indexed: 11/26/2022] Open
Abstract
Objective Trichilemmoma is a benign tumour derived from the outer root sheath of hair follicles. Trichilemmoma can be associated with basal cell carcinoma (BCC), either as a collision lesion or from malignant transformation. This study evaluates malignancy associated with eyelid trichilemmoma and principles of treatment. Methods and analysis Retrospective study involving biopsy-proven eyelid trichilemmoma cases over 14 years encountered at a tertiary referral centre. Presenting features, differential diagnosis, type and number of operations required and histopathological features including coexisting BCC were analysed. Results We identified 36 cases with an average age of 66 years. The clinical differential diagnoses were mainly BCC (44%), papilloma (36%) and squamous cell carcinoma (SCC) (3%). Three patients (8%) had trichilemmoma with associated BCC. Of the 19 cases (53%) of trichilemmomas without BCC with equivocal surgical margins, seven patients (19%) opted for further excision while 12 patients (33%) opted for observation and were discharged. A patient re-presented two years later with invasive BCC. Overall, 11% of our biopsy-proven eyelid trichilemmoma cases were associated with BCC. Conclusion Patients should be informed that a proportion of incompletely excised eyelid trichilemmomas may conceal underlying BCC. Therefore, further surgery to achieve clear surgical margins should be offered. Patients who opt for observation should be offered 6-monthly follow-up for three to five years. Alternatively, they can be discharged with advice to report any recurrence of lumps, skin changes or loss of lashes at the site of previous lesion.
Collapse
Affiliation(s)
| | - Hardeep Singh Mudhar
- National Specialist Ophthalmic Pathology Service (NSOPS), Department of Histopathology, Royal Hallamshire Hospital, Sheffield, UK
| | - Adam Meeney
- National Specialist Ophthalmic Pathology Service (NSOPS), Department of Histopathology, Royal Hallamshire Hospital, Sheffield, UK
| | - Jennifer H Y Tan
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK
| |
Collapse
|
5
|
Zhong S, Wang L, Mei XL. Desmoplastic trichilemmoma of the scalp: case report and literature review of immunohistochemical staining features. J Int Med Res 2019; 47:3918-3925. [PMID: 31304849 PMCID: PMC6726769 DOI: 10.1177/0300060519859739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Desmoplastic trichilemmoma (DT) of the scalp is a rare disease. In this report, we describe a 67-year-old man who had a small papule lesion around the hairline of the left scalp for more than 40 years. The lesion had rapidly grown to become a solitary, round, 15-mm neoplasm within 6 months. Histopathological examination showed that the mass was composed of a peripheral layer of columnar cells with nuclear palisading resembling the outer root sheath; the mass was surrounded by a thickened glassy basement membrane. The stroma in the center of the mass displayed solid, hyaline degeneration and an eosinophilic pattern, streaked with epithelial cords or islands. Immunohistochemical evaluation showed diastase-resistant, periodic acid–Schiff-positive desmoplastic stroma at the center, and Ber-EP4-negative tumor cells (CD34-positive focally and Bcl-2-positive at the periphery). The tumor was completely resected, and no recurrence occurred during the follow-up period. In this report, we also summarize immunohistochemical features from previous reports of DT, facilitating differential diagnosis of DT from some invasive skin tumors.
Collapse
Affiliation(s)
- Shan Zhong
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Li Wang
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xue-Ling Mei
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
6
|
Lee K, Chi M. A Case of Eyelid Desmoplastic Trichilemmoma. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.4.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Kiwoong Lee
- Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, Korea
| | - Mijung Chi
- Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, Korea
| |
Collapse
|
7
|
Abstract
A 16-year-old African American male, the youngest patient to date, presented with a well-circumscribed upper eyelid lesion. On excision, the dermal nodule was contiguous with the epidermis, displayed trichohyalin-like bodies in an expanded outer root sheath, and was composed chiefly of small cellular clusters separated by a prominent network of periodic acid Schiff -positive hyaline bands of basement membrane material. The tumor cells were positive for high molecular weight cytokeratins (CK) 5/6, CK14, and CK34βE12 and were negative for CK7, carcinoembryonic antigen and epithelial membrane antigen. Negative S100, glial fibrillary acidic protein, and smooth muscle actin immunoreactions ruled out a myoepithelial lesion. The Ki-67 proliferation index was <10%. The diagnosis was a hyalinized trichilemmoma, contrasting with the more common lobular type. As an isolated lesion, trichilemmoma does not portend Cowden syndrome.
Collapse
|
8
|
Martínez-Ciarpaglini C, Monteagudo C. Pigmented desmoplastic trichilemmoma. J Cutan Pathol 2016; 43:535-537. [DOI: 10.1111/cup.12694] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 07/19/2015] [Accepted: 09/08/2015] [Indexed: 11/29/2022]
Affiliation(s)
| | - Carlos Monteagudo
- Department of pathology; Hospital Clínico Universitario, University of Valencia; Valencia Spain
| |
Collapse
|
9
|
Malignant Clear Cell Acanthoma: Report of a Rare Case of Clear Cell Acanthoma-Like Tumor With Malignant Features. Am J Dermatopathol 2016; 38:553-6. [PMID: 26885606 DOI: 10.1097/dad.0000000000000499] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An erythematous and moist tumor nodule on the left temple of a 92-year-old woman was biopsied and identified as a clear cell acanthoma (CCA)-like tumor with malignant cytology and high proliferation activity. This case is similar to 2 cases reported previously as atypical CCA. The authors believe that these tumors are malignant counterparts of CCA and propose to call them malignant CCA. The clinicopathologic features of the present case are described along with dermoscopic findings.
Collapse
|
10
|
Astarci HM, Gurbuz GA, Sengul D, Hucumenoglu S, Kocer U, Ustun H. Significance of androgen receptor and CD10 expression in cutaneous basal cell carcinoma and trichoepithelioma. Oncol Lett 2015; 10:3466-3470. [PMID: 26788151 PMCID: PMC4665148 DOI: 10.3892/ol.2015.3804] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 08/25/2015] [Indexed: 11/23/2022] Open
Abstract
Differential diagnosis of trichoepithelioma (TE) and basal cell carcinoma (BCC) on the basis of clinical symptoms and laboratory investigations may be difficult in certain patients. The aim of the present study was to compare cluster of differentiation 10 (CD10) and androgen receptor (AR) expression patterns in BCC and TE, to investigate the predictive power of these proteins as markers of the two conditions. A total of 39 cases of BCC and 15 cases of TE were retrieved from the pathology department archives. AR and CD10 immunohistochemistry was performed on all of the specimens; 23 BCC cases displayed focal nuclear AR staining, however, none of the cases demonstrated diffuse nuclear staining and 16 BCC cases were negative for AR staining. Stromal CD10 staining was more common in TE cases than in BCC cases, and peripheral CD10 staining was more common in BCC cases than in TE cases. AR immunostaining of the BCC samples typically appeared as scattered clusters and individual cells. In addition, AR and CD10 staining exhibited varying staining intensities within each samples. Incisional punch biopsy specimens have the potential to present false-negative results. Therefore, AR and CD10 staining of total excision biopsies provides a more accurate differential diagnosis of BCC and TE for cases with difficulties in the histopathological analysis.
Collapse
Affiliation(s)
- Hesna M Astarci
- Department of Pathology, Abant Izzet Baysal University, Bolu 14280, Turkey
| | - Gulfem A Gurbuz
- Department of Dermatology, Dr. N.K. Sincan State Hospital, Ankara 06930, Turkey
| | - Demet Sengul
- Department of Pathology, Giresun University, Giresun 28200, Turkey
| | - Sema Hucumenoglu
- Department of Pathology, Ankara Training and Research Hospital, Ankara 06340, Turkey
| | - Ugur Kocer
- Department of Plastic and Reconstructive Surgery, Ankara Training and Research Hospital, Ankara 06340, Turkey
| | - Huseyin Ustun
- Department of Pathology, Kafkas University, Kars 36100, Turkey
| |
Collapse
|
11
|
Abstract
CONTEXT Immunohistochemistry is not a diagnostic test but a highly valuable tool that requires interpretation within a context. OBJECTIVE To review the current status and limitations of immunohistochemistry in dermatopathology. DATA SOURCES English-language literature published between 1980 and 2014. CONCLUSIONS Although immunohistochemistry is rarely completely specific or sensitive, it is an important adjunctive technique in dermatopathology and can be helpful in a series of diagnostic dilemmas.
Collapse
Affiliation(s)
- Tammie Ferringer
- From the Departments of Dermatology and Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania
| |
Collapse
|
12
|
Abstract
Desmoplastic trichilemmomas (DTs) are a rare variant of trichilemmomas first described in 1985. Since then, 11 cases involving the eyelid have been reported. Two cases of this study raise this total to 13. DTs are often clinically confused with basal cell carcinoma and must be proven by biopsy to obtain the correct diagnosis. These lesions are more commonly present in patients older than 50 years. Despite the fact that they are benign, they are often associated with basal cell carcinomas and as such should be managed carefully, requiring excisional biopsy with frozen borders or Mohs controlled margins.
Collapse
|
13
|
Jha AK, Prasad S, Sinha R. Linear trichilemmoma following a blaschkoid pattern: a clinical dilemma. J Eur Acad Dermatol Venereol 2015; 30:299-301. [PMID: 25640573 DOI: 10.1111/jdv.12962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 12/11/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Trichilemmoma are benign adnexal neoplasm with follicular outer sheath differentiation. It usually appears as single or multiple papules that resembles colour of the surrounding skin. They are most commonly seen on the face particularly on the nose and cheek. OBJECTIVES We report a case of linear trichilemmoma following blaschkoid pattern. METHODS A 13 year old boy presenting with asymptomatic plaque on the right side of the nose was fully evaluated for possible cause. RESULTS On histopathology, a diagnosis of trichilemmoma was made. CONCLUSION This is the first case report where linear trichilemmoma following a blaschkoid pattern is seen.
Collapse
Affiliation(s)
- A K Jha
- Department of Dermatology, STD and Leprosy, All India Institute of Medical Sciences, Patna, Bihar, India
| | - S Prasad
- Department of Dermatology, STD and Leprosy, All India Institute of Medical Sciences, Patna, Bihar, India
| | - R Sinha
- Department of Dermatology, STD and Leprosy, All India Institute of Medical Sciences, Patna, Bihar, India
| |
Collapse
|
14
|
Chuang HC, Kao PH, Huang YL, Lee LY, Kuo TT. Desmoplastic sebaceoma arising from nevus sebaceus: a new variant. J Cutan Pathol 2014; 41:509-12. [PMID: 24698382 DOI: 10.1111/cup.12330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 02/19/2014] [Accepted: 02/26/2014] [Indexed: 11/29/2022]
Abstract
Nevus sebaceus is known to have the potential to develop into various secondary tumors. We observed a sebaceoma arising from a nevus sebaceus excised from the left cheek of a 51-year-old woman. This sebaceoma showed desmoplastic change similar to that observed in desmoplastic trichoepithelioma and desmoplastic trichilemmoma. This heretofore undescribed desmoplastic variant of sebaceoma should not be mistaken for invasive sebaceous carcinoma.
Collapse
Affiliation(s)
- Huei-Chieh Chuang
- Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | | | | | | | | |
Collapse
|
15
|
Diagnostic utility of immunohistochemistry in distinguishing trichoepithelioma and basal cell carcinoma: evaluation using tissue microarray samples. Mod Pathol 2012; 25:1345-53. [PMID: 22684216 DOI: 10.1038/modpathol.2012.96] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Trichoepithelioma is a benign neoplasm that shares both clinical and histological features with basal cell carcinoma. It is important to distinguish these neoplasms because they require different clinical behavior and therapeutic planning. Many studies have addressed the use of immunohistochemistry to improve the differential diagnosis of these tumors. These studies present conflicting results when addressing the same markers, probably owing to the small number of basaloid tumors that comprised their studies, which generally did not exceed 50 cases. We built a tissue microarray with 162 trichoepithelioma and 328 basal cell carcinoma biopsies and tested a panel of immune markers composed of CD34, CD10, epithelial membrane antigen, Bcl-2, cytokeratins 15 and 20 and D2-40. The results were analyzed using multiple linear and logistic regression models. This analysis revealed a model that could differentiate trichoepithelioma from basal cell carcinoma in 36% of the cases. The panel of immunohistochemical markers required to differentiate between these tumors was composed of CD10, cytokeratin 15, cytokeratin 20 and D2-40. The results obtained in this work were generated from a large number of biopsies and resulted in the confirmation of overlapping epithelial and stromal immunohistochemical profiles from these basaloid tumors. The results also corroborate the point of view that trichoepithelioma and basal cell carcinoma tumors represent two different points in the differentiation of a single cell type. Despite the use of panels of immune markers, histopathological criteria associated with clinical data certainly remain the best guideline for the differential diagnosis of trichoepithelioma and basal cell carcinoma.
Collapse
|
16
|
Afshar M, Lee RA, Jiang SIB. Desmoplastic trichilemmoma--a report of successful treatment with Mohs micrographic surgery and a review and update of the literature. Dermatol Surg 2012; 38:1867-71. [PMID: 22805188 DOI: 10.1111/j.1524-4725.2012.02514.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Maryam Afshar
- Division of Dermatology, Department of Medicine, University of California at San Diego, CA, USA
| | | | | |
Collapse
|
17
|
Herráiz M, Martín-Fragueiro LM, Tardío JC. Trichilemmoma arising in the nasal vestibule: report of three cases with special emphasis on the differential diagnosis. Head Neck Pathol 2012; 6:492-5. [PMID: 22669747 PMCID: PMC3500889 DOI: 10.1007/s12105-012-0360-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Accepted: 04/28/2012] [Indexed: 11/24/2022]
Abstract
Trichilemmoma is a benign cutaneous epithelial tumor with differentiation towards cells of the outer hair root sheath and usually presents as a small papule on the face of middle-aged or older adults. We herein report three cases of trichilemmoma located in the nasal vestibule, including two of the conventional type and one of the desmoplastic variant. To our knowledge, only one case of trichilemmoma arising in the nasal vestibule has been previously reported. Trichilemmoma must be included in the differential diagnosis of epithelial lesions arising in this location. This is particularly important in the case of the desmoplastic trichilemmoma, a tumor that resembles invasive carcinoma such as desmoplastic squamous cell carcinoma, sclerosing basal cell carcinoma, and trichilemmal carcinoma. The circumscription of the lesion, the architectural pattern of epithelial cell cords and small nests merging with a desmoplastic stroma in the central area of the tumor, the expression of CD34, and the lack of an obvious squamous differentiation or basaloid foci favor the diagnosis of desmoplastic trichilemmoma. All these features help to rule out the diagnosis of carcinoma with significant clinical implications.
Collapse
Affiliation(s)
- Marisa Herráiz
- Department of Pathology, Hospital Universitario de Fuenlabrada, Camino del Molino 2, 28942 Fuenlabrada, Madrid Spain
| | - Luz M. Martín-Fragueiro
- Department of Pathology, Hospital Universitario de Fuenlabrada, Camino del Molino 2, 28942 Fuenlabrada, Madrid Spain
| | - Juan C. Tardío
- Department of Pathology, Hospital Universitario de Fuenlabrada, Camino del Molino 2, 28942 Fuenlabrada, Madrid Spain
| |
Collapse
|
18
|
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]
|
19
|
|
20
|
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: 45] [Impact Index Per Article: 3.5] [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.
Collapse
Affiliation(s)
- K Sellheyer
- Department of Dermatology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
| |
Collapse
|
21
|
Sellheyer K. Stem cell markers can help identify adnexal tumor differentiation when evaluated in the context of morphology: methodology matters. J Cutan Pathol 2011; 38:460-74. [DOI: 10.1111/j.1600-0560.2010.01671.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
22
|
Abstract
Desmoplasia describes a histological pattern characterized by a hyalinized stroma and a minimal cellular infiltrate. In non-cutaneous neoplasms, this pattern of stromal response is classically associated with malignancy, whereas in cutaneous pathology, desmoplasia is observed in malignant as well as benign neoplasms. Given this, the obvious question is whether desmoplasia associated with a benign neoplasm is any different from that associated with malignant tumours. Is the stromal response a mere epiphenomenon, or does it actually contribute to the biological behaviour of the neoplasm? What happens at the tumour-host interface? Which molecules are involved in mediating the desmoplastic reaction pattern? This review is an attempt to answer these questions. Examples of benign and malignant cutaneous neoplasms associated with the desmoplastic reaction pattern will be included.
Collapse
Affiliation(s)
- Ossama Abbas
- Dermatopathology Section, Department of Dermatology, Boston University School of Medicine, Boston, MA 02118, USA
| | | |
Collapse
|
23
|
|
24
|
Corbalán-Vélez R, Ruiz-Maciá J, Martínez-Sánchez D, Martínez-Barba E. Utilidad de la tinción inmunohistoquímica con CD34 en el diagnóstico de lesiones con diferenciación tricolemal. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s0001-7310(09)72297-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
25
|
Corbalán-Vélez R, Ruiz-Maciá J, Martínez-Sánchez D, Martínez-Barba E. Utility of Immunohistochemical Analysis of CD34 Expression in the Diagnosis of Lesions with Trichilemmal Differentiation. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s1578-2190(09)70166-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
26
|
Córdoba A, Guerrero D, Larrinaga B, Iglesias ME, Arrechea MA, Yanguas JI. Bcl-2 and CD10 expression in the differential diagnosis of trichoblastoma, basal cell carcinoma, and basal cell carcinoma with follicular differentiation. Int J Dermatol 2009; 48:713-7. [PMID: 19570076 DOI: 10.1111/j.1365-4632.2009.04076.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Both trichoblastoma and basal cell carcinoma (BCC) of the skin are characterized morphologically by the proliferation of basaloid cells; however, BCCs are clinically associated with a more aggressive behavior. An accurate diagnosis of these lesions is essential for effective, timely treatment and appropriate therapeutic decisions. METHODS This study includes 40 lesions. Bcl-2 and CD10 immunohistochemistry were performed in all cases and the patterns of expression were analyzed. RESULTS Bcl-2 is useful for the detection of BCC with diffuse expression in nests of basaloid cells, but cannot distinguish between BCC with follicular differentiation and trichoblastoma, as both lesions show the same pattern with positive and negative areas. Conversely, CD10 expression can distinguish between trichoblastomas with peritumoral stromal staining and BCCs with epithelial staining. If both stromal and epithelial areas are stained, these cases are classified as BCC with follicular differentiation. CONCLUSIONS CD10 is useful for distinguishing between BCC with widespread follicular differentiation and trichoblastomas.
Collapse
Affiliation(s)
- Alicia Córdoba
- Department of Pathology, Hospital of Navarra, Pamplona, Spain.
| | | | | | | | | | | |
Collapse
|
27
|
Tardío JC. CD34-reactive tumors of the skin. An updated review of an ever-growing list of lesions. J Cutan Pathol 2009; 36:89-102. [PMID: 19125742 DOI: 10.1111/j.1600-0560.2008.01212.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Over the past few years, a growing number of cutaneous tumors expressing CD34 is being reported. The list contains benign and malignant neoplasms as well as reactive and hamartomatous lesions of diverse lineages of differentiation, including fibroblastic, myofibroblastic, fibrohistiocytic, vascular, neural, adipocytic, smooth muscle, hematopoietic, melanocytic and epithelial. The more frequent diagnostic difficulties are found in spindle cell proliferations, mainly in those of the fibrocytic lineage. In part, this is because of the fact that in this area are, aside to well-defined entities, histologically and clinically diverse, recently reported cutaneous CD34-reactive lesions, whose definitions, limits and relationships are not completely established. The CD34 expression plays a key role in the differential diagnosis of some tumors, such as dermatofibrosarcoma protuberans, epithelioid sarcoma or pleomorphic hyalinizing angiectatic tumor of soft parts, with important therapeutic consequences. In others, as in desmoplastic trichilemmoma, it can help to resolve diagnostic problems in concrete cases. Finally, in many of the CD34-positive lesions, the diagnosis with the hematoxylin and eosin stain is straightforward. However, in all of them, the knowledge of the immunohistochemical profile contributes to our understanding of the cutaneous pathology.
Collapse
Affiliation(s)
- Juan C Tardío
- Department of Pathology, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain.
| |
Collapse
|
28
|
Tardío JC. THIS ARTICLE HAS BEEN RETRACTED
CD34-reactive tumors of the skin. An updated review of an ever-growing list of lesions. J Cutan Pathol 2008; 35:1079-92. [DOI: 10.1111/j.1600-0560.2008.01124.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
29
|
Cabral ES, Cassarino DS. Desmoplastic tricholemmoma of the eyelid misdiagnosed as sebaceous carcinoma: a potential diagnostic pitfall. J Cutan Pathol 2007; 34 Suppl 1:22-5. [DOI: 10.1111/j.1600-0560.2006.00717.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
30
|
Carter JJ, Kaur MR, Hargitai B, Brown R, Slator R, Abdullah A. Congenital desmoplastic trichoepithelioma. Clin Exp Dermatol 2007; 32:522-4. [PMID: 17459070 DOI: 10.1111/j.1365-2230.2007.02431.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Desmoplastic trichoepithelioma (DT) is a rare benign adnexal neoplasm considered to have follicular differentiation. It usually presents as an asymptomatic, firm, annular plaque with a raised border. The most common site of occurrence is the face, usually on the cheek. Females are more often affected than males and the age range of patients previously reported is 8-79 years. We present a case of congenital desmoplastic trichoepithelioma. A girl was born at term to a healthy mother after an uneventful pregnancy and was noted to have widespread erythematous plaques with milia-like lesions over the right scalp, face and neck, with some areas of atrophic scarring. Histology and immunohistochemistry of incisional biopsies of the lesions were consistent with a diagnosis of DT. To our knowledge, this is the first reported case of congenital DT.
Collapse
Affiliation(s)
- J J Carter
- Department of Dermatology, City Hospital, Birmingham, UK.
| | | | | | | | | | | |
Collapse
|
31
|
|
32
|
|
33
|
Alsaad KO, Obaidat NA, Ghazarian D. Skin adnexal neoplasms--part 1: an approach to tumours of the pilosebaceous unit. J Clin Pathol 2007; 60:129-44. [PMID: 16882696 PMCID: PMC1860623 DOI: 10.1136/jcp.2006.040337] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2006] [Indexed: 12/16/2022]
Abstract
Skin adnexal neoplasms comprise a wide spectrum of benign and malignant tumours that exhibit morphological differentiation towards one or more types of adnexal structures found in normal skin. Most adnexal neoplasms are relatively uncommonly encountered in routine practice, and pathologists can recognise a limited number of frequently encountered tumours. In this review, the first of two, the normal histology of the skin adnexal structures is reviewed, and the histological features of selected but important benign and malignant tumours and tumour-like lesions of pilosebaceous origin discussed, with emphasis on the diagnostic approach and pitfalls in histological diagnosis.
Collapse
Affiliation(s)
- K O Alsaad
- Department of Laboratory Medicine and Pathobiology, University of Toronto and University Health Network, Toronto, Ontario, Canada
| | | | | |
Collapse
|
34
|
Pham TTN, Selim MA, Burchette JL, Madden J, Turner J, Herman C. CD10 expression in trichoepithelioma and basal cell carcinoma. J Cutan Pathol 2006; 33:123-8. [PMID: 16420307 DOI: 10.1111/j.0303-6987.2006.00283.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Trichoepithelioma (TE) is a benign neoplasm that shares both clinical and histologic features with basal cell carcinoma (BCC). However, it is important to distinguish these neoplasms. Limited immunohistochemical stains are available to separate these two tumors. METHODS CD10 protein immunohistochemistry was performed on paraffin-embedded biopsies of 13 TE and 23 BCC diagnosed by routine microscopy. Cases were analyzed for pattern of CD10 expression by tumor cells and surrounding stroma. RESULTS Twelve of 13 (92%) TE showed positive stromal immunoreactivity. Of these, eight cases also demonstrated positivity of the papilla, and two also showed positivity of the basaloid cells. No TE demonstrated epithelial expression alone. On the other hand, expression of CD10 by basaloid cells was identified in 20 (87%) cases of BCC. Stromal positivity was also identified in three cases of BCC. Condensation of CD10-positive stromal cells around basaloid nests was statistically significant in differentiating TE from BCC (p < 0.0001). Conversely, CD10-positive basaloid cells were seen predominantly in BCC (p < 0.0001). CONCLUSIONS This study demonstrates a statistically significant difference in CD10 staining pattern between TE and BCC. Thus, CD10 may be a useful adjunct marker in distinguishing these tumors.
Collapse
Affiliation(s)
- Teresa Tram N Pham
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
| | | | | | | | | | | |
Collapse
|
35
|
Kalekou H, Kostopoulos I, Milias S, Papadimitriou CS. Comparative study of CD34, alpha-SMA and h-caldesmon expression in the stroma of gynaecomastia and male breast carcinoma. Histopathology 2005; 47:74-81. [PMID: 15982326 DOI: 10.1111/j.1365-2559.2005.02171.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS To address the fibroblastic/myofibroblastic nature of stroma in gynaecomastia and in male breast carcinoma, the expression of CD34, alpha-smooth muscle actin (SMA) and h-caldesmon in the stromal cells was investigated by immunohistochemistry. METHODS AND RESULTS Representative archival paraffin blocks were collected from male patients with gynaecomastia (32 cases) and mammary carcinoma (24 cases) between 1984 and 2004 and CD34, alpha-SMA and h-caldesmon were assessed immunohistochemically using a streptavidin-biotin method. Thirty cases of gynaecomastia showed a CD34+, alpha-SMA- and h-caldesmon- immunophenotype with different CD34 staining intensity in the various histological subtypes. Positivity for alpha-SMA and negativity for CD34 and h-caldesmon was found in a case of florid gynaecomastia relating to reactive fibrosis due to previous surgical intervention. Acquisition of alpha-SMA expression by stromal fibroblasts but absence of CD34 staining was identified in 22 cases of male breast carcinoma. CONCLUSIONS The immunophenotype of periductal connective tissue stroma in gynaecomastia appears to parallel the phenotype of normal breast stroma. In male breast carcinoma the stromal cell immunophenotype is similar to that of its female counterpart showing myofibroblastic differentiation. However alpha-SMA+ and CD34- are not specific to malignancy because such findings are also encountered in reactive fibrosis.
Collapse
Affiliation(s)
- H Kalekou
- Department of Pathology, St Paul General Hospital , Aristotle University, Thessaloniki, Greece
| | | | | | | |
Collapse
|
36
|
Abstract
PURPOSE To report an upper eyelid mass which proved to be a desmoplastic trichilemmoma. METHODS A 60-year-old man had a slowly enlarging upper eyelid mass. The tumor was excised. The pathologic evaluation of the tumor was centered on the differential diagnosis. RESULTS The clinical appearance of this lesion is nonspecific and can simulate a verruca, follicular keratosis, or basal cell carcinoma. Central desmoplasia, outer root sheath differentiation of the tumor cells, and CD34 positivity are the main characteristics that allow differentiation from basal cell carcinoma. CONCLUSIONS Proper recognition of a benign neoplasm that may be misdiagnosed as basal cell cancer can prevent aggressive surgical treatment.
Collapse
Affiliation(s)
- K H Keskinbora
- Bakirkoy Education and Research Hospital, Eye Clinic - Turkey.
| | | | | |
Collapse
|
37
|
Schweiger E, Spann CT, Weinberg JM, Ross B. A case of desmoplastic trichilemmoma of the lip treated with Mohs surgery. Dermatol Surg 2004; 30:1062-4. [PMID: 15209802 DOI: 10.1111/j.1524-4725.2004.30318.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Desmoplastic trichilemmoma is a rare pseudomalignant variant of trichilemmoma. It generally presents as a small papule on the face and is often clinically misdiagnosed as a basal cell carcinoma or verruca vulgaris. It is histologically similar to a trichilemmoma, but has a central area of desmoplasia that can mimic an invasive carcinoma. OBJECTIVE The objective was to report a case of desmoplastic trichilemmoma of the lower lip that was treated with Mohs micrographic surgery. METHODS A case is reported and the literature is reviewed. RESULTS The patient underwent Mohs micrographic surgery for removal of the neoplasm. Six months after the procedure, the patient remained tumor free. CONCLUSIONS Although desmoplastic trichilemmoma is a benign neoplasm, it is often histologically confused with basal cell carcinoma and malignant trichilemmoma. Desmoplastic trichilemmoma is also most frequently located on the face. Considering these factors, Mohs micrographic surgery appears to represent an excellent choice for removal of these tumors to achieve clear margins and a good cosmetic result.
Collapse
Affiliation(s)
- Eric Schweiger
- Department of Dermatology, St. Luke's-Roosevelt Hospital Center, New York, New York 10025, USA
| | | | | | | |
Collapse
|
38
|
A Case of Desmoplastic Trichilemmoma of the Lip Treated with Mohs Surgery. Dermatol Surg 2004. [DOI: 10.1097/00042728-200407000-00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
39
|
Boulton JE, Sullivan TJ, Whitehead KJ. The eyelid is a site of occurrence of desmoplastic trichilemmoma. Eye (Lond) 2001; 15:257. [PMID: 11339617 DOI: 10.1038/eye.2001.87] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|