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Sharma R, Poddar S, Batrani M, Podder I. Multiple nonfamilial trichoepithelioma presenting as leonine facies with concomitant lupus nephritis and alopecia areata - An unusual concurrence. Australas J Dermatol 2022; 63:e270-e273. [PMID: 35674390 DOI: 10.1111/ajd.13887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/15/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022]
Affiliation(s)
| | - Shreya Poddar
- Department of Dermatology, Asansol District Hospital, Asansol, India
| | | | - Indrashis Podder
- Department of Dermatology, College of Medicine and SagoreDutta Hospital, Kolkata, India
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Basaloid Follicular Hamartoma of the Eyelid: A Case Report and Literature Review about an Unusual Lesion in the Ocular Region. Diagnostics (Basel) 2022; 12:diagnostics12010140. [PMID: 35054307 PMCID: PMC8774580 DOI: 10.3390/diagnostics12010140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/30/2021] [Accepted: 01/03/2022] [Indexed: 11/18/2022] Open
Abstract
Basaloid follicular hamartoma (BFH) is a normally benign, uncommon, malformative lesion involving the hair follicles, which usually poses challenges in the differential diagnosis with other benign and malignant tumours, especially basal cell carcinoma, due to significant clinical and morphological overlap. Here, we report the case of a 53-year-old male who presented with a mass in the upper left eyelid evolving for one year. The patient had a previous history of total colectomy and an abdominal desmoid tumour within the context of Familial Adenomatous Polyposis (FAP), with a documented germline mutation in the Adenomatous Polyposis Coli (APC) gene. The eyelid lesion was biopsied and the histological analysis of the three small tissue fragments received revealed fragments with cutaneous–conjunctival lining displaying a subepithelial proliferation of basaloid nests with peripheral palisading, compatible with primitive hair follicles. There were images of anastomosis between different basaloid nests, which had their connection to the epithelial lining preserved. The stroma had high cellularity and sometimes primitive mesenchymal papillae were evident. Pleomorphism was absent, mitotic figures were barely identified, and no necrosis was seen. The basaloid nests did not have epithelial–stromal retraction nor mucin deposits. A diagnosis of BFH was proposed, which was later confirmed after surgical excision of the whole eyelid lesion. No evidence of carcinoma was present. This case illustrates the main features of the rare benign eyelid BFH. The standard medical or surgical approach of these lesions remains to be firmly established. Nearly nine months after surgical excision our patient remains well without signs of disease recurrence.
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Hazemann G, Michel C, Mahé A, Lipsker D, Cribier B. [Histopathological study of basaloid follicular hamartoma]. Ann Dermatol Venereol 2019; 146:181-191. [PMID: 30691875 DOI: 10.1016/j.annder.2018.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/29/2018] [Accepted: 12/03/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Basaloid follicular hamartoma (BFH) is a rare tumor first described in 1985. It bears clinical and histologic similarities with basal cell carcinoma (BCC), in particular the so-called infundibulocystic form. We performed a single-center clinicopathological study of a series of typical cases of this entity that is occasionally difficult to diagnose. MATERIALS AND METHODS All cases of BFH seen at the Dermatopathology Laboratory of Strasbourg University Hospital were included and analyzed by means of HE staining and Ber-EP4 and PHLDA1 immunolabelling. Diagnosis was made in the event of basaloid proliferation with anastomosing cords developed from a hair follicle. Clinical data were collected from clinical files. RESULTS We identified 15 cases in 13 patients of mean age 44.8 years (range: 4 to 90) and the sex-ratio was 5/8. Lesions consisted of flesh-colored papules measuring 0.3 to 1.2cm in diameter, without any preferential site. Three patients had multiple lesions consisting of several coalescent papules on a breast for one, sparse papules on the back for another, and hundreds of linear unilateral BFHs, associated with osseous abnormalities, characteristic of Happle-Tinschert syndrome, for the third. All tumors were limited to the superficial and mid dermis, with a vertical orientation and connection to the epidermis in 14 of the 15 patients. In some cases, the outermost cells were basophilic while the central cells were eosinophilic. Peripheral palisading and clefting were frequently observed. Keratin cysts or sebaceous ducts were consistently present, indicating follicular differentiation. Ber-EP4+ cells were restricted to the periphery of the cords and PHLDA1 was weakly expressed. DISCUSSION BFH is a rare entity that must be differentiated from BCC. It presents as solitary or multiple lesions, either grouped in plaques or with a generalized or linear unilateral distribution. Generalized BFH may be associated with autoimmune diseases and linear unilateral BFH with osseous, dental and cerebral abnormalities in Happle-Tinschert syndrome. It is important to distinguish BFH from BCC to avoid inappropriate aggressive treatment.
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Affiliation(s)
- G Hazemann
- Clinique dermatologique, université de Strasbourg, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
| | - C Michel
- Centre hospitalier Emile-Muller, 20, avenue du Dr-René-Laennec, 68100 Mulhouse, France
| | - A Mahé
- Hôpitaux civils de Colmar, 39, rue de la Liberté, 68000 Colmar, France
| | - D Lipsker
- Clinique dermatologique, université de Strasbourg, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - B Cribier
- Clinique dermatologique, université de Strasbourg, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
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Garcias-Ladaria J, Cuadrado Rosón M, Pascual-López M. Nevus epidérmicos y síndromes relacionados. Parte 2: Nevus derivados de estructuras anexiales. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:687-698. [DOI: 10.1016/j.ad.2018.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/16/2018] [Accepted: 05/23/2018] [Indexed: 02/06/2023] Open
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5
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Garcias-Ladaria J, Cuadrado Rosón M, Pascual-López M. Epidermal Nevi and Related Syndromes —Part 2: Nevi Derived from Adnexal Structures. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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6
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Abstract
Cutaneous and systemic lupus erythematosus (SLE) commonly involves the hair and scalp. Alopecia can result from direct activity of disease on the scalp or from the state of physical stress in the form of telogen effluvium. Discoid lupus erythematosus and lupus panniculitis/profundus are known to cause scarring alopecia, while accumulation of recent studies has shown that non-scarring alopecia in SLE may have different subtypes, comprising lupus erythematosus-specific and lupus erythematosus-nonspecific changes on histology. This review aims to summarize the clinical pattern, trichoscopic, histopathological, and direct immunofluorescence features of different types of alopecia in cutaneous and systemic lupus erythematosus, as well as exploring their relationship with SLE disease activity.
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Kaiser A, Spence RJ, Parwani A, Tihan T, Barrett TL. Basaloid Follicular Hamartoma with Trichoblastomatous Proliferations. J Cutan Med Surg 2016. [DOI: 10.1177/120347540300700506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Basaloid follicular hamartomas (BFH) are rare, benign, adnexal lesions with diverse clinical presentations. Previous studies documented BFHs with fibroepithelioma of Pinkus-like proliferations, or proliferations that resemble trichoepitheliomas. Objective: We report on a patient with linear, unilateral BFH and extensive trichoblastomatous proliferations involving the right arm, torso, and leg. An 18-year-old female presented with multiple, hyperkeratotic, linear nodules and plaques limited to her right side from the shoulder to the leg. The lesions had existed since birth and gradually increased over time. Results: The lesions contained hyperpigmented, exophytic nodules with acanthosis, pseudoepitheliomatous hyperplasia, focally associated with hyperkeratosis, and squamous eddies. Some areas contained trichoepithelioma-like proliferations, or large nodules of basaloid cells with numerous cystic spaces, marked hyperpigmentation, and melanophages. The diagnosis was linear, unilateral BFH with an unusual trichoblastomatous component. Conclusion: While trichoblastomatous proliferations could occur in a BFH, to our knowledge this finding has not been reported.
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Affiliation(s)
- Adeel Kaiser
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert J. Spence
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Plastic Surgery, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | | | - Tarik Tihan
- Department of Pathology, University of California at San Francisco, San Francisco, California, USA
| | - Terry L. Barrett
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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9
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Huang SH, Hsiao TF, Lee CC. Basaloid follicular hamartoma: A case report and review of the literature. Kaohsiung J Med Sci 2012; 28:57-60. [DOI: 10.1016/j.kjms.2011.06.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 12/01/2010] [Indexed: 10/14/2022] Open
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10
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Yang XC, Yan H, Hao F, Yie QY, Zhong BY. Congenital localized basaloid follicular hamartoma: a case report and review of the literature. Int J Dermatol 2010; 49:443-7. [PMID: 20465704 DOI: 10.1111/j.1365-4632.2010.04275.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Xi-chuan Yang
- Dermatology Department of Southwest Hospital, Third Military Medical University, Chongqing 400038, China
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11
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Ramos-Ceballos FI, Pashaei S, Kincannon JM, Morgan MB, Smoller BR. Bcl-2, CD34 and CD10 expression in basaloid follicular hamartoma, vellus hair hamartoma and neurofollicular hamartoma demonstrate full follicular differentiation. J Cutan Pathol 2008; 35:477-83. [PMID: 18399809 DOI: 10.1111/j.1600-0560.2007.00832.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Generalized basaloid follicular hamartoma syndrome (GBFHS) is a rare, recently-described, autosomal-dominantly inherited disorder that presents with disseminated milia, palmoplantar pitting, hypotrichosis and basaloid follicular hamartomas (BFH). BFH is a benign adnexal tumor that resembles basal cell carcinoma (BCC). In this study, we report two cases of GBFHS and stain BFH, a vellus hair hamartoma (VHH) and a neurofollicular hamartoma (NH) with CD34, bcl-2 and CD10 to characterize and compare the staining patterns of these follicular tumors. Standard immunohistochemistry labeling with CD34, bcl-2 and CD10 was performed on paraffin-embedded, formalin-fixed tissue sections of five BFH (four for CD10), one VHH and one NH. CD34 stromal staining was observed in all specimens. Bcl-2 stained the outermost cell layers of the basaloid nests in all specimens. CD10 stained the peritumoral stroma of all specimens. The BFH, NFH and the VHH showed CD10 staining of matrical cells. CD34 and CD10 stain peritumoral stroma of BFH, VHH and NH. Bcl-2 stains the outermost cell layer of these tumors. CD10 was also observed to stain matrical cells. These results show the similarities in differentiation between these benign follicular neoplasms and trichoepithelioma.
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Affiliation(s)
- Frances I Ramos-Ceballos
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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12
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Saxena A, Shapiro M, Kasper DA, Fitzpatrick JE, Mellette JR. Basaloid follicular hamartoma: a cautionary tale and review of the literature. Dermatol Surg 2007; 33:1130-5. [PMID: 17760608 DOI: 10.1111/j.1524-4725.2007.33231.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Aradhna Saxena
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
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13
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Basaloid Follicular Hamartoma. Dermatol Surg 2007. [DOI: 10.1097/00042728-200709000-00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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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.
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Affiliation(s)
- K O Alsaad
- Department of Laboratory Medicine and Pathobiology, University of Toronto and University Health Network, Toronto, Ontario, Canada
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15
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Lee DA, Grossman ME, Schneiderman P, Celebi JT. Genetics of skin appendage neoplasms and related syndromes. J Med Genet 2006; 42:811-9. [PMID: 16272260 PMCID: PMC1735949 DOI: 10.1136/jmg.2004.025577] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In the past decade the molecular basis of many inherited syndromes has been unravelled. This article reviews the clinical and genetic aspects of inherited syndromes that are characterised by skin appendage neoplasms, including Cowden syndrome, Birt-Hogg-Dube syndrome, naevoid basal cell carcinoma syndrome, generalised basaloid follicular hamartoma syndrome, Bazex syndrome, Brooke-Spiegler syndrome, familial cylindromatosis, multiple familial trichoepitheliomas, and Muir-Torre syndrome.
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Affiliation(s)
- D A Lee
- Department of Dermatology, Columbia University Medical Center, New York, USA
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16
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Abstract
Lupus erythematosus is the great imitator of other diseases. There is a broad range of cutaneous symptoms induced by lupus or by its various treatments. This article provides a short overview of uncommon presentations of cutaneous symptoms in the lupus spectrum.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology, Academic Teaching Hospital Dresden-Friedrichstadt, 01067 Dresden, Germany.
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17
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Tsuru K, Ohashi A, Ueda M. A case of generalized hair follicle hamartoma associated with systemic lupus erythematosus. J Dermatol 2004; 31:573-6. [PMID: 15492425 DOI: 10.1111/j.1346-8138.2004.tb00558.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2004] [Accepted: 03/02/2004] [Indexed: 11/29/2022]
Abstract
A hair-follicle hamartoma (HFH) may be localized or diffuse. Generalized HFH is frequently associated with an autoimmune disease such as myasthenia gravis or systemic lupus erythematosus (SLE). We report here a female patient with SLE who developed typical generalized HFH. This is the fourth case of generalized HFH associated with SLE.
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Affiliation(s)
- Kenta Tsuru
- Clinical Molecular Medicine, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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18
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Smith KJ, Skelton H. Basaloid follicular hamartomas associated with autoimmune disease: a possible role for retinoids in therapy. J Am Acad Dermatol 2003; 49:1067-70. [PMID: 14639386 DOI: 10.1016/s0190-9622(02)61779-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A basaloid follicular hamartoma (BFH) may be localized or diffuse. It may also be congenital or acquired. Development of diffuse BFHs has been associated with autoimmune disease and with the development of diffuse alopecia. Two women with autoimmune diseases had diffuse alopecia develop. We present the histologic features of BFH seen in these 2 women using vertical and transverse sections, and the response of 1 patient to retinoid therapy. Histologic sections showed a hamartomatous proliferation of hair follicles involving the majority of their hairs. The hamartomatous follicles showed variable degrees of hair differentiation. One patient, treated with oral and then topical retinoids, showed a partial regrowth of scalp hair and some regression of the cutaneous nodules. Increased sonic hedgehog signaling pathways with increased Gli-1 transcription has been shown to be present in the spectrum of follicular hamartomatous changes seen in BFHs. This may explain the response of one patient to retinoid therapy, because retinoids decrease Gli-1 transcriptional activity.
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Affiliation(s)
- Kathleen J Smith
- Department of Dermatology, University of Alabama at Birmingham, Eye Foundation Hospital, Suite 414, 1720 University Boulevard, Birmingham, AL 35294-0009, USA.
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19
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Jih DM, Shapiro M, James WD, Levin M, Gelfand J, Williams PT, Oakey RJ, Fakharzadeh S, Seykora JT. Familial basaloid follicular hamartoma: lesional characterization and review of the literature. Am J Dermatopathol 2003; 25:130-7. [PMID: 12652194 DOI: 10.1097/00000372-200304000-00006] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Basaloid follicular hamartoma (BFH) is a rare cutaneous lesion associated with the acquisition of small papules that remain stable for many years. Basaloid follicular hamartoma lesions can present sporadically or as part of an inherited syndrome. Occasionally, biopsies of BFH lesions are interpreted as basal cell carcinoma (BCC), which necessitates complete removal of the lesion. In this report, we characterize a case of a familial BFH syndrome and discuss the clinical, histologic, and molecular features of BFH lesions that help to distinguish it from BCC. The BFH lesions in our patients remained stable for many years. Histologically, BFH lesions exhibit fewer mitoses and decreased single cell necrosis when compared with BCC. Immunohistochemical staining for the proliferation markers proliferating cell nuclear antigen and Ki-67 demonstrated less staining in BFH than in BCC. In addition, levels of PTCH (patched) mRNA were increased relative to unremarkable epidermis in familial BFH lesions but to a lesser degree and in a different pattern than that seen in BCC. In summary, familial BFH can be distinguished from BCC based on clinical, histologic, and molecular features and is associated with deregulation of the PTCH pathway. Basaloid follicular hamartoma may represent an indolent lesion within the spectrum of basaloid epithelial neoplasms associated with deregulation of the PTCH signaling pathway. We discuss this case in parallel with a growing body of literature that supports the nosologic designation of BFH.
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Affiliation(s)
- Debra M Jih
- Advanced Dermatology Associates, Allentown, Pennsylvania, USA
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Girardi M, Federman GL, McNiff JM. Familial multiple basaloid follicular hamartomas: A report of two affected sisters. Pediatr Dermatol 1999; 16:281-4. [PMID: 10469412 DOI: 10.1046/j.1525-1470.1999.00061.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Basaloid follicular hamartoma (BFH) is one of several benign skin tumors that may occur in multiple and solitary forms. While the histologic findings of BFH may be observed in a variety of clinical settings, familial multiple BFH represents a distinct clinical entity characterized by tiny flesh-colored papules scattered predominantly over the face. We present two sisters with this rare condition and review the clinical and histologic differential diagnosis of familial multiple BFH.
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Affiliation(s)
- M Girardi
- Yale University School of Medicine, New Haven, Connecticut 06520-8059, USA
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