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Baykal C, Polat Ekinci A. Annular skin tumors and lymphoproliferative diseases. Clin Dermatol 2023; 41:692-711. [PMID: 37586571 DOI: 10.1016/j.clindermatol.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Determining the shape of a skin lesion may provide a diagnostic clue in dermatology practice, more commonly for inflammatory diseases but also for skin tumors. The annular formation may develop by diverse mechanisms in skin tumors. Annular lesions may occur from the onset of the tumor as sparing the central area or depression and/or ulceration in the center of the tumor or outward expansion of the primary lesion. Clustering of multiple papulonodular lesions sparing the central area or relatively independent processes acting on the central and peripheral components of the tumor may also result in an annular appearance. We have explored a wide variety of benign and malignant skin tumors and lymphoproliferative diseases forming an annular shape.
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Affiliation(s)
- Can Baykal
- Department of Dermatology and Venereology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Algün Polat Ekinci
- Department of Dermatology and Venereology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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2
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Baykal C, Ekinci AP. Annular skin tumors and lymphoproliferative diseases. Clin Dermatol 2023; 41:382-395. [PMID: 37421997 DOI: 10.1016/j.clindermatol.2023.07.007] [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: 07/10/2023]
Abstract
Determining the shape of the skin lesion may provide a diagnostic clue in dermatology practice, more commonly for inflammatory diseases but also for skin tumors. The annular formation may develop by diverse mechanisms in skin tumors. Annular lesions may occur from the onset of the tumor as sparing the central area or depression and/or ulceration in the center of the tumor or outward expansion of the primary lesion. Clustering of multiple papulonodular lesions sparing the central area or relatively independent processes acting on the central and peripheral components of the tumor may also result in an annular appearance. We have explored a wide variety of benign and malignant skin tumors and lymphoproliferative diseases forming an annular shape.
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Affiliation(s)
- Can Baykal
- Department of Dermatology and Venereology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Algün Polat Ekinci
- Department of Dermatology and Venereology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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3
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Dong J, Duan Y, Zhang K, Zhang X. Cutaneous Lymphadenoma: A Case Report and Literature Review. Clin Cosmet Investig Dermatol 2023; 16:505-514. [PMID: 36860584 PMCID: PMC9969865 DOI: 10.2147/ccid.s378468] [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: 06/26/2022] [Accepted: 01/19/2023] [Indexed: 02/25/2023]
Abstract
Cutaneous lymphadenoma (CL) is an uncommon epithelioid tumor that is usually present on the head and face. It was first described by Santa Cruz and Barr in 1987, as a lymphoepithelial tumor, and was renamed as CL in 1991. Although CL is considered as a benign tumor, there are cases of recurrence after shave excision and metastasis to regional lymph nodes. Correct diagnosis and complete resection are of great importance. Here, we report a typical case of CL and make a comprehensive review of this rare skin tumor.
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Affiliation(s)
- Jie Dong
- Department of Dermatology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yuntao Duan
- Department of Dermatology, Dali Bai Autonomous Prefecture People’s Hospital, Dali Medical College, Yunnan, People’s Republic of China
| | - Kunning Zhang
- Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xiuying Zhang
- Department of Dermatology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China,Correspondence: Xiuying Zhang, Department of Dermatology, Beijing Chaoyang Hospital, Capital Medical University, 8# South Road, Worker’s Stadium, Chaoyang District, Beijing, 100020, People’s Republic of China, Tel +86 15810698436, Email
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4
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Monteagudo C, Fúnez R, Sánchez-Sendra B, González-Muñoz JF, Nieto G, Alfaro-Cervelló C, Murgui A, Barr RJ. Cutaneous Lymphadenoma Is a Distinct Trichoblastoma-like Lymphoepithelial Tumor With Diffuse Androgen Receptor Immunoreactivity, Notch1 Ligand in Reed-Sternberg-like Cells, and Common EGFR Somatic Mutations. Am J Surg Pathol 2021; 45:1382-1390. [PMID: 34232601 PMCID: PMC8428866 DOI: 10.1097/pas.0000000000001727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The term "cutaneous lymphadenoma" was coined in this journal for an unusual lymphoepithelial cutaneous adnexal neoplasm, possibly with immature pilosebaceous differentiation. Some authors further proposed that cutaneous lymphadenoma was an adamantinoid trichoblastoma. However, although a hair follicle differentiation is widely accepted, the fact that this is a lymphoepithelial tumor is not appropriately explained by the trichoblastoma hypothesis. Our goal was to further clarify the phenotypic and genotypic features of cutaneous lymphadenoma in a series of 11 cases. Histologically, a lobular architecture surrounded by a dense fibrous stroma was present in all cases. The lobules were composed of epithelial cells admixtured with small lymphocytes and isolated or clustered large Reed-Sternberg-like (RS-L) cells. The epithelial cells were diffusely positive for the hair follicle stem cell markers CK15, PHLDA1, and for androgen receptor. No immunostaining for markers of sebaceous differentiation was found. Intraepithelial lymphocytes were predominantly CD3+, CD4+, FoxP3+ T cells. RS-L cells showed both strong Jagged-1 and Notch1 cytoplasmic immunostaining. Androgen-regulated NKX3.1 nuclear immunostaining was present in a subset of large intralobular cells in all cases. Double immunostaining showed coexpression of NKX3.1 and CD30 in a subset of RS-L cells. No immunostaining for lymphocytic or epithelial markers was present in RS-L cells. EGFR, PIK3CA, and FGFR3 somatic mutations were found by next-generation sequencing in 56% of the cases. We consider that cutaneous lymphadenoma is a distinct benign lymphoepithelial tumor with androgen receptor and hair follicle bulge stem cell marker expression, RS-L cell-derived Notch1 ligand, and common EGFR gene mutations.
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Affiliation(s)
- Carlos Monteagudo
- Department of Pathology, University Clinic Hospital, INCLIVA Biomedical Research Institute
- Departments of Pathology
| | - Rafael Fúnez
- Department of Pathology, Costa del Sol Health Agency, Málaga, Spain
| | | | - José F. González-Muñoz
- Department of Pathology, University Clinic Hospital, INCLIVA Biomedical Research Institute
| | | | - Clara Alfaro-Cervelló
- Department of Pathology, University Clinic Hospital, INCLIVA Biomedical Research Institute
| | - Amelia Murgui
- Biochemistry and Molecular Biology, University of Valencia, Valencia
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5
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Rahman J, Tahir M, Arekemase H, Murtazaliev S, Sonawane S. Desmoplastic Trichoepithelioma: Histopathologic and Immunohistochemical Criteria for Differentiation of a Rare Benign Hair Follicle Tumor From Other Cutaneous Adnexal Tumors. Cureus 2020; 12:e9703. [PMID: 32923292 PMCID: PMC7486105 DOI: 10.7759/cureus.9703] [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: 07/31/2020] [Accepted: 08/12/2020] [Indexed: 11/05/2022] Open
Abstract
Desmoplastic trichoepitheliomas (DTEs) are benign cutaneous neoplasms that originate from the hair follicle and exhibit a preference for the facial region. This type of neoplasm is characterized by accelerated growth, with vigorous histologic and immunohistochemical features that may be confused with other skin cancers. Thus, the objective of this study is to establish a definitive diagnosis that can be widely used. This review was systematically carried out and includes case series and studies to establish valuable data that can be used for research. The articles were sought in PubMed, MEDLINE, and Google Scholar using the keywords "desmoplastic trichoepithelioma," "morphea basal cell carcinoma," "microcystic adnexal carcinoma," "syringoma," and "cutaneous breast carcinoma." From a total of 65 journal articles, we chose 42 studies describing the clinical features, etiology, histopathology, and immunohistochemical characteristics of tumors. After quality assessment, 10 studies were selected, representing the differentiating features among the four mentioned cutaneous tumors. The differential diagnosis of DTE also includes other cutaneous and follicular tumors. At present, there is no standardized grading system for trichogenic tumors, although several symptomatic terms have been offered. More recently, immunohistochemistry and histopathological studies support the differentiation between the above-mentioned cutaneous tumors. However, additional research needs to be conducted to obtain complete information regarding the specific distinct traits of the indicated cutaneous tumors.
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Affiliation(s)
- Jawaria Rahman
- Pathology, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Muhammad Tahir
- Pathology, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Hassan Arekemase
- Anatomical and Clinical Pathology, Saint Barnabas Medical Center, Livingston, USA
| | - Salikh Murtazaliev
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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6
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Patel P, Nawrocki S, Hinther K, Khachemoune A. Trichoblastomas Mimicking Basal Cell Carcinoma: The Importance of Identification and Differentiation. Cureus 2020; 12:e8272. [PMID: 32596088 PMCID: PMC7314372 DOI: 10.7759/cureus.8272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/25/2020] [Indexed: 11/26/2022] Open
Abstract
Trichoblastoma is a rare, slow-growing, benign cutaneous tumor derived from follicular germinative cells. Trichoblastoma commonly appears as an asymptomatic, symmetrical, well-circumscribed, skin-colored to brown or blue-black papule or nodule. It may appear clinically and histologically similar to basal cell carcinoma, making its diagnosis challenging. Even on dermoscopy, it is challenging to differentiate trichoblastoma from basal cell carcinoma. In practice, it is important to differentiate the two, because the choice of treatment and resulting prognosis differ between the lesions. Surgical biopsy to analyze histopathological and immunohistochemical differences is the gold standard for diagnosing and differentiating trichoblastoma from basal cell carcinoma. Trichoblastoma typically has a favorable prognosis, with a low incidence of recurrence, progression or association with malignancy. This paper provides a review of the epidemiology, clinical presentation, dermoscopy, histology, immunochemistry, treatment, and prognosis of trichoblastoma.
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Affiliation(s)
- Parth Patel
- Dermatology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA
| | - Shiri Nawrocki
- Dermatology, Rutgers-Robert Wood Johnson Medical School, Piscataway, USA
| | | | - Amor Khachemoune
- Dermatology, State University of New York Downstate Medical Center, Brooklyn, USA
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7
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Huet P, Barnéon G, Cribier B. [Desmoplastic trichoepithelioma: The correlation between dermatopathology and dermatoscopy]. Ann Dermatol Venereol 2019; 146:760-763. [PMID: 31601440 DOI: 10.1016/j.annder.2019.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- P Huet
- Zone médicale de Fescau, 50, allée des Vignes, 34980 Montferrier-sur-Lez, France.
| | - G Barnéon
- Euromed pathologie, parc Euromédecine, 1227, rue de la Valsière, 34790 Grabels, France
| | - B Cribier
- Hôpitaux universitaires de Strasbourg, BP 426, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
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8
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Lovgren ML, Rajan N, Joss S, Melly L, Porter M. Inherited desmoplastic trichoepitheliomas. Clin Exp Dermatol 2019; 44:e238-e239. [PMID: 30697781 PMCID: PMC6766857 DOI: 10.1111/ced.13876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2018] [Indexed: 11/27/2022]
Affiliation(s)
- M-L Lovgren
- Dermatology Department, West Glasgow Ambulatory Care Hospital, NHS Greater Glasgow and Clyde, Dalnair Street, Yorkhill, Glasgow, G3 8SJ, UK
| | - N Rajan
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - S Joss
- Genetics Department, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - L Melly
- Histopathology Department, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - M Porter
- Dermatology Department, West Glasgow Ambulatory Care Hospital, NHS Greater Glasgow and Clyde, Dalnair Street, Yorkhill, Glasgow, G3 8SJ, UK
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9
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Rajabi-Estarabadi A, Zheng C, Vazquez T, Akhtar S, Williams N, Nouri K. Cells to Surgery Quiz: December 2018. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Kunz M, Kerl K, Braun RP. Basal Cell Carcinoma Mimicking Desmoplastic Trichoepithelioma: A Case with Correlation of Dermoscopy and Histology. Case Rep Dermatol 2018; 10:133-137. [PMID: 29928202 PMCID: PMC6006647 DOI: 10.1159/000489164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/10/2018] [Indexed: 11/19/2022] Open
Abstract
Basal cell carcinoma (BCC) is the most common cancer in humans worldwide. Many highly specific dermoscopic criteria for BCC are well established in the literature. On the contrary, other malignant or benign skin tumors may mimic BCC by exhibiting similar or even the same dermoscopic features and therefore obscuring the diagnosis of BCC in certain situations. We herein report a case of BCC with dermoscopic features of both BCC and desmoplastic trichoepithelioma (DT). We would like to remind of the often neglected differential diagnosis of DT in a lesion with arborizing vessels and otherwise unusual dermoscopic presentation.
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Affiliation(s)
- Michael Kunz
- Dermatology Clinic, University Hospital Zurich, Zurich, Switzerland
| | - Katrin Kerl
- Dermatology Clinic, University Hospital Zurich, Zurich, Switzerland
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11
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Rajabi-Estarabadi A, Williams N, Albreakan R, Algain M, Smith SC, Dormishian A, Iglesia S, Galimberti F, Nouri K. Cells to Surgery Quiz: December 2017. J Invest Dermatol 2017; 137:e207. [PMID: 29169467 DOI: 10.1016/j.jid.2017.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ali Rajabi-Estarabadi
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Natalie Williams
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rakan Albreakan
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Dermatology, College of Medicine, Al Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Maysoon Algain
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Dermatology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Samuel C Smith
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alaleh Dormishian
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sofia Iglesia
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Fabrizio Galimberti
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
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Abstract
CONTEXT - Basal cell carcinoma (BCC) is the most common human malignant neoplasm and is a frequently encountered diagnosis in dermatopathology. Although BCC may be locally destructive, it rarely metastasizes. Many diagnostic entities display morphologic and immunophenotypic overlap with BCC, including nonneoplastic processes, such as follicular induction over dermatofibroma; benign follicular tumors, such as trichoblastoma, trichoepithelioma, or basaloid follicular hamartoma; and malignant tumors, such as sebaceous carcinoma or Merkel cell carcinoma. Thus, misdiagnosis has significant potential to result in overtreatment or undertreatment. OBJECTIVE - To review key features distinguishing BCC from histologic mimics, including current evidence regarding immunohistochemical markers useful for that distinction. DATA SOURCES - Review of pertinent literature on BCC immunohistochemistry and differential diagnosis. CONCLUSIONS - In most cases, BCC can be reliably diagnosed by histopathologic features. Immunohistochemistry may provide useful ancillary data in certain cases. Awareness of potential mimics is critical to avoid misdiagnosis and resulting inappropriate management.
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Affiliation(s)
- Lauren M Stanoszek
- From the Departments of Pathology (Drs Stanoszek, Wang, and Harms) and Dermatology (Dr Harms), University of Michigan Medical School, Ann Arbor. Drs Stanoszek and Wang contributed equally
| | - Grace Y Wang
- From the Departments of Pathology (Drs Stanoszek, Wang, and Harms) and Dermatology (Dr Harms), University of Michigan Medical School, Ann Arbor. Drs Stanoszek and Wang contributed equally
| | - Paul W Harms
- From the Departments of Pathology (Drs Stanoszek, Wang, and Harms) and Dermatology (Dr Harms), University of Michigan Medical School, Ann Arbor. Drs Stanoszek and Wang contributed equally
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13
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Induction of Desmoplastic Trichoepithelioma in a Dermatofibroma. Am J Dermatopathol 2017; 40:924-926. [PMID: 29053493 DOI: 10.1097/dad.0000000000000982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Induction of follicular germinative structures above a dermatofibroma (DF) is a common finding. Rarely, induction of a trichoblastoma in a DF has been observed. Here, we report the case of a desmoplastic trichoepithelioma induced by a DF. The lesion with clinical and histological appearance of a DF situated on the left dorsal foot showed an associated adnexal proliferation that fulfilled histopathological criteria of desmoplastic trichoepithelioma. Immunohistochemistry (Ber-EP4, Bcl-2, CK17, CK20, CK7, EMA, and Ki67) helped to confirm the diagnosis and to exclude possible differential diagnoses.
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14
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Gulseren D, Kwock JM, Patterson JW. A case of combined desmoplastic trichoepithelioma and compound melanocytic nevus. J Cutan Pathol 2017; 44:657-659. [DOI: 10.1111/cup.12948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/30/2017] [Accepted: 04/10/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Duygu Gulseren
- Department of Dermatology; Ankara Polatlı State Hospital; Ankara Turkey
- Division of Dermatopathology; University of Virginia Medical Center; Charlottesville Virginia
| | - Jessica M. Kwock
- Division of Dermatopathology; University of Virginia Medical Center; Charlottesville Virginia
| | - James W. Patterson
- Division of Dermatopathology; University of Virginia Medical Center; Charlottesville Virginia
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15
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Abstract
BACKGROUND Collagen is the most abundant protein in the body and the main structural component of the skin. OBJECTIVE To provide a review of the histopathology of collagen alterations and to propose a classification with the most important types of collagen anomalies in dermatopathology. The authors describe some of the main morphological clues of collagen anomalies for specific diagnosis of some cutaneous inflammatory and neoplastic conditions. METHODS The authors review histopathologic collagen anomalies, concerning both morphology and disposition in some inflammatory and neoplastic cutaneous conditions, and they review previous terminology and proposed a classification of the most important types of collagen anomalies that can be seen in dermatopathological practice. RESULTS Collagen anomalies in skin can be classified into lamellar fibrosis, sclerosis, and "balls" and "rings" of collagen. Lamellar fibrosis presents as long and thin collagen bundles forming a delicate network, which can be disposed in a parallel pattern, onion-bulb-like pattern, and storiform pattern. Sclerosis is characterized by large, thick, and eosinophilic bundles of collagen, which may present as a homogenous-diffuse pattern or as individual thick bundles of collagen with few or abundant number of fibroblasts between them. Finally, the authors propose the terms "balls" and "rings" of collagen. The term "balls" of collagen stands for thick, homogenous, eosinophilic, globular collagen bundles, with no distinguishable individual composing fibers, which include the floating sign and the free-floating sign. The term "rings" of collagen is characterized by sclerotic collagen arranged in a homogenous rimming pattern around vessels without independent fibers in its composition. CONCLUSIONS Collagen anomalies may be important clues to establish specific clues for specific diagnoses in dermatopathology.
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