An Immunohistochemical Study of Basal Cell Carcinoma and Trichoepithelioma

Poniecka, Anna W.; Alexis, John

doi:10.1097/00000372-199908000-00004

Cited by 94 publications

(75 citation statements)

References 14 publications

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“…[7][8][9][10] The diffuse staining of bcl-2 in tumor nests of basal cell carcinoma and peripheral staining of tumor nests in cases of trichoepithelioma reported in some studies was refuted by others claiming that the differential expression pattern at the periphery compared with the center of lesional aggregates cannot be assessed reliably, as the epithelial strands are usually thin in the desmoplastic variants of both neoplasms. 3,[9][10][11][12] Use of expression of the AR, initially shown by Izikson et al, were later reproduced by Costache et al 3 Both groups showed AR expression in 475% of basal cell carcinomas tested and lack of the same in both trichoepithelioma and desmoplastic trichoepithelioma. 15 Undermining these results were those obtained by Katona et al who found AR expression in only 65% of basal cell carcinomas tested and also showed AR positivity in 13% of desmoplastic trichoepitheliomas in their series.…”

Section: Discussionmentioning

confidence: 93%

“…Immunohistochemical markers putatively useful in reliably differentiating trichoepithelioma (and/or trichoblastoma) and basal cell carcinoma in general and desmoplastic trichoepithelioma and morpheaform/infiltrative basal cell carcinoma in particular include CD34, Bcl-2, CK20, and AR. 3,[7][8][9][10][11][12][15][16][17] Positive peritumoral staining of trichoepithelioma and desmoplastic trichoepithelioma by CD34, shown by Kirchmann et al, in 100% of cases of both with negative staining in all cases of basal cell carcinoma was contradicted by subsequent studies that showed positive peritumoral staining in some cases of basal cell carcinoma and absence of the same in cases of trichoepithelioma. [7][8][9][10] The diffuse staining of bcl-2 in tumor nests of basal cell carcinoma and peripheral staining of tumor nests in cases of trichoepithelioma reported in some studies was refuted by others claiming that the differential expression pattern at the periphery compared with the center of lesional aggregates cannot be assessed reliably, as the epithelial strands are usually thin in the desmoplastic variants of both neoplasms.…”

Section: Discussionmentioning

confidence: 94%

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Fibroblast-activation protein: a single marker that confidently differentiates morpheaform/infiltrative basal cell carcinoma from desmoplastic trichoepithelioma

2010

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Microscopically, differentiating desmoplastic trichoepithelioma from morpheaform/infiltrative basal cell carcinoma can be difficult as both show 'islands and strands of basaloid cells embedded in a sclerotic stroma'. A superficial shave biopsy further compounds the diagnostic conundrum. Although a plethora of immunohistochemical markers have been touted as being of use as adjunct histologic tools, none thus far appears to be consistent and reliable in terms of specificity and/or sensitivity. Fibroblast-activation protein, a type II membrane-bound glycoprotein belonging to the serine protease family, is expressed in the granulation tissue of healing wounds. More recently, it has been identified as a marker of reactive tumor stromal fibroblasts, as it is reportedly selectively expressed in peritumoral stromal fibroblasts of multiple epithelial cancers including cutaneous malignancies such as basal cell carcinoma. Given this, we sought to ascertain the use of fibroblast-activation protein in distinguishing morpheaform/infiltrative basal cell carcinoma from desmoplastic trichoepithelioma. Immunohistochemical staining for fibroblast-activation protein was performed on desmoplastic trichoepithelioma (n ¼ 25) and morpheaform/infiltrative basal cell carcinoma (n ¼ 25), with the control group comprising scars from reexcision specimens (n ¼ 10). As expected, fibroblast-activation protein expression was observed in stromal fibroblasts of all control cases (10 of 10, 100%). Of interest, fibroblastactivation protein expression was observed in peritumoral fibroblasts of all cases of morpheaform/infiltrative basal cell carcinoma (25 of 25, 100%) but not in any cases of desmoplastic trichoepithelioma (0 of 25, 0%). A gradient of fibroblast-activation protein expression was observed in morpheaform/infiltrative basal cell carcinoma with more intense expression noted in fibroblasts abutting the tumor cells, a less intense expression in the distal peritumoral stromal portion, and minimal to loss of expression in adjacent normal tissue. In summary, findings from this study underscore the use of fibroblast-activation protein as a histologic adjunct in confidently differentiating morpheaform/infiltrative basal cell carcinoma from desmoplastic trichoepithelioma.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 94%

Fibroblast-activation protein: a single marker that confidently differentiates morpheaform/infiltrative basal cell carcinoma from desmoplastic trichoepithelioma

2010

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“…However, in the literature, diffuse Bcl-2 expression by basaliomatous cells was observed in basal cell carcinoma tumors, while expression of this marker only in the outermost layers of basaloid nests was observed in trichoepithelioma tumors; this difference in Bcl-2 localization was considered feasible for the discrimination between these two basaloid tumors. [15][16][17][18] Trichoepithelioma and basal cell carcinoma tumors displayed different epithelial membrane antigen staining patterns. However, epithelial membrane antigen expression did not reach significant 'Beta' values in the regression analysis.…”

mentioning

confidence: 99%

“…Other authors built panels with epithelial markers or the association of epithelial and stromal markers. 11,12,16 In this work, the more effective panel was built using data obtained from a linear regression analysis and was composed of at least one marker displaying stromal labeling.…”

mentioning

confidence: 99%

Diagnostic utility of immunohistochemistry in distinguishing trichoepithelioma and basal cell carcinoma: evaluation using tissue microarray samples

2012

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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.

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“…Immunohistochemistry techniques (33) and lectin staining (3,27) have been tested as supporting tools for differential diagnosis for skin lesions.…”

Section: Introductionmentioning

confidence: 99%

Digital image analysis of skin neoplasms evaluated by lectin histochemistry: potential marker to biochemical alterations and tumour differential diagnosis

Melo-Júnior¹,

Araújo-Filho²,

Patu³

et al. 2006

J. Bras. Patol. Med. Lab.

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An Immunohistochemical Study of Basal Cell Carcinoma and Trichoepithelioma

Cited by 94 publications

References 14 publications

Fibroblast-activation protein: a single marker that confidently differentiates morpheaform/infiltrative basal cell carcinoma from desmoplastic trichoepithelioma

Fibroblast-activation protein: a single marker that confidently differentiates morpheaform/infiltrative basal cell carcinoma from desmoplastic trichoepithelioma

Diagnostic utility of immunohistochemistry in distinguishing trichoepithelioma and basal cell carcinoma: evaluation using tissue microarray samples

Digital image analysis of skin neoplasms evaluated by lectin histochemistry: potential marker to biochemical alterations and tumour differential diagnosis

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