Desmoplastic trichoepithelioma

Brownstein, Martin H.; Shapiro, Lucille

doi:10.1002/1097-0142(197712)40:6<2979::aid-cncr2820400633>3.0.co;2-8

Cited by 129 publications

(103 citation statements)

References 7 publications

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“…[1][2][3] Desmoplastic trichoepithelioma is an uncommon benign neoplasm of follicular derivation that usually manifests as a sporadic asymptomatic small indurated annular lesion with a raised border and a depressed center over the face of adolescents and young adults. [3][4][5][6] Like morpheaform/infiltrative basal cell carcinoma, desmoplastic trichoepithelioma is characterized by infiltrating strands and islands of monomorphic, basaloid cells with scant cytoplasm and prominent oval nuclei embedded in a sclerotic and hypocellular stroma. [3][4][5][6] Features of use in distinguishing desmoplastic trichoepithelioma from morpheaform/infiltrative basal cell carcinoma include the additional presence of variably sized horn cysts and foreign-body granulomas in the former.…”

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confidence: 99%

“…[3][4][5][6] Like morpheaform/infiltrative basal cell carcinoma, desmoplastic trichoepithelioma is characterized by infiltrating strands and islands of monomorphic, basaloid cells with scant cytoplasm and prominent oval nuclei embedded in a sclerotic and hypocellular stroma. [3][4][5][6] Features of use in distinguishing desmoplastic trichoepithelioma from morpheaform/infiltrative basal cell carcinoma include the additional presence of variably sized horn cysts and foreign-body granulomas in the former. [3][4][5][6] Although desmoplastic trichoepithelioma is a benign tumor that can be managed by conservative treatment such as curettage or shave biopsy, morpheaform/infiltrative basal cell carcinoma is an aggressive malignant neoplasm that requires complete excision usually with Mohs micrographic surgery.…”

mentioning

confidence: 99%

“…[3][4][5][6] Features of use in distinguishing desmoplastic trichoepithelioma from morpheaform/infiltrative basal cell carcinoma include the additional presence of variably sized horn cysts and foreign-body granulomas in the former. [3][4][5][6] Although desmoplastic trichoepithelioma is a benign tumor that can be managed by conservative treatment such as curettage or shave biopsy, morpheaform/infiltrative basal cell carcinoma is an aggressive malignant neoplasm that requires complete excision usually with Mohs micrographic surgery. [1][2][3][4][5][6] Based on the different biologic behaviors, the histopathologic distinction of desmoplastic trichoepithelioma from morpheaform/infiltrative basal cell carcinoma is not just semantics but crucial to patient management.…”

mentioning

confidence: 99%

“…[3][4][5][6] Although desmoplastic trichoepithelioma is a benign tumor that can be managed by conservative treatment such as curettage or shave biopsy, morpheaform/infiltrative basal cell carcinoma is an aggressive malignant neoplasm that requires complete excision usually with Mohs micrographic surgery. [1][2][3][4][5][6] Based on the different biologic behaviors, the histopathologic distinction of desmoplastic trichoepithelioma from morpheaform/infiltrative basal cell carcinoma is not just semantics but crucial to patient management. This has thus driven an extensive effort to find an immunohistochemical marker of utility in differentiating the two.…”

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

2010

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“…The desmoplastic trichoepithelioma typically presents as a small mid-facial papule or as multiple small firm papules as distinct from the ill-defined plaque of microcystic adnexal carcinoma. 218,231,232 This clinical morphology has a histologic analog; in particular, the microcystic adnexal carcinoma is widely invasive to the edges of a 5-mm punch biopsy specimen, whereas the desmoplastic trichoepithelioma might well be completely encompassed by a biopsy of this size. Put another way, the desmoplastic trichoepithelioma is a shallow tumor, whereas the microcystic adnexal carcinoma invades deeply.…”

Section: Differential Diagnosismentioning

confidence: 99%

Malignant adnexal neoplasms

2006

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Malignant cutaneous adnexal neoplasms are one of the most challenging areas of dermatopathology. Tumors of the pilosebaceous apparatus can occur as single-lineage neoplasms or may manifest as complex proliferations with multilineal differentiation patterns including not only the germinative component of the hair bulb, the inner or outer root sheath epithelium and the sebaceous gland and duct, but also the sweat duct components that relate to the apocrine secretory apparatus which empties into the follicle near the follicular bulge. Eccrine and apocrine neoplasms present a bewildering array of morphologies, which often defy precise classification. The purpose of this review is to discuss in detail the malignant neoplasms of the cutaneous adnexae and their benign and prognostically indeterminate mimics. Modern Pathology (2006) 19, S93-S126. doi:10.1038/modpathol.3800511Keywords: eccrine carcinoma; sebaceous neoplasia Malignant tumors of the pilosebaceous apparatus, their mimics and precursors IntroductionTumors of the pilosebaceous unit can occur in isolation or in combination with complex proliferations showing multilineal differentiation patterns encompassing those of sweat ducts, epidermis and stroma with its varied components. In this review, we will focus upon the malignant adnexal proliferations, considering benign entities mainly insofar as they impact the diagnostic approach to adnexal carcinoma. We will first turn to the malignant sebaceous neoplasms, their precursors and their mimics. Sebaceous adenoma Clinical FeaturesThe sebaceous adenoma is a benign neoplasm that manifests clinically as a pale yellow nodular lesion, typically of the face, that expresses itself clinically after the age of 50. Tumors range in size from o1 to 45 cm. [1][2][3][4][5][6] These lesions are associated with the Muir-Torre syndrome, comprising the coexpression of cutaneous neoplasms, including those of sebaceous type with well-differentiated squamous epithelial neoplasms, and visceral malignancies, including carcinomas of the breast, ovary, gastrointestinal tract and larynx. [7][8][9][10][11][12][13][14] An occasional patient may manifest a malignant lymphoma of nodal or extranodal type. 10,12,14 Sebaceous neoplasms in the setting of Muir-Torre syndrome are often difficult to classify, showing overlap features between all of the prototypic forms of sebaceous neoplasm ranging from hyperplasia to carcinoma. 13 HistologyThe prototypic sebaceous adenoma manifests 1-2 layers of germinitive cells which mature to form central sebocytes, and have an architecture comprising a sharply circumscribed sebaceous lobule surrounded by a compressed pseudocapsule of dermal stroma ( Figure 1a). The overlying epidermis may be attenuated, but sometimes forms a collarette around the peripheral aspect of the neoplasm. Unlike sebaceous hyperplasia, occasional mitoses may be seen in the lobules of a sebaceous adenoma and in concert with this nucleoli may be somewhat prominent, but the pleomorphism, hyperchromasia and individual cell necrosis of the se...

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