Desmoplastic trichoepithelioma

Mamelak, Adam J.; Goldberg, Leonard Harry; Katz, Tracy M.; Graves, Jeffery J.; Arnon, Ofer; Kimyai‐Asadi, Arash

doi:10.1016/j.jaad.2009.06.066

Cited by 35 publications

(20 citation statements)

References 12 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 tumor occurs at an incidence of 1 in 5,000 skin biopsies in adults, and is usually observed in middle-aged females, but has been reported in all age groups and genders. DTE usually presents as an asymptomatic, flesh-colored, solitary, annular, indurated and centrally depressed papule or plaque (2,3). The most commonly affected areas are the sun-exposed areas, particularly facial areas such as the cheeks, chin and forehead; less commonly, the tumors may be localized to the upper trunk area, the neck and the scalp (4).…”

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Desmoplastic trichoepithelioma: A clinicopathological study of three cases and a review of the literature

et al. 2015

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Abstract. Desmoplastic trichoepithelioma (DTE) is a rare benign adnexal tumor with the characteristic features of asymptomatic, solitary, annular, indurated and centrally depressed papules or plaques, most commonly occurring in younger individuals on the face. Microscopically and clinically, DTE may be difficult to distinguish from other cutaneous adnexal neoplasms, particularly syringoma, cutaneous metastatic breast cancer, morpheaform basal cell carcinoma and microcystic adnexal carcinoma. The present study reports three cases of DTE. The first case was of a 45-year-old male with an asymptomatic flesh-colored plaque below the right edge of the outer canthus that had been present for seven years. The second case was of a 23-year-old female with an asymptomatic skin lesion on the right cheek that had slowly and progressively increased in size. The third case was of a 26-year-old female who presented with a hard yellowish-white plaque, which gradually grew and formed a rectangular, 3x4-cm patch, on the tip of the left brow. This plaque was present for three years without evident cause or subjective symptoms. In all three cases, the routine systemic examinations and laboratory findings were normal. Histopathological and immunohistochemical findings from incisional biopsies of the lesions were consistent with a diagnosis of DTE. DTE treatment methods and immunohistochemical markers were analyzed by reviewing clinical pathological aspects in order to avoid a misdiagnosis and to provide the best available treatment approach for DTE.

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Adnexal Disorders

Wang¹,

Sidbury²

2019

Harper's Textbook of Pediatric Dermatology

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Desmoplastic trichoepithelioma

Cited by 35 publications

References 12 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

Desmoplastic trichoepithelioma: A clinicopathological study of three cases and a review of the literature

Adnexal Disorders

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