Desmoplastic Trichoepithelioma: Histopathologic and Immunohistochemical Criteria for Differentiation of a Rare Benign Hair Follicle Tumor From Other Cutaneous Adnexal Tumors

Rahman, Jawaria; Tahir, Muhammad; Arekemase, Hassan; Murtazaliev, Salikh; Sonawane, Snehal

doi:10.7759/cureus.9703

Cited by 5 publications

(10 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This benign neoplasm has a bimodal age distribution, primarily affecting females either in childhood or adulthood. 13 Histologically, strands and nests of basaloid epithelial cells proliferate in a dense eosinophilic desmoplastic stroma. The basaloid islands are narrow and cordlike with growth parallel to the surface epidermis and do not dive deeply into the deep dermis or subcutis.…”

Section: Plaque-type Syringomamentioning

confidence: 99%

Solitary Pink Plaque on the Neck

Burke¹

2022

Cutis

View full text Add to dashboard Cite

Section: Plaque-type Syringomamentioning

confidence: 99%

Solitary Pink Plaque on the Neck

Burke¹

2022

Cutis

View full text Add to dashboard Cite

“…The identification of Merkel cells in a sclerosing epithelial neoplasm of the skin makes DTE the most likely diagnosis. Hence, CK20, a marker for Merkel cells, has demonstrated utility in distinguishing DTE from MAC and MBCC 7,11. We found a few scattered CK20 positive Merkel cells in the epidermis of all cases of DTE, whereas no Merkel cells were identified in MBCC and MAC cases.…”

Section: Discussionmentioning

confidence: 58%

“…Hence, CK20, a marker for Merkel cells, has demonstrated utility in distinguishing DTE from MAC and MBCC. 7,11 We found a few scattered CK20 positive Merkel cells in the epidermis of all cases of DTE, whereas no Merkel cells were identified in MBCC and MAC cases. Moreover, no CK20 reactivity was noticed in any of the tumor cells.…”

Section: Discussionmentioning

confidence: 71%

Does Immunohistochemistry Add to Morphology in Differentiating Trichoepithelioma, Desmoplastic Trichoepithelioma, Morpheaform Basal Cell Carcinoma, and Microcystic Adnexal Carcinoma?

Mohanty¹,

Sardana²,

McFall

et al. 2022

Applied Immunohistochemistry &Amp; Molecular Morphology

View full text Add to dashboard Cite

Background: The distinction among cutaneous basaloid neoplasms such as trichoepithelioma (TE), desmoplastic trichoepithelioma (DTE), morpheaform basal cell carcinoma (MBCC), and microcystic adnexal carcinoma (MAC) can be difficult, especially in superficial biopsies. As the treatment plan of each entity is different, accurate characterization is important for appropriate management. While TE and DTE are benign neoplasms with indolent behavior, MBCC and MAC are typically locally aggressive. The expression of several recently described immunohistochemical (IHC) markers, including p40, IMP3, and ProEx C, has not been adequately established in cutaneous neoplasms. We explored the potential utility of a broad IHC panel, including previously reported and novel markers to differentiate TE, DTE, MBCC, and MAC.Design: A total of 35 archival cases [TE (n = 14), DTE (n = 9), MBCC (n = 6), and MAC (n = 6)] were stained with 9 IHC markers: p40, IMP3, ProEx C, p16, CK20, Ki-67, androgen receptor, D2-40, and beta-catenin. Tumors with > 5% immunoreactivity were scored as positive. The intensity was scored on a scale from 1+ to 3+. The pattern of positivity-nuclear, cytoplasmic, membranous, or in combination; peripheral or central distribution with lesion was also recorded.Results: CK20 (in contrast to prior studies) and IMP3 were negative in all cases. Likewise, with the exception of one case of TE, androgen receptor showed no immunoreactivity in all categories. No significant difference was observed in the expression of betacatenin, p16, ProEx C, and p40 among the four groups of cutaneous neoplasms. The mean Ki-67 labeling index for MBCC (8%) was slightly higher than DTE (3%). Interestingly, the proliferation index for TE (15%) was significantly higher than that of MBCC. All six cases of MAC and 36% of TEs expressed D2-40; neither the MBCC nor DE cases showed D2-40immunoreactivity. Also, we confirmed the previously published observation of scattered CK20 positive Merkel cells in the epidermis of all cases of DTE; whereas, no Merkel cells were identified in MBCC and MAC cases.Conclusions: Except Ki-67, our IHC panel showed no significant added diagnostic utility of IHC in discriminating among TE, DTE, MBCC, and MAC. Among the four cutaneous neoplasms, DTE and MBCC show a small but discernible difference in Ki-67.

show abstract

“…MAC is a malignant adnexal tumor that typically presents as solitary, smooth, yellow, or flesh-colored, slowly growing, indurated plaque or cystic nodule (average diameter of 2.0 cm). 1,2,4,5,[12][13][14]21 It predominantly occurs in the head and neck region with a preference for the centrofacial area, including the upper lips (74%) and nasolabial fold. 5 Unlike syringoma, MAC is a poorly circumscribed asymmetrical tumor with an infiltrative growth pattern often associated with perineural invasion and extension into the subcutis, underlying muscle, and bone.…”

Section: Discussionmentioning

confidence: 99%

Solitary Vulvar Syringoma With Deep Extension; Potential for Misdiagnosis as the Microcystic Adnexal Carcinoma (MAC)

Regmi

Zelman

Mudaliar

et al. 2022

The American Journal of Dermatopathology

View full text Add to dashboard Cite

A 43-year-old woman presented with a palpable, pruritic, minimally painful right vulvar lesion. Physical examination revealed approximately 2.0-cm tender nodule at 70' clock in the right labia majora. Histological sections of the excision specimen showed an unremarkable epidermis with large, well-circumscribed dermal proliferation with extension to the reticular dermis. Within this proliferation are small solid and ductal structures relatively evenly distributed in the sclerotic stroma. The epithelial elements consisted of monomorphous cuboidal cells and assumed round, oval, curvilinear, or have other peculiar geometric shapes, including "commalike" or "tadpole"-like configurations. The tumor cells were positive for CEA, EMA, and estrogen receptor and negative for progesterone receptor. The clinical presentation and the deep extension of the tumor were similar to the microcystic adnexal carcinoma. Although a syringoma generally presents with multiple lesions and usually involves the superficial dermis, a syringoma with deep extension was favored based on the lack of follicular differentiation, atypia, mitoses, and perineural invasion. Microcystic adnexal carcinoma and syringoma have a morphologic overlap and are misdiagnosed in 30% of the cases. Thus, it is exceptionally important for pathologists to be aware of and be able to distinguish these entities. To the best of our knowledge, this is the first case of a solitary, painful vulvar syringoma with deep extension.

show abstract

Desmoplastic Trichoepithelioma: Histopathologic and Immunohistochemical Criteria for Differentiation of a Rare Benign Hair Follicle Tumor From Other Cutaneous Adnexal Tumors

Abstract: Rahman et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cited by 5 publications

References 40 publications

Solitary Pink Plaque on the Neck

Solitary Pink Plaque on the Neck

Does Immunohistochemistry Add to Morphology in Differentiating Trichoepithelioma, Desmoplastic Trichoepithelioma, Morpheaform Basal Cell Carcinoma, and Microcystic Adnexal Carcinoma?

Solitary Vulvar Syringoma With Deep Extension; Potential for Misdiagnosis as the Microcystic Adnexal Carcinoma (MAC)

Contact Info

Product

Resources

About