The correlation of cytological atypia and stromal reaction in basal cell carcinoma

Abstract

Background and Design:The literature does not include sufficient data on the associations between cytological atypia and stromal reactions in basal cell carcinoma (BCC) subtypes. The aim of the study was to evaluate the grade of cytological atypia and to determine the associations between atypia grade and stromal reactions in BCC. Materials and Methods: The study included 85 BCC patients. Clinical parameters including age, gender and lesion location were evaluated. As histopathological parameters; subtype (high risk/low risk), grade of cytological atypia (mild/moderate/severe), density of peritumoral/adjacent perivascular inflammation, presence of lymphoid follicle formation, and the stromal reaction type (fibromyxoid/desmoplastic) were evaluated. Results: The mean age of the patients was 67.93±11.46 years (range: 38-88) and the female to male ratio was 45:40. 54.1% of the lesions were located on high-risk regions and high-risk subtype was observed in 50.6% of the lesions. Severe cytological atypia was associated with high-risk subtype (p<0.001), dense peritumoral/perivascular inflammation (p<0.001), and desmoplastic stroma (p<0.001). Moderate/severe atypia, desmoplastic stroma, dense peritumoral/perivascular inflammation and lymphoid follicle formation were significantly more common in high-risk subtypes (p<0.001). Locations were not associated with aytpia grades, density of peritumoral/perivascular inflammation, lymphoid follicle formation, and stromal reactions (p=0.774, p=0.665, 0.416, 0.230, 0.461, and 1, respectively). Conclusion: Severe cytological atypia in BCC was associated with more intense inflammation, desmoplastic stroma and high-risk subtypes in BCC. In conclusion, cytological atypia grade may be a factor influencing stromal reactions. Thus, evaluating the atypia grade in routine histopathological examination of BCCs might be used to identify high-risk BCC subtypes with more infiltrative potential.