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| This article deals with '''dermatologic neoplasms'''. It includes '''dermatologic cancer''', which can be deadly. Collectively, dermatologic cancers are the most common form of cancer. | | This article deals with '''dermatologic neoplasms''', also known as '''skin tumours'''. It includes '''dermatologic cancer''', which can be deadly. Collectively, dermatologic cancers are the most common form of cancer. |
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| An introduction to dermatopathy is found in the ''[[dermatopathology]]'' article. Non-malignant disease is covered in the ''[[non-malignant skin disease]]'' article. | | An introduction to dermatopathy is found in the ''[[dermatopathology]]'' article. Non-malignant disease is covered in the ''[[non-malignant skin disease]]'' article. |
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| =The Big Three malignant= | | =The Big Three malignant= |
| ==Basal cell carcinoma== | | ==Basal cell carcinoma== |
| *Abbreviated ''BCC''.
| | {{Main|Basal cell carcinoma}} |
| ===General===
| |
| *Very common.
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| *Sun exposed skin.
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| *Hair bearing area; tumour derived from hair follicle - a more appropriate name might be ''trichoblastic carcinoma''.<ref name=Ref_Derm389>{{Ref Derm|389}}</ref>
| |
| *Very rarely metastasizes:
| |
| **Dermatopathologists might see a couple in their career.
| |
| **There are only ~ 300 literature reports of metastatic BCC.<ref name=pmid16208438>{{Cite journal | last1 = Ting | first1 = PT. | last2 = Kasper | first2 = R. | last3 = Arlette | first3 = JP. | title = Metastatic basal cell carcinoma: report of two cases and literature review. | journal = J Cutan Med Surg | volume = 9 | issue = 1 | pages = 10-5 | month = Jan | year = 2005 | doi = 10.1007/s10227-005-0027-1 | PMID = 16208438 }}</ref>
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| | |
| ====Clinical====
| |
| *Telangiectasias.
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| *Raised pearly nodule.
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| | |
| ====As part of a syndrome====
| |
| *[[Nevoid basal cell carcinoma syndrome]] (NBCCS), AKA ''Gorlin syndrome''.
| |
| *[[Bazex syndrome]] (X-linked).<ref>URL: [http://emedicine.medscape.com/article/1101146-diagnosis http://emedicine.medscape.com/article/1101146-diagnosis]. Accessed on: 6 May 2010.</ref>
| |
| *[[Xeroderma pigmentosum]].
| |
| | |
| ===Microscopic===
| |
| Features:<ref name=Ref_PBoD8_1180-1>{{Ref PBoD8|1180-1}}</ref><ref name=Ref_Derm390>{{Ref Derm|390}}</ref>
| |
| #Basaloid cells - similar in appearance to basal cells:
| |
| #*Moderate blue/grey cytoplasm.
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| #*Dark ovoid/ellipsoid nucleus with uniform chromatin.
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| #Palisading of cells at the edge of the cell nests.
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| #Artefactual separation of cells (forming the nests) from the underlying stroma - '''key feature'''.
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| #Surrounded by blue [[myxoid stroma|(myxoid) stroma]] - '''key feature'''.
| |
| | |
| May be present:<ref name=Ref_Derm390>{{Ref Derm|390}}</ref>
| |
| *[[Dystrophic calcification]] - possibly more aggressive behaviour.<ref name=pmid20489568>{{Cite journal | last1 = Slodkowska | first1 = EA. | last2 = Cribier | first2 = B. | last3 = Peltre | first3 = B. | last4 = Jones | first4 = DM. | last5 = Carlson | first5 = JA. | title = Calcifications associated with basal cell carcinoma: prevalence, characteristics, and correlations. | journal = Am J Dermatopathol | volume = 32 | issue = 6 | pages = 557-64 | month = Aug | year = 2010 | doi = 10.1097/DAD.0b013e3181ca65e2 | PMID = 20489568 }}</ref>
| |
| *[[Amyloid]].
| |
| *Inflammation.
| |
| | |
| Notes:
| |
| *Palisading = the long axes of the cells are alined and the axes are perpendicular to the interface between the (basaloid cell) nests and stroma.
| |
| *Key elements in a list: Artefactual clefting (of nests), Basaloid cells, Peripheral palisading, Myxoid stroma.
| |
| **Memory device ''PAM'': palisading, artefactual clefts, myxoid stroma.
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| | |
| DDx:
| |
| *[[Trichoepithelioma]] - no artefactual cleft.<ref name=Ref_PBoD8_1180-1>{{Ref PBoD8|1180-1}}</ref>
| |
| *[[Adenoid cystic carcinoma]] - no myxoid stroma, no peripheral palisading.
| |
| *[[Eccrine poroma]] - on palms & soles, BCC rarely found there.<ref>{{Ref DCHH|284}}</ref>
| |
| *Reticulated [[seborrheic keratosis]] - for BCC, fibroepitheliomatous pattern.
| |
| | |
| Images:
| |
| *[[WC]]:
| |
| **[http://commons.wikimedia.org/wiki/File:Basal_cell_carcinoma_pathology.jpg BCC - crappy (WC)].
| |
| **[http://commons.wikimedia.org/wiki/File:SkinTumors-P6040209.JPG Fibroepithelioma of Pinkus (WC)].
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| *www:
| |
| **[http://missinglink.ucsf.edu/lm/DermatologyGlossary/img/Dermatology%20Glossary/Glossary%20Histo%20Images/basal_cell_carcinoma_high_power.jpg BCC (ucsf.edu)].<ref>URL: [http://missinglink.ucsf.edu/lm/DermatologyGlossary/basal_cell_carcinoma.html http://missinglink.ucsf.edu/lm/DermatologyGlossary/basal_cell_carcinoma.html]. Accessed on: 4 September 2011.</ref>
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| **[http://www.surgicalpathologyatlas.com/glfusion/mediagallery/media.php?f=1&sort=0&s=20080802171910891 BCC with fibroepitheliomatous pattern / fibroepithelioma of Pinkus (surgicalpathologyatlas.com)].
| |
| **[http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=930934558 BCC with fibroepitheliomatous pattern (dermatlas.med.jhmi.edu)].
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| | |
| ====Basal cell carcinoma subtypes/unique features====
| |
| *Many patterns exist.
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| *Recurrence higher in morpheaform (sclerosing), infiltrative, micronodular, and superficial patterns.<ref>Basal cell carcinoma. eMedicine. ''Prognosis'' section. URL: [http://emedicine.medscape.com/article/276624-overview http://emedicine.medscape.com/article/276624-overview]. Accessed on: 17 September 2011.</ref>
| |
| *DG says the prognosis is similar for all BCC subtypes, except for ''sclerosing'' pattern and ''infiltrative'' pattern.<ref>Ghazarian, Danny; 14 September 2011.</ref>
| |
| | |
| The subtypes:<ref name=Ref_Derm392-5>{{Ref Derm|392-5}}</ref>
| |
| {| class="wikitable sortable" style="margin-left:auto;margin-right:auto"
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| ! Pattern
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| ! Key histologic feature
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| ! Other histologic features
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| ! Other
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| |-
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| | Superficial pattern
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| | connected to epidermis
| |
| |
| |
| |
| |
| |-
| |
| | Nodular pattern
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| | nodules
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| | partial detachment from epidermis
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| | subgroup ''micronodular'' = nests equal size ~ 0.2 mm dia., >=25% of lesion
| |
| |-
| |
| | Morpheaform (sclerosing) pattern
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| | stroma sclerosis
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| |
| |
| | often seen with ''infiltrative pattern''
| |
| |-
| |
| | Infiltrative pattern
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| | small irregular cell aggregates
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| |
| |
| | often also sclerosing or morpheaform
| |
| |-
| |
| | Fibroepitheliomatous pattern
| |
| | cords and columns of basaloid cells
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| | fibrous stroma
| |
| | name of pattern comes from ''fibroepithelioma of Pinkus''; DDx: reticulated [[seborrheic keratosis]]
| |
| |-
| |
| | Infundibulocystic pattern
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| | small keratocysts (keratin cysts)
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| | usu. small, often in cords
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| | usu. indolent
| |
| |-
| |
| | Adenoidal pattern
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| | cribriform / pseudoglandular arch.
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| | myxoid stroma, peripheral palisading
| |
| | DDx: [[adenoid cystic carcinoma]]
| |
| |-
| |
| |}
| |
| | |
| Unique features/differentiation:<ref name=Ref_Derm392-5>{{Ref Derm|392-5}}</ref>
| |
| {| class="wikitable sortable" style="margin-left:auto;margin-right:auto"
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| ! Differentiation / unique cell
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| ! Key histologic feature
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| ! Other histologic features
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| ! Other
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| |-
| |
| | Pigmented cells
| |
| | '''any pattern''' can have pigmentation
| |
| | pigment may be in malignant cell
| |
| | DDx: collision lesion with [[melanocytic lesion]]
| |
| |-
| |
| | Squamous differentiation (metatypical BCC)
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| | pink cytoplasm, keratinization
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| |
| |
| | assoc. with ulceration/tumour recurrence
| |
| |-
| |
| | Eccrine differentiation
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| | focal duct formation
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| |
| |
| | very rare, DDx: BCC engulfing sweat ducts
| |
| |-
| |
| | Clear cells (Clear cell BCC)
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| | clear cytoplasm
| |
| |
| |
| | due to glycogen
| |
| |}
| |
| | |
| ===IHC===
| |
| *CK5/6 +ve.
| |
| **Useful to assess [[margins]]... if very close.
| |
| *BerEP4 +ve.
| |
| **SCC usually negative.<ref name=pmid19187107>{{Cite journal | last1 = Yu | first1 = L. | last2 = Galan | first2 = A. | last3 = McNiff | first3 = JM. | title = Caveats in BerEP4 staining to differentiate basal and squamous cell carcinoma. | journal = J Cutan Pathol | volume = 36 | issue = 10 | pages = 1074-176 | month = Oct | year = 2009 | doi = 10.1111/j.1600-0560.2008.01223.x | PMID = 19187107 }}</ref>
| |
| *CD10 +ve.
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| *Actin +ve.
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| | |
| ===Sign-out===
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| <pre>
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| SKIN, SHAVE BIOPSY WITH ELECTRODESICCATION AND CURETTAGE (EDC):
| |
| - BASAL CELL CARCINOMA, MARGIN STATUS ASSESSED CLINICALLY DURING EDC.
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| - EXTENSIVE SOLAR ELASTOSIS.
| |
| </pre>
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| | |
| <pre>
| |
| SKIN, RIGHT EAR, EXCISION:
| |
| - BASAL CELL CARCINOMA.
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| - MARGINS NEGATIVE FOR BASAL CELL CARCINOMA.
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| - EXTENSIVE SOLAR ELASTOSIS.
| |
| </pre>
| |
| | |
| ====Micro====
| |
| The sections show hair-bearing skin with nests of basaloid cells in the dermis. The basaloid nests have peripheral palisading of the nuclei, have numerous mitoses, and are surrounded by a myxoid stroma. The nests are well demarcated from the stroma and show focal clefting from the stroma. The margins are negative for basal cell carcinoma.
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|
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|
| ==Squamous cell carcinoma of the skin== | | ==Squamous cell carcinoma of the skin== |
| {{Main|Squamous carcinoma}}
| | *Abbreviated ''skin SCC'', ''SCC of the skin'', and ''SCC of skin''. |
| ===General===
| | {{Main|Squamous cell carcinoma of the skin}} |
| Precursor:<ref name=Ref_PBoD8_1180>{{Ref PBoD8|1180}}</ref>
| |
| *[[Actinic keratosis]] (solar keratosis). | |
| **Clinical: yellow-brown scaly, patches, sandpaper sensation.
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| | |
| Risk factors:<ref name=Ref_PBoD8_1180>{{Ref PBoD8|1180}}</ref>
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| *Sun exposure.
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| *Immune suppression (e.g. organ transplant recipients).
| |
| | |
| Notes:
| |
| *[[Keratoacanthoma]].
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| **Some don't believe this entity exists.
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| ***These people sign this entity as ''low grade squamous cell carcinoma, keratoacanthoma type''.<ref>RS. 17 May 2010.</ref>
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| | |
| ===Microscopic===
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| *See ''[[squamous cell carcinoma]]''.
| |
| | |
| High risk features - for SCC of the skin:<ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/SkinSquamousCell_11protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/SkinSquamousCell_11protocol.pdf]. Accessed on: 29 March 2012.</ref>
| |
| *Primary site is ear ''or'' lip.†
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| *Clark level IV/V = reticular dermis or deeper.
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| *>=2 mm thickness -- measured from ''granular layer'' (stratum granulosum) ''or'' ulcer base to deepest aspect.
| |
| *[[Lymphovascular invasion]].
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| *Perineural invasion.
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| *Poorly differentiated.
| |
| | |
| Note:
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| * † The words used are "hair-bearing lip" - but there is considerable confusion about this as the AJCC manual contradicts itself.<ref name=pmid21151529>{{Cite journal | last1 = Buethe | first1 = D. | last2 = Warner | first2 = C. | last3 = Miedler | first3 = J. | last4 = Cockerell | first4 = CJ. | title = Focus Issue on Squamous Cell Carcinoma: Practical Concerns Regarding the 7th Edition AJCC Staging Guidelines. | journal = J Skin Cancer | volume = 2011 | issue = | pages = 156391 | month = | year = 2011 | doi = 10.1155/2011/156391 | PMID = 21151529 | PMC = 2990020 | URL = http://www.hindawi.com/journals/jsc/2011/156391/ }}</ref>
| |
| | |
| DDx:
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| *[[Inverted follicular keratosis]].
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| *[[Bowen disease]].
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| *[[Malignant melanoma]].
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| *[[Paget disease of the breast]].
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| *[[Eccrine carcinoma]]
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| | |
| ====Bowen disease====
| |
| '''Bowen disease''' is ''[[squamous cell carcinoma]] in situ'' of the skin.
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| *Its histomorphologic appearance may be similar to [[Paget disease of the breast]]/[[Extramammary Paget disease]], Toker cell hyperplasia and [[melanoma]].
| |
| **[[IHC]] is used to separate the entities definitively.
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| | |
| Histologic DDx of Bowen disease:
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| *Benign Toker cell hyperplasia.
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| *[[Malignant melanoma]].
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| *[[Paget disease of the breast]].
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| *[[Eccrine carcinoma]].
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| | |
| Images:
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| *[http://commons.wikimedia.org/wiki/File:Bowen_disease_%281%29.jpg Bowen disease - 1 (WC)].
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| *[http://commons.wikimedia.org/wiki/File:Bowen_disease_%283%29.jpg Bowen disease - 3 (WC)].
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| | |
| ===IHC===
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| Bowen's disease panel:
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| *CK5/6 +ve.<ref>RS. May 2010.</ref>
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| **Usu. -ve in [[Paget disease of the breast]]/[[Extramammary Paget disease]].
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| *S100 -ve, HMB-45 -ve.
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| **Both typically +ve in melanoma.
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| *CEA -ve<ref name=emed_pagets>URL: [http://emedicine.medscape.com/article/1101235-workup#a0721 http://emedicine.medscape.com/article/1101235-workup#a0721]. Accessed on: 2 September 2011.</ref> (+ve in [[Paget disease of the breast]]/[[Extramammary Paget disease]], -ve in Toker cells).
| |
| *CK7 -ve.
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| **Toker cells CK7 +ve.<ref name=pmid19601945>{{Cite journal | last1 = Nofech-Mozes | first1 = S. | last2 = Hanna | first2 = W. | title = Toker cells revisited. | journal = Breast J | volume = 15 | issue = 4 | pages = 394-8 | month = | year = | doi = 10.1111/j.1524-4741.2009.00743.x | PMID = 19601945 }}</ref>
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| | |
| ===Sign-out===
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| <pre>
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| SKIN, SITE, BIOPSY:
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| - MODERATELY-DIFFERENTIATED INVASIVE SQUAMOUS CELL CARCINOMA, SEE COMMENT.
| |
| - NEGATIVE FOR LYMPHOVASCULAR INVASION.
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| - NEGATIVE FOR PERINEURAL INVASION.
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| | |
| COMMENT:
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| The nearest margin (lateral margin) is 1 mm. The tumour is 9 mm in maximal dimension.
| |
| </pre>
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|
| |
|
| ==Melanoma== | | ==Melanoma== |
| {{Main|Malignant melanoma}} | | {{Main|Malignant melanoma}} |
| ===General===
| |
| *Known as the great mimicker in pathology; it may look like many things. | | *Known as the great mimicker in pathology; it may look like many things. |
|
| |
| ===Microscopic===
| |
| Features:
| |
| *Classic appearance of melanoma:
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| **Loosely cohesive; mix of small nests of cells, single cells.
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| **Usu. mixed of spindle and ovoid cell morphology.
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| **+/-Occasional large binucleated cells.
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| **+/-Cytoplasm: brown pigment (melanin).
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| **+/-Prominent (large) red nucleoli (like in ''serous carcinoma'' of the ovary).
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| **Often marked nuclear pleomorphism - variation in cell size, shape & staining (like in ''serous carcinoma'' of the ovary).
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| **[[Nuclear pseudoinclusions]] (like in ''papillary thyroid carcinoma'').
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|
| |
|
| =Less common malignant= | | =Less common malignant= |
| ==Dermatofibrosarcoma protuberans== | | ==Dermatofibrosarcoma protuberans== |
| *Abbreviated ''DFSP''. | | *Abbreviated ''DFSP''. |
| ===General===
| | {{Main|Dermatofibrosarcoma protuberans}} |
| *Dermal location.
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| *Destroys adnexal structures.
| |
| *Occasionally transforms to a (more aggressive) [[adult fibrosarcoma|fibrosarcoma]].<ref name=pmid21128251>{{Cite journal | last1 = Stacchiotti | first1 = S. | last2 = Pedeutour | first2 = F. | last3 = Negri | first3 = T. | last4 = Conca | first4 = E. | last5 = Marrari | first5 = A. | last6 = Palassini | first6 = E. | last7 = Collini | first7 = P. | last8 = Keslair | first8 = F. | last9 = Morosi | first9 = C. | title = Dermatofibrosarcoma protuberans-derived fibrosarcoma: clinical history, biological profile and sensitivity to imatinib. | journal = Int J Cancer | volume = 129 | issue = 7 | pages = 1761-72 | month = Oct | year = 2011 | doi = 10.1002/ijc.25826 | PMID = 21128251 }}</ref>
| |
| | |
| Treatment:<ref name=Ref_PBoD8_1183>{{Ref PBoD8|1183}}</ref>
| |
| *Wide excision.
| |
| *May include [[imatinib]] (Gleevec).
| |
| | |
| ===Gross===
| |
| Features:<ref name=Ref_PCPBoD8_600>{{Ref PCPBoD8|600}}</ref>
| |
| *Firm plaque, often bosselated, usually on the trunk.
| |
| *+/-Ulceration.
| |
| | |
| Images:
| |
| *[http://dermatlas.med.jhmi.edu/derm/display.cfm?ImageID=-375107780 Protuberant DFSP (dermatlas.med.jhmi.edu)].
| |
| *[http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=-1421097348 Huge DFSP on back (dermatlas.med.jhmi.edu)].
| |
| *[http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=-109598044 Protuberant DFSP - gross and histology (dermatlas.med.jhmi.edu)].
| |
| | |
| ===Microscopic===
| |
| Features:<ref name=Ref_PBoD8_1183>{{Ref PBoD8|1183}}</ref>
| |
| *Dermal spindle cell lesion with storiform pattern.
| |
| **Spokes of the wheel-pattern.
| |
| *Contains adipose tissue within the tumour -- '''key feature'''.
| |
| **Described as "honeycomb pattern" and "Swiss cheese pattern".
| |
| | |
| Notes:
| |
| *Adnexal structure within tumour are preserved -- this is unusual for a malignant tumour -- '''important'''.
| |
| | |
| | |
| Main DDx:
| |
| *[[Dermatofibroma]] - has entrapment of collagen bundles at the edge of the lesion.
| |
| | |
| DDx of storiform pattern:
| |
| *DFSP, dermatofibroma, [[solitary fibrous tumour]], [[undifferentiated pleomorphic sarcoma]].
| |
| | |
| Images:
| |
| *[http://commons.wikimedia.org/w/index.php?title=File:Storiform_pattern_-_intermed_mag.jpg DFSP - storiform pattern - intermed. mag. (WC)].
| |
| *[http://commons.wikimedia.org/wiki/File:Storiform_pattern_-_very_high_mag.jpg DFSP - storiform pattern - very high mag. (WC)].
| |
| *[http://webpathology.com/image.asp?case=317&n=1 DFSP (webpathology.com)].
| |
| | |
| ===IHC===
| |
| Panel:<ref>AP. May 2009.</ref>
| |
| *CD34 +ve.
| |
| **Usually negative in dermatofibroma.<ref name=pmid7694515>{{cite journal |author=Abenoza P, Lillemoe T |title=CD34 and factor XIIIa in the differential diagnosis of dermatofibroma and dermatofibrosarcoma protuberans |journal=Am J Dermatopathol |volume=15 |issue=5 |pages=429–34 |year=1993 |month=October |pmid=7694515 |doi= |url=}}</ref><ref name=pmid9129699>{{cite journal |author=Goldblum JR, Tuthill RJ |title=CD34 and factor-XIIIa immunoreactivity in dermatofibrosarcoma protuberans and dermatofibroma |journal=Am J Dermatopathol |volume=19 |issue=2 |pages=147–53 |year=1997 |month=April |pmid=9129699 |doi= |url=}}</ref>
| |
| *Factor XIIIa -ve.
| |
| **Usually positive in dermatofibroma.<ref name=pmid7694515>{{cite journal |author=Abenoza P, Lillemoe T |title=CD34 and factor XIIIa in the differential diagnosis of dermatofibroma and dermatofibrosarcoma protuberans |journal=Am J Dermatopathol |volume=15 |issue=5 |pages=429–34 |year=1993 |month=October |pmid=7694515 |doi= |url=}}</ref><ref name=pmid9129699>{{cite journal |author=Goldblum JR, Tuthill RJ |title=CD34 and factor-XIIIa immunoreactivity in dermatofibrosarcoma protuberans and dermatofibroma |journal=Am J Dermatopathol |volume=19 |issue=2 |pages=147–53 |year=1997 |month=April |pmid=9129699 |doi= |url=}}</ref>
| |
| *S100 -ve (screen for melanoma).
| |
| *Caldesmin -ve (screen for muscle differentiation).
| |
| *Beta-catenin. (???)
| |
| *MIB1 (proliferation marker).
| |
| **Should not be confused with ''MIB-1'' a gene that regulates [[apoptosis]].
| |
| | |
| ===Molecular===
| |
| A characteristic [[translocation]] is seen:<ref>{{Ref PBoD8|1249}}</ref>
| |
| t(17;22)(q22;q15) COLA1/PDGFB.
| |
|
| |
|
| ==Cutaneous B-cell lymphoma== | | ==Cutaneous B-cell lymphoma== |
| Line 324: |
Line 36: |
| ==Cutaneous T-cell lymphoma== | | ==Cutaneous T-cell lymphoma== |
| *Abbreviated CTCL. | | *Abbreviated CTCL. |
| | | {{Main|Cutaneous T-cell lymphoma}} |
| ===General===
| |
| *''Mycosis fungoides'' - is a subtype (???).
| |
| *CTCL is more common than cutaneous B-cell lymphoma (CBCL).<ref>URL: [http://emedicine.medscape.com/article/1099540-overview http://emedicine.medscape.com/article/1099540-overview]. Accessed on: 24 August 2010.</ref><ref>URL: [http://emedicine.medscape.com/article/1098342-overview http://emedicine.medscape.com/article/1098342-overview]. Accessed on: 24 August 2010.</ref>
| |
| | |
| Stages - like [[Kaposi sarcoma]]:
| |
| *Patch.
| |
| *Plaque.
| |
| *Nodular.
| |
| | |
| ===Microscopic===
| |
| *Atypical lymphocytes:
| |
| **Have folded "cerebriform" nuclei; ''Sezary-Lutzner cells''.<ref name=Ref_Klatt385>{{Ref Klatt|385}}</ref>
| |
| *Grouping:
| |
| **Nests in the epidermis - known as "Pautrier microabscesses".
| |
| **Single lymphocytes in epidermis; "lymphocyte exocytosis".<ref>URL: [http://www.mdconsult.com/das/book/body/199872830-2/0/1709/I4-u1.0-B978-0-443-06694-8..50117-2--f2.fig http://www.mdconsult.com/das/book/body/199872830-2/0/1709/I4-u1.0-B978-0-443-06694-8..50117-2--f2.fig]. Accessed on: 6 May 2010.</ref>
| |
| **Short linear arrays of lymphocytes along the basal layer of the epidermis; "epidermotropism".<ref name=Ref_Klatt385>{{Ref Klatt|385}}</ref>
| |
| | |
| DDx:
| |
| *[[Lymphomatoid papulosis]].
| |
| | |
| Images:
| |
| *[http://commons.wikimedia.org/wiki/File:Cutaneous_T-cell_lymphoma_-_very_high_mag.jpg CTCL - very high mag. (WC)].
| |
| *[http://commons.wikimedia.org/wiki/File:Cutaneous_T-cell_lymphoma_-_intermed_mag.jpg CTCL - intermed. mag. (WC)].
| |
| *[http://www.jci.org/articles/view/24826/figure/2 CTCL (jci.org)].
| |
| *[http://www.mdconsult.com/das/book/body/199872830-2/0/1709/I4-u1.0-B978-0-443-06694-8..50117-2--f2.fig CTCL (mdconsult.com)].
| |
| | |
| ===IHC===
| |
| Key stain:
| |
| *CD4 +ve.<ref>{{Ref PBoD8|1185}}</ref>
| |
| | |
| Other stains:
| |
| *CD3 +ve.
| |
| *CD8 -ve.
| |
| *CD20 -ve (to r/o significant B cell population).
| |
| *CD30 -ve.
| |
| *CD5 +ve.
| |
| *CD7 -ve (often lost first in T cell lymphomas).
| |
| *Ki-67 high.
| |
| *CD56 -ve.
| |
|
| |
|
| ==Merkel cell carcinoma== | | ==Merkel cell carcinoma== |
| *Abbreviated ''MCC''.
| | {{Main|Merkel cell carcinoma}} |
| | |
| ===General===
| |
| Features:<ref name=pmid20418670>{{Cite journal | last1 = Calder | first1 = KB. | last2 = Smoller | first2 = BR. | title = New insights into merkel cell carcinoma. | journal = Adv Anat Pathol | volume = 17 | issue = 3 | pages = 155-61 | month = May | year = 2010 | doi = 10.1097/PAP.0b013e3181d97836 | PMID = 20418670 }}</ref>
| |
| *Rare.
| |
| *Aggressive course/poor prognosis.
| |
| *Neuroendocrine-like.<ref name=pmid19395876>{{Cite journal | last1 = Pulitzer | first1 = MP. | last2 = Amin | first2 = BD. | last3 = Busam | first3 = KJ. | title = Merkel cell carcinoma: review. | journal = Adv Anat Pathol | volume = 16 | issue = 3 | pages = 135-44 | month = May | year = 2009 | doi = 10.1097/PAP.0b013e3181a12f5a | PMID = 19395876 }}
| |
| </ref>
| |
| | |
| Etiology:
| |
| *Most caused by ''Merkel cell [[polyomavirus]]''.<ref name=pmid18202256>{{Cite journal | last1 = Feng | first1 = H. | last2 = Shuda | first2 = M. | last3 = Chang | first3 = Y. | last4 = Moore | first4 = PS. | title = Clonal integration of a polyomavirus in human Merkel cell carcinoma. | journal = Science | volume = 319 | issue = 5866 | pages = 1096-100 | month = Feb | year = 2008 | doi = 10.1126/science.1152586 | PMID = 18202256 }}</ref><ref name=pmid20418670/>
| |
| *Immunocompromised/immunosuppressed (e.g. organ transplant recipients).
| |
| | |
| ===Microscopic===
| |
| Features:<ref name=Ref_WMSP491>{{Ref WMSP|491}}</ref>
| |
| *Neuroendocrine nuclear features - round nucleus, small nucleoli/no nucleolus, stippled chromatin - '''key feature'''.
| |
| *Typically medium size cells ~3x resting lymphocyte.
| |
| **May be small or large.
| |
| *Architecture: nests, sheets or trabeculae.
| |
| *Scant cytoplasm.
| |
| *Abundant mitoses. †
| |
| *+/-Nuclear moulding.
| |
| **Nuclei of adjacent cells conform to one another.
| |
| *+/-Tumour infiltrating lymphocytes. ‡
| |
| | |
| Notes:
| |
| *† >10 mitoses/HPF = poor prognosis - definition suffers from [[HPFitis]].<ref name=capp_mcc>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols /2011/SkinMerkelCell_11protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/SkinMerkelCell_11protocol.pdf]. Accessed on: 28 March 2012.</ref>
| |
| *‡ May be associated with a worse prognosis.<ref name=capp_mcc/>
| |
| *Merkel cell carcinoma [[lymph node metastases]] is difficult to diagnose with routine stains; use of IHC stains are advised.<ref name=capp_mcc/>
| |
| *Arise from the epidermis - very rarely in situ.<ref name=pmid15606676>{{Cite journal | last1 = Ferringer | first1 = T. | last2 = Rogers | first2 = HC. | last3 = Metcalf | first3 = JS. | title = Merkel cell carcinoma in situ. | journal = J Cutan Pathol | volume = 32 | issue = 2 | pages = 162-5 | month = Feb | year = 2005 | doi = 10.1111/j.0303-6987.2005.00270.x | PMID = 15606676 }}</ref>
| |
| | |
| DDx:
| |
| *[[Basal cell carcinoma]] - no stippled chromatin, less mitoses active.
| |
| *Cutaneous [[Ewing sarcoma]] - sorted-out with immunostains.
| |
| *[[Lymphoma]].
| |
| **[[Burkitt lymphoma]].
| |
| *Metastatic [[small cell carcinoma]].
| |
| *Other [[small round cell tumours]].
| |
| | |
| Images:
| |
| *www:
| |
| **[http://www.bccancer.bc.ca/HPI/CE/cytotechnology/cytosleuthquiz/nongyne/ng12hist.htm MCC (bccancer.bc.ca)].
| |
| **[http://www.joplink.net/prev/200403/07.html MCC (joplink.net)].
| |
| **[http://www.ispub.com/ispub/ijd/volume_5_number_2_8/concurrent_merkel_cell_carcinoma_and_bowen_s_disease_of_the_thigh/bowen-fig3.jpg Merkel cell carcinoma (ispub.com)].
| |
| **[http://path.upmc.edu/cases/case398.html Merkel cell carcinoma - several images (upmc.edu)].
| |
| *[[WC]]:
| |
| **[http://commons.wikimedia.org/wiki/File:Merkel_cell_carcinoma_-_intermed_mag.jpg MCC - intermed. mag. (WC)].
| |
| **[http://commons.wikimedia.org/wiki/File:Merkel_cell_carcinoma_-_very_high_mag.jpg MCC - very high mag. (WC)].
| |
| **[http://commons.wikimedia.org/wiki/File:Merkelcellcarcinoma_Tag.jpg Merkel cell carcinoma - nested pattern (WC)].
| |
| | |
| ===IHC===
| |
| Features:
| |
| *CK7 -ve.
| |
| *CK20 +ve (perinuclear dot-like).<ref name=pmid11533085>{{Cite journal | last1 = Leech | first1 = SN. | last2 = Kolar | first2 = AJ. | last3 = Barrett | first3 = PD. | last4 = Sinclair | first4 = SA. | last5 = Leonard | first5 = N. | title = Merkel cell carcinoma can be distinguished from metastatic small cell carcinoma using antibodies to cytokeratin 20 and thyroid transcription factor 1. | journal = J Clin Pathol | volume = 54 | issue = 9 | pages = 727-9 | month = Sep | year = 2001 | doi = | PMID = 11533085 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1731517/ }}</ref>
| |
| *CAM5.2 +ve (dot-like pattern).
| |
| *CD56 +ve.
| |
| *AE1/AE3 +ve.
| |
| *Merkel cell polyomavirus +ve ~85% of cases.<ref name=pmid21870327>{{Cite journal | last1 = Jung | first1 = HS. | last2 = Choi | first2 = YL. | last3 = Choi | first3 = JS. | last4 = Roh | first4 = JH. | last5 = Pyon | first5 = JK. | last6 = Woo | first6 = KJ. | last7 = Lee | first7 = EH. | last8 = Jang | first8 = KT. | last9 = Han | first9 = J. | title = Detection of Merkel cell polyomavirus in Merkel cell carcinomas and small cell carcinomas by PCR and immunohistochemistry. | journal = Histol Histopathol | volume = 26 | issue = 10 | pages = 1231-41 | month = Oct | year = 2011 | doi = | PMID = 21870327 }}</ref>
| |
| | |
| Others:
| |
| *TTF-1 -ve.
| |
| | |
| ===EM===
| |
| *''[[Neurosecretory granules]]'' ([[AKA]] dense-core granules).<ref name=pmid9062165>{{Cite journal | last1 = Gil-Moreno | first1 = A. | last2 = Garcia-Jiménez | first2 = A. | last3 = González-Bosquet | first3 = J. | last4 = Esteller | first4 = M. | last5 = Castellví-Vives | first5 = J. | last6 = Martínez Palones | first6 = JM. | last7 = Xercavins | first7 = J. | title = Merkel cell carcinoma of the vulva. | journal = Gynecol Oncol | volume = 64 | issue = 3 | pages = 526-32 | month = Mar | year = 1997 | doi = | PMID = 9062165 }}</ref>
| |
|
| |
|
| ==Eccrine carcinoma== | | ==Eccrine carcinoma== |
| Line 448: |
Line 58: |
|
| |
|
| ==Sebaceous carcinoma== | | ==Sebaceous carcinoma== |
| ===General===
| | {{Main|Sebaceous carcinoma}} |
| *Malignant.
| |
| *May arise in a [[salivary gland]].<ref name=Warman/>
| |
| | |
| Notes:
| |
| *Sebaceous lesions (from benign to malignant): [[sebaceous hyperplasia]], [[sebaceous adenoma]], sebaceoma, sebaceous carcinoma.
| |
| | |
| ===Microscopic===
| |
| Features:
| |
| *Nuclear atypia.
| |
| *Sebaceous differentiation:
| |
| **Abundant pale fluffy cytoplasm.
| |
| | |
| Images:
| |
| *www:
| |
| **[http://www.ispub.com/journal/the-internet-journal-of-otorhinolaryngology/volume-9-number-2/sebaceous-adenocarcinoma-of-the-parotid-gland-a-case-report-and-literature-review.article-g01.fs.jpg Sebaceous carcinoma (ispub.com)].<ref name=Warman>URL: [http://www.ispub.com/journal/the_internet_journal_of_otorhinolaryngology/volume_9_number_2_11/article/sebaceous_adenocarcinoma_of_the_parotid_gland_a_case_report_and_literature_review.html http://www.ispub.com/journal/the_internet_journal_of_otorhinolaryngology/volume_9_number_2_11/article/sebaceous_adenocarcinoma_of_the_parotid_gland_a_case_report_and_literature_review.html]. Accessed on: 8 September 2011.</ref>
| |
| *[[WC]]:
| |
| **[http://commons.wikimedia.org/wiki/File:Sebaceous_carcinoma_-_intermed_mag.jpg Sebaceous carcinoma - intermed. mag. (WC)].
| |
| **[http://commons.wikimedia.org/wiki/File:Sebaceous_carcinoma_-_very_high_mag.jpg Sebaceous carcinoma - very high mag. (WC)].
| |
| | |
| ===IHC===
| |
| *CK7 +ve.<ref name=pmid21592202>{{Cite journal | last1 = Ansai | first1 = S. | last2 = Arase | first2 = S. | last3 = Kawana | first3 = S. | last4 = Kimura | first4 = T. | title = Immunohistochemical findings of sebaceous carcinoma and sebaceoma: retrieval of cytokeratin expression by a panel of anti-cytokeratin monoclonal antibodies. | journal = J Dermatol | volume = 38 | issue = 10 | pages = 951-8 | month = Oct | year = 2011 | doi = 10.1111/j.1346-8138.2011.01274.x | PMID = 21592202 }}</ref>
| |
|
| |
|
| ==Microcystic adnexal carcinoma== | | ==Microcystic adnexal carcinoma== |
| *[[AKA]] ''syringomatous carcinoma'', [[AKA]] ''sclerosing sweat duct carcinoma''.<ref name=dermaamin>URL: [http://www.dermaamin.com/site/histopathology-of-the-skin/65-m/1926-microcystic-adnexal-carcinoma-.html http://www.dermaamin.com/site/histopathology-of-the-skin/65-m/1926-microcystic-adnexal-carcinoma-.html]. Accessed on: 16 September 2011.</ref>
| | {{Main|Microcystic adnexal carcinoma}} |
| ===General===
| |
| *Low-grade tumour.
| |
| *Adults.
| |
| | |
| ===Microscopic===
| |
| Features:<ref>{{Ref Derm|412}}</ref>
| |
| *Small basaloid cells - often forming small cystic spaces - '''key feature'''.
| |
| *Fibrotic stroma.
| |
| | |
| DDx:
| |
| *Sclerosing [[basal cell carcinoma]].
| |
| *Desmoplastic [[trichoepithelioma]].
| |
| *Infiltrative [[squamous cell carcinoma]].
| |
| | |
| Image:
| |
| *[http://www.dermaamin.com/site/images/histo-pic/m/microcystic-adnexal-carcinoma/microcystic-adnexal-carcinoma2.jpg Microcystic adnexal carcinoma (dermaamin.com)].<ref name=dermaamin>URL: [http://www.dermaamin.com/site/histopathology-of-the-skin/65-m/1926-microcystic-adnexal-carcinoma-.html http://www.dermaamin.com/site/histopathology-of-the-skin/65-m/1926-microcystic-adnexal-carcinoma-.html]. Accessed on: 16 September 2011.</ref>
| |
|
| |
|
| ==Trichilemmal carcinoma== | | ==Trichilemmal carcinoma== |
| ===General===
| | {{Main|Trichilemmal carcinoma}} |
| *Super rare.
| |
| *Not well-described.
| |
| | |
| ===Microscopic===
| |
| Features:<ref>{{Ref Derm|399-400}}</ref>
| |
| *Clear (glycogen-rich) cytoplasm in center of lesion.
| |
| *Peripheral palisading at edge of lesion - root sheath differentiation (hair follicle).
| |
| *Contiguous with hair follicle ''or'' assoc. with [[trichilemmoma]].
| |
| | |
| DDx:
| |
| *[[Squamous cell carcinoma]], clear cell variant.
| |
| *[[Basal cell carcinoma]], clear cell variant.
| |
| *[[Trichilemmoma]].
| |
|
| |
|
| ==Lymphomatoid papulosis== | | ==Lymphomatoid papulosis== |
| Line 549: |
Line 109: |
| ==Atypical fibroxanthoma== | | ==Atypical fibroxanthoma== |
| *Abbreviated ''AFX''. | | *Abbreviated ''AFX''. |
| ===General===
| | {{Main|Atypical fibroxanthoma}} |
| *Typically head & neck region.<ref>URL: [http://emedicine.medscape.com/article/1056204-overview http://emedicine.medscape.com/article/1056204-overview]. Accessed on 2 September 2011.</ref>
| |
| *Thought to be related to [[pleomorphic undifferentiated sarcoma]];<ref name=pmid21664889>{{Cite journal | last1 = Withers | first1 = AH. | last2 = Brougham | first2 = ND. | last3 = Barber | first3 = RM. | last4 = Tan | first4 = ST. | title = Atypical fibroxanthoma and malignant fibrous histiocytoma. | journal = J Plast Reconstr Aesthet Surg | volume = | issue = | pages = | month = Jun | year = 2011 | doi = 10.1016/j.bjps.2011.05.004 | PMID = 21664889 }}</ref> some say it is the same thing.<ref name=danny>Ghazarian, Danny; 16 September 2011.</ref>
| |
| *Usually benign.
| |
| **May metastasize - case report-type of occurrence.<ref>{{Cite journal | last1 = New | first1 = D. | last2 = Bahrami | first2 = S. | last3 = Malone | first3 = J. | last4 = Callen | first4 = JP. | title = Atypical fibroxanthoma with regional lymph node metastasis: report of a case and review of the literature. | journal = Arch Dermatol | volume = 146 | issue = 12 | pages = 1399-404 | month = Dec | year = 2010 | doi = 10.1001/archdermatol.2010.206 | PMID = 20713774 | URL = http://archderm.jamanetwork.com/article.aspx?articleid=422416 }}</ref>
| |
| | |
| Clinical:
| |
| *Rapid growth.
| |
| *Elderly.
| |
| *Good prognosis.<ref name=pmid20526171>{{Cite journal | last1 = Beer | first1 = TW. | last2 = Drury | first2 = P. | last3 = Heenan | first3 = PJ. | title = Atypical fibroxanthoma: a histological and immunohistochemical review of 171 cases. | journal = Am J Dermatopathol | volume = 32 | issue = 6 | pages = 533-40 | month = Aug | year = 2010 | doi = 10.1097/DAD.0b013e3181c80b97 | PMID = 20526171 }}</ref>
| |
| | |
| ===Microscopic===
| |
| Features:<ref name=Ref_Derm521>{{Ref Derm|521}}</ref>
| |
| *Dermal lesion - '''key point'''.
| |
| *Marked nuclear atypia.
| |
| *Mitoses.
| |
| *Mulitnucleated cells.
| |
| *Foamy cytoplasm - '''key feature'''.
| |
| | |
| DDx:
| |
| *[[Melanoma]].
| |
| *[[Pleomorphic undifferentiated sarcoma]] (MFH).
| |
| *[[Leiomyosarcoma]].
| |
| *Sarcomatoid [[squamous carcinoma]].
| |
| | |
| Notes:
| |
| *No Grenz zone. (???)
| |
| | |
| Image:
| |
| *[http://dermatology.cdlib.org/141/case_reports/afx/1.jpg AFX (cdlib.org)].<ref name=pmid18319023>{{Cite journal | last1 = Vandergriff | first1 = TW. | last2 = Reed | first2 = JA. | last3 = Orengo | first3 = IF. | title = An unusual presentation of atypical fibroxanthoma. | journal = Dermatol Online J | volume = 14 | issue = 1 | pages = 6 | month = | year = 2008 | doi = | PMID = 18319023 }}</ref>
| |
| | |
| ===IHC===
| |
| Features:<ref name=Ref_Derm521>{{Ref Derm|521}}</ref>
| |
| *S100 -ve (done to r/o melanoma).
| |
| *34betaE12 -ve.
| |
| *p63 -ve (done to exclude SCC)
| |
| **Scant staining not considered +ve.
| |
| *Desmin -ve (done to r/o leiomyosarcoma).
| |
|
| |
|
| =Benign= | | =Benign= |
| Line 593: |
Line 116: |
| *Benign sweat duct tumour. | | *Benign sweat duct tumour. |
| *Eccrine differentiation. | | *Eccrine differentiation. |
| *Usually close to lower eyelid.<ref>{{Ref PBoD8|1177}}</ref> | | *Usually close to lower [[eyelid]].<ref>{{Ref PBoD8|1177}}</ref> |
|
| |
|
| ===Microscopic=== | | ===Microscopic=== |
| Line 626: |
Line 149: |
|
| |
|
| Images: | | Images: |
| *[http://www.ispub.com/ispub/ijd/volume_7_number_1_18/cutaneous_mixed_tumor/mixed-fig1.jpg Chondroid syringoma - low mag. (ispub.com)].<ref name=ispub_mts>URL: [http://www.ispub.com/journal/the_internet_journal_of_dermatology/volume_7_number_2_23/article/cutaneous_mixed_tumor.html http://www.ispub.com/journal/the_internet_journal_of_dermatology/volume_7_number_2_23/article/cutaneous_mixed_tumor.html]. Access on: 21 September 2011.</ref> | | *[https://www.dermnetnz.org/topics/apocrine-mixed-tumour-pathology Chondroid syringoma (DermnetNZ)]. |
| *[http://www.ispub.com/ispub/ijd/volume_7_number_1_18/cutaneous_mixed_tumor/mixed-fig2.jpg Chondroid syringoma - high mag. (ispub.com)].<ref name=ispub_mts>URL: [http://www.ispub.com/journal/the_internet_journal_of_dermatology/volume_7_number_2_23/article/cutaneous_mixed_tumor.html http://www.ispub.com/journal/the_internet_journal_of_dermatology/volume_7_number_2_23/article/cutaneous_mixed_tumor.html]. Access on: 21 September 2011.</ref>
| |
|
| |
|
| ==Dermal cylindroma== | | ==Dermal cylindroma== |
| ===General===
| | {{Main|Dermal cylindroma}} |
| *Benign skin lesion.
| |
| **Occasionally malignant.<ref name=pmid16882695/>
| |
| *Should not be confused with ''cylindroma'' ([[adenoid cystic carcinoma]]).
| |
| *May be related to ''[[eccrine spiradenoma]]''.<ref name=pmid6302142>{{Cite journal | last1 = Gerber | first1 = JE. | last2 = Descalzi | first2 = ME. | title = Eccrine spiradenoma and dermal cylindroma. | journal = J Cutan Pathol | volume = 10 | issue = 1 | pages = 73-8 | month = Feb | year = 1983 | doi = | PMID = 6302142 }}</ref><ref name=pmid8936072>{{Cite journal | last1 = Lee | first1 = MW. | last2 = Kelly | first2 = JW. | title = Dermal cylindroma and eccrine spiradenoma. | journal = Australas J Dermatol | volume = 37 | issue = 1 | pages = 48-9 | month = Feb | year = 1996 | doi = | PMID = 8936072 }}</ref>
| |
| | |
| May be familial:<ref name=pmid16882695/>
| |
| *Familial cylindromatosis (autosomal dominant).
| |
| *Brook–Spiegler syndrome.
| |
| | |
| ===Gross===
| |
| *Classically scalp - usually head and neck or face.
| |
| | |
| ===Microscopic===
| |
| Features:<ref name=pmid16882695/>
| |
| *Nests of cells that fit together like a jigsaw puzzle - the borders of the nests are opposed and undulate.
| |
| *#Basaloid cells with scant cytoplasm and dark nuclei palisade around the edge of the nests.
| |
| *#Larger cells with moderate eosinophilic cytoplasm and lighter staining nuclei are at the centre of the nests.
| |
| *Cells nests surrounded by a band of hyaline (i.e. glassy, eosinophilic, acellular) material ~ 2X thickness of a basilar cell - '''key feature'''.
| |
| **This is basement membrane.
| |
|
| |
| DDx:
| |
| *[[Eccrine spiradenoma]].
| |
| *[[Basal cell carcinoma]] - has [[myxoid stroma]].
| |
| | |
| Images:
| |
| *[[WC]]:
| |
| **[http://commons.wikimedia.org/wiki/File:Dermal_cylindroma_intermed_mag.jpg Dermal cylindroma (WC)].
| |
| **[http://commons.wikimedia.org/wiki/File:Dermal_cylindroma_intermed_mag_deep.jpg Dermal cylindroma - high mag. (WC)].
| |
| *www:
| |
| **[http://jcp.bmj.com/content/60/2/145/F7.large.jpg Dermal cylindroma (bmj.com)].<ref name=pmid16882695>{{Cite journal | last1 = Obaidat | first1 = NA. | last2 = Alsaad | first2 = KO. | last3 = Ghazarian | first3 = D. | title = Skin adnexal neoplasms--part 2: an approach to tumours of cutaneous sweat glands. | journal = J Clin Pathol | volume = 60 | issue = 2 | pages = 145-59 | month = Feb | year = 2007 | doi = 10.1136/jcp.2006.041608 | PMID = 16882695 | PMC = 1860616 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860616/?tool=pubmed }}</ref>
| |
| | |
| ===Stains===
| |
| *PAS +ve (basement membrane).<ref name=pmid16882695/>
| |
|
| |
|
| ==Keratoacanthoma== | | ==Keratoacanthoma== |
| *Abbreviated ''KA''.
| | {{Main|Keratoacanthoma}} |
| ===General===
| |
| *Generally considered to be benign.
| |
| **Rare reports of [[metastases]] suggesting it may be a form of [[squamous cell carcinoma]].<ref>{{cite journal |author=Mandrell JC, Santa Cruz D |title=Keratoacanthoma: hyperplasia, benign neoplasm, or a type of squamous cell carcinoma? |journal=Semin Diagn Pathol |volume=26 |issue=3 |pages=150–63 |year=2009 |month=August |pmid=20043514 |doi= |url=}}</ref>
| |
| | |
| ====Clinical====
| |
| *May grow rapidly (weeks or months) then involute.
| |
| *Main DDx is [[squamous cell carcinoma]].
| |
| *Exophytic lesion, well-circumscribed.
| |
| | |
| ===Microscopic===
| |
| Features:<ref name=Ref_Klatt378>{{Ref Klatt|378}}</ref>
| |
| *Expansion of stratum spinosum - pushing [[tongue]]-like downward growth of epidermis into the dermis.
| |
| *Keratin collection ("keratin plug") at the center of lesion-superficial aspect.
| |
| *Cells have glassy pink cytoplasm.
| |
| *Minimal/no nuclear atypia.
| |
| | |
| Note:
| |
| *Classically described as a "volcano lesion" with pale pink cells.
| |
| *May have features of regression - [[PMN]]s, fibrosis (???).
| |
| | |
| DDx:<ref name=Ref_Derm379>{{Ref Derm|379}}</ref>
| |
| *[[Verruca vulgaris]].
| |
| *Conventional [[squamous cell carcinoma of the skin]] with a cup-shape.
| |
| *[[Pseudoepitheliomatous hyperplasia]].
| |
| | |
| Image:
| |
| *[http://commons.wikimedia.org/wiki/File:Skin_keratoacanthoma_whole_slide.jpg Keratocanthoma (WC).]
| |
|
| |
|
| ==Sebaceous adenoma== | | ==Sebaceous adenoma== |
| Line 708: |
Line 170: |
| **Multiple dilated glands - opening to the surface. | | **Multiple dilated glands - opening to the surface. |
|
| |
|
| Images: | | ====Images==== |
| *www:
| | <gallery> |
| **[http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=587283984 Sebaceous adenoma (jhmi.edu)].
| | Image:Sebaceous_adenoma_-_low_mag.jpg | Sebaceous adenoma - low mag. (WC/Nephron) |
| *[[WC]]:
| | Image:Sebaceous_adenoma_-_high_mag.jpg | Sebaceous adenoma - high mag. (WC/Nephron) |
| **[http://commons.wikimedia.org/wiki/File:Sebaceous_adenoma_-_low_mag.jpg Sebaceous adenoma - low mag. (WC)].
| | </gallery> |
| **[http://commons.wikimedia.org/wiki/File:Sebaceous_adenoma_-_high_mag.jpg Sebaceous adenoma - high mag. (WC)].
| | www: |
| | *[http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=587283984 Sebaceous adenoma (jhmi.edu)]. |
|
| |
|
| ==Trichilemmoma== | | ==Trichilemmoma== |
| *May be spelled ''tricholemmoma''. | | *May be spelled ''tricholemmoma''. |
| ===General===
| | {{Main|Trichilemmoma}} |
| *Benign neoplasm with features of the pilosebaceous follicular epithelium.<ref>URL: [http://emedicine.medscape.com/article/1059940-overview http://emedicine.medscape.com/article/1059940-overview]. Accessed on: 2 September 2011.</ref>
| | |
| *Associated with ''nevus sebaceous''.<ref name=pmid16503928>{{Cite journal | last1 = Baykal | first1 = C. | last2 = Buyukbabani | first2 = N. | last3 = Yazganoglu | first3 = KD. | last4 = Saglik | first4 = E. | title = [Tumors associated with nevus sebaceous]. | journal = J Dtsch Dermatol Ges | volume = 4 | issue = 1 | pages = 28-31 | month = Jan | year = 2006 | doi = 10.1111/j.1610-0387.2006.05855.x | PMID = 16503928 }}</ref>
| | ==Poroma== |
| *Muliple trichilemmomas associated with [[Cowden syndrome]].<ref name=Ref_Derm386>{{Ref Derm|386}}</ref>
| | {{Main|Poroma}} |
|
| |
|
| ===Microscopic=== | | ==Nodular hidradenoma== |
| Features:<ref name=Ref_Derm386>{{Ref Derm|386}}</ref>
| | *[[AKA]] ''eccrine acrospiroma''.<ref name=pmid18319032>{{Cite journal | last1 = Punia | first1 = RP. | last2 = Garg | first2 = S. | last3 = Bal | first3 = A. | last4 = Mohan | first4 = H. | title = Pigmented nodular hidradenoma masquerading as nodular malignant melanoma. | journal = Dermatol Online J | volume = 14 | issue = 1 | pages = 15 | month = | year = 2008 | doi = | PMID = 18319032 |URL = http://dermatology.cdlib.org/141/case_presentations/hidradenoma/punia.html }}</ref> |
| *Superficial dermal lesion contiguous with the epidermis:
| | {{Main|Nodular hidradenoma}} |
| **Core of lesion:
| |
| ***Cuboidal cells with round nuclei, eosinophilic-clear cytoplasm.
| |
| **Periphery of lesion:
| |
| ***Surrounded by hyaline band.
| |
| ***Peripheral palisading.
| |
|
| |
|
| DDx:
| | ==Trichoblastoma== |
| *[[Trichilemmal carcinoma]].
| | {{Main|Trichoblastoma}} |
| *[[Basal cell carcinoma]].
| |
| *[[Inverted follicular keratosis]].
| |
|
| |
|
| Images:
| | ==Trichofolliculoma== |
| *[http://ccr.cancer.gov/staff/images/9033_12822_Lee_1520.jpg Trichilemmoma - low mag. (cancer.gov)].<ref name=lee>URL: [http://ccr.cancer.gov/staff/gallery.asp?profileid=12822 http://ccr.cancer.gov/staff/gallery.asp?profileid=12822]. Accessed on: 2 September 2011.</ref>
| | {{Main|Trichofolliculoma}} |
| *[http://ccr.cancer.gov/staff/images/9033_12822_Lee_1521.jpg Trichilemmoma - high mag. (cancer.gov)].<ref name=lee/>
| |
| *[http://dermimages.med.jhmi.edu/images/trichilemmoma_1_060109.jpg Trichilemmoma (jhmi.edu)].<ref>URL: [http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=667496720 http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=667496720]. Accessed on: 2 September 2011.</ref>
| |
| *[http://www.flickr.com/photos/40981620@N04/3812019838/in/pool-1185084@N23/ Trichilemmoma - low mag. (flickr.com/Irlam)].
| |
| *[http://www.flickr.com/photos/40981620@N04/3812019930/in/pool-1185084@N23/ Trichilemmoma - intermed. mag. (flickr.com/Irlam)].
| |
| *[http://www.flickr.com/photos/40981620@N04/3811204517/in/pool-1185084@N23/ Trichilemmoma - high mag. (flickr.com/Irlam)].
| |
|
| |
|
| ==Eccrine poroma== | | ==Apocrine carcinoma of the skin== |
| ===General=== | | ===General=== |
| *Benign tumour arising from the distal sweat duct. | | *Rare.<ref name=pmid7678545>{{Cite journal | last1 = Paties | first1 = C. | last2 = Taccagni | first2 = GL. | last3 = Papotti | first3 = M. | last4 = Valente | first4 = G. | last5 = Zangrandi | first5 = A. | last6 = Aloi | first6 = F. | title = Apocrine carcinoma of the skin. A clinicopathologic, immunocytochemical, and ultrastructural study. | journal = Cancer | volume = 71 | issue = 2 | pages = 375-81 | month = Jan | year = 1993 | doi = | PMID = 7678545 }}</ref> |
| *Erythematous - gross. | | *Usually very good prognosis.<ref name=pmid7678545/> |
|
| |
|
| ===Microscopic=== | | ===Microscopic=== |
| Features:<ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675(06)70190-5 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675(06)70190-5]. Accessed on: 2 July 2010.</ref> | | Features:<ref name=pmid7678545/> |
| *Broad sheets of basaloid cells - attached to the epidermis - containing ductal structures - '''key feature'''. | | *Nests. |
| *Biphasic stroma:
| | *Apocrine snouts - "decapitation secretion" |
| *#Edematous stroma.
| |
| *#Sclerotic stroma.
| |
| *Moderate nuclear pleomorphism. | |
| *+/-Occasional mitoses.
| |
| | |
| Notes:
| |
| *Area above gland appears crusted.
| |
|
| |
|
| DDx: | | DDx: |
| *[[Trichilemmoma]]. | | *[[Paget disease of the breast]]/[[Extramammary Paget disease]]. |
| *[[Nodular hidradenoma]].
| |
|
| |
|
| Images:
| | ====Images==== |
| *[http://www.flickr.com/photos/40981620@N04/3808316834/in/photostream/ Eccrine poroma - low mag. (flickr.com)]
| | <gallery> |
| *[http://www.flickr.com/photos/40981620@N04/3807502071/in/photostream Eccrine poroma - intermed. mag. (flickr.com)].
| | Image:Apocrine_carcinoma_-_intermed_mag.jpg | Apocrine carcinoma - intermed. mag. (WC/Nephron) |
| | | Image:Apocrine_carcinoma_-_high_mag.jpg | Apocrine carcinoma - high mag. (WC/Nephron) |
| ==Nodular hidradenoma== | | </gallery> |
| *[[AKA]] ''eccrine acrospiroma''.<ref name=pmid18319032>{{Cite journal | last1 = Punia | first1 = RP. | last2 = Garg | first2 = S. | last3 = Bal | first3 = A. | last4 = Mohan | first4 = H. | title = Pigmented nodular hidradenoma masquerading as nodular malignant melanoma. | journal = Dermatol Online J | volume = 14 | issue = 1 | pages = 15 | month = | year = 2008 | doi = | PMID = 18319032 |URL = http://dermatology.cdlib.org/141/case_presentations/hidradenoma/punia.html }}</ref>
| | ===Stains=== |
| ===General===
| | Features:<ref name=pmid7678545/> |
| *Benign adnexal tumour.<ref name=pmid9537017>{{Cite journal | last1 = Stratigos | first1 = AJ. | last2 = Olbricht | first2 = S. | last3 = Kwan | first3 = TH. | last4 = Bowers | first4 = KE. | title = Nodular hidradenoma. A report of three cases and review of the literature. | journal = Dermatol Surg | volume = 24 | issue = 3 | pages = 387-91 | month = Mar | year = 1998 | doi = | PMID = 9537017 }}</ref>
| | *PAS +ve. |
| | | *PASD +ve. |
| Typical locations:<ref name=pmid18319032/>
| |
| *Scalp.
| |
| *Face.
| |
| *Trunk, anterior.
| |
| | |
| ===Microscopic=== | |
| Features:<ref name=pmid9537017/> | |
| *Well-circumscribed dermal lesions with: | |
| **Back-to-back nests with a whorled appearance.
| |
| **Spaces between cells.
| |
| **Nuclei ovoid and centrally placed in the cell.
| |
| ***No nucleolus. | |
| **Cystic spaces with degenerated cells.
| |
| | |
| DDx:
| |
| *[[Eccrine poroma]].
| |
|
| |
|
| ===IHC=== | | ===IHC=== |
| Features:<ref name=pmid9537017/>
| | *[[GCDFP-15]] (gross cystic disease fluid protein-15) +ve.<ref name=pmid7678545/> |
| *CAM5.2 +ve.
| |
| *AE1/AE3 +ve.
| |
| *EMA +ve.
| |
| *S100 -ve.
| |
| *Desmin -ve.
| |
|
| |
|
| ==Trichoblastoma== | | ==Dermatomyofibroma== |
| *[[AKA]] ''trichoepithelioma''.
| | :Should ''not'' be confused with [[dermatofibroma]]. |
| **''Trichoepithelioma'' is considered a superficial version of trichoblastoma; WHO lumps the two entities together.<ref name=Ref_Derm383>{{Ref Derm|383}}</ref> | | *Abbreviated ''DMF''. |
| ===General=== | | ===General=== |
| *Benign. | | *Uncommon. |
| **Maligant counterpart of trichoepithelioma: [[trichilemmal carcinoma]].
| |
| *May be familial:
| |
| **Multiple familial trichoepithelioma.<ref name=pmid15289313>{{Cite journal | last1 = Salhi | first1 = A. | last2 = Bornholdt | first2 = D. | last3 = Oeffner | first3 = F. | last4 = Malik | first4 = S. | last5 = Heid | first5 = E. | last6 = Happle | first6 = R. | last7 = Grzeschik | first7 = KH. | title = Multiple familial trichoepithelioma caused by mutations in the cylindromatosis tumor suppressor gene. | journal = Cancer Res | volume = 64 | issue = 15 | pages = 5113-7 | month = Aug | year = 2004 | doi = 10.1158/0008-5472.CAN-04-0307 | PMID = 15289313 }}</ref>
| |
| **Brooke-Spiegler syndrome.
| |
|
| |
|
| ===Microscopic=== | | ===Microscopic=== |
| Features:<ref>URL: [http://emedicine.medscape.com/article/1060049-workup#a0723 http://emedicine.medscape.com/article/1060049-workup#a0723]. Accessed on: 31 August 2011.</ref> | | Features:<ref name=Ref_Derm504>{{Ref Derm|504}}</ref> |
| *Well-circumscribed cell nest in the superficial dermis. | | *Poorly formed fasicles parallel to the skin surface, usu. restricted to the superficial dermis. |
| *Surrounding by a fibrous stroma. | | *Moderate cellular density - less cellular than [[DFSP]]. |
| *Basaloid cells with [[peripheral palisading]].
| | *Eosinophilic cytoplasm. |
| *+/-Surround keratin-filled cysts.
| |
| *Fibroblasts-like cell aggregate, similar to a follicular papillae (papillary-mesenchymal body).
| |
| | |
| Notes:
| |
| *Very rarely an artefactual cleft - as in [[basal cell carcinoma]].
| |
| | |
| Variants:
| |
| *Desmoplastic trichoblastoma. | |
|
| |
|
| DDx: | | DDx: |
| *[[Basal cell carcinoma]] - usu. mitoses, [[myxoid stroma]] and '''no''' papillary-mesenchymal bodies. | | *[[DFSP]]. |
| *[[Dermal cylindroma]] - has hyaline stroma.
| | *[[Dermatofibroma]]. |
| *[[Trichofolliculoma]]. | |
|
| |
|
| Images: | | Images: |
| *[[WC]]:
| | *[http://www.dermpedia.org/node/8822 DMF - low mag. (dermpedia.org)]. |
| **[http://commons.wikimedia.org/wiki/File:Trichoepithelioma_-_low_mag.jpg Trichoepithelioma - low mag. (WC)].
| | *[http://www.dermpedia.org/node/8824 DMF - high mag. (dermpedia.org)]. |
| **[http://commons.wikimedia.org/wiki/File:Trichoepithelioma_-_high_mag.jpg Trichoepithelioma - high mag. (WC)].
| |
| *www:
| |
| **[http://img.medscape.com/pi/emed/ckb/dermatology/1048885-1055824-1060049-1348744.jpg Papillary-mesenchymal body (medscape.com)].<ref>URL: [http://emedicine.medscape.com/article/1060049-workup#a0723 http://emedicine.medscape.com/article/1060049-workup#a0723 Papillary-mesenchymal body (emedicine.medscape.com)]. Accessed on: 22 August 2012.</ref>
| |
| **[http://skinpathologyatlas.com/tumors/hair/images/trichofollic-20x-pal.jpg Papillary-mesenchymal body (skinpathologyatlas.com)].<ref>URL: [http://skinpathologyatlas.com/tumors/hair/trichofollic.htm http://skinpathologyatlas.com/tumors/hair/trichofollic.htm]. Accessed on: 22 August 2012.</ref>
| |
|
| |
|
| ==Trichofolliculoma== | | ===IHC=== |
| | Features:<ref name=Ref_Derm504>{{Ref Derm|504}}</ref> |
| | *CD10 +ve. |
| | *Vimentin +ve. |
| | |
| | Others:<ref name=Ref_Derm504>{{Ref Derm|504}}</ref> |
| | *CD34 -ve. |
| | *Factor XIIIa -ve. |
| | *S-100 -ve. |
|
| |
|
| | ==Papillary eccrine adenoma== |
| | *Abbreviated ''[[PEA]]''. |
| ===General=== | | ===General=== |
| *Benign. | | *Uncommon. |
| | *Benign.<ref name=pmid857729>{{Cite journal | last1 = Rulon | first1 = DB. | last2 = Helwig | first2 = EB. | title = Papillary eccrine adenoma. | journal = Arch Dermatol | volume = 113 | issue = 5 | pages = 596-8 | month = May | year = 1977 | doi = | PMID = 857729 }}</ref> |
| | |
| | Treatment: |
| | *Excision.<ref>URL: [http://archderm.jamanetwork.com/article.aspx?articleid=541159 http://archderm.jamanetwork.com/article.aspx?articleid=541159]. Accessed on: 10 December 2012.</ref> |
| | ===Gross=== |
| | *Central location. |
| | |
| | Note: |
| | *The ''digital papillary adenoma'' is considered malignant; the AFIP says these are best classified as ''adenocarcinomas'', i.e. ''[[digital papillary adenocarcinoma]]''.<ref name=pmid10843279>{{Cite journal | last1 = Duke | first1 = WH. | last2 = Sherrod | first2 = TT. | last3 = Lupton | first3 = GP. | title = Aggressive digital papillary adenocarcinoma (aggressive digital papillary adenoma and adenocarcinoma revisited). | journal = Am J Surg Pathol | volume = 24 | issue = 6 | pages = 775-84 | month = Jun | year = 2000 | doi = | PMID = 10843279 }}</ref> |
|
| |
|
| ===Microscopic=== | | ===Microscopic=== |
| Features:<ref name=Ref_Derm382>{{Ref Derm|382}}</ref> | | Features:<ref name=pmid17642667>{{Cite journal | last1 = Laxmisha | first1 = C. | last2 = Thappa | first2 = DM. | last3 = Jayanthi | first3 = S. | title = Papillary eccrine adenoma. | journal = Indian J Dermatol Venereol Leprol | volume = 70 | issue = 6 | pages = 370-2 | month = | year = | doi = | PMID = 17642667 | URL = http://www.ijdvl.com/article.asp?issn=0378-6323;year=2004;volume=70;issue=6;spage=370;epage=372;aulast=Laxmisha }}</ref><ref name=pmid9793207/> |
| *Irregular hair follicle (basilar nest of cells with an acellular hair shaft) with: | | *Well-circumscribed lesions consisting of multiple cystic spaces lined by a bilayered epithelium with: |
| **Smaller satellites (follicles) consisting of well-circumscribed basilar cells. | | **Papillary projections into the lumen. |
| | **Amorphous eosinophilic material in the cystic spaces. |
| | **Surrounded by a fibrous stroma.<ref name=pmid9508346>{{Cite journal | last1 = Mizuoka | first1 = H. | last2 = Senzaki | first2 = H. | last3 = Shikata | first3 = N. | last4 = Uemura | first4 = Y. | last5 = Tsubura | first5 = A. | title = Papillary eccrine adenoma: immunohistochemical study and literature review. | journal = J Cutan Pathol | volume = 25 | issue = 1 | pages = 59-64 | month = Jan | year = 1998 | doi = | PMID = 9508346 }}</ref> |
|
| |
|
| Note: | | Note: |
| *Lack artificial clefting between the (basilar) nests and stroma (seen in [[BCC]]). | | *May appear to have more than two cell layers. |
| *Surrounding stroma does not have a basophilic tingle (seen in [[BCC]]).
| |
|
| |
|
| DDx: | | DDx: |
| *[[Trichoblastoma]]. | | *[[Digital papillary adenocarcinoma]] - location important. |
| *[[Basal cell carcinoma]]. | | *[[Tubular apocrine adenoma]] (tubulopapillary hidradenoma<ref name=pmid1566975>{{Cite journal | last1 = Fox | first1 = SB. | last2 = Cotton | first2 = DW. | title = Tubular apocrine adenoma and papillary eccrine adenoma. Entities or unity? | journal = Am J Dermatopathol | volume = 14 | issue = 2 | pages = 149-54 | month = Apr | year = 1992 | doi = | PMID = 1566975 }}</ref>) - a related tumour.<ref name=pmid8238787>{{Cite journal | last1 = Ishiko | first1 = A. | last2 = Shimizu | first2 = H. | last3 = Inamoto | first3 = N. | last4 = Nakmura | first4 = K. | title = Is tubular apocrine adenoma a distinct clinical entity? | journal = Am J Dermatopathol | volume = 15 | issue = 5 | pages = 482-7 | month = Oct | year = 1993 | doi = | PMID = 8238787 }}</ref> |
|
| |
|
| Images:
| | Image: |
| *[http://www.dermatopathonline.com/trichofolliculoma2.html Trichofolliculoma - several images (dermatopathonline.com)]. | | *[http://www.ijdvl.com/viewimage.asp?img=ijdvl_2004_70_6_370_13482_2.jpg PEA - crappy image (ijdvl.com)].<ref name=pmid17642667/> |
| *[http://commons.wikimedia.org/wiki/File:SkinTumors-P6190340.JPG Trichofolliculoma (WC)]. (???)
| |
|
| |
|
| ==Apocrine carcinoma of the skin== | | ===IHC=== |
| ===General=== | | Outer layer of epithelium:<ref name=pmid9508346/> |
| *Rare.<ref name=pmid7678545>{{Cite journal | last1 = Paties | first1 = C. | last2 = Taccagni | first2 = GL. | last3 = Papotti | first3 = M. | last4 = Valente | first4 = G. | last5 = Zangrandi | first5 = A. | last6 = Aloi | first6 = F. | title = Apocrine carcinoma of the skin. A clinicopathologic, immunocytochemical, and ultrastructural study. | journal = Cancer | volume = 71 | issue = 2 | pages = 375-81 | month = Jan | year = 1993 | doi = | PMID = 7678545 }}</ref>
| | *SMA-alpha +ve. |
| *Usually very good prognosis.<ref name=pmid7678545/> | | *Keratin 14 +ve. |
| | Inner layer of epithelium:<ref name=pmid9508346/> |
| | *Keratin 8 +ve. |
|
| |
|
| ===Microscopic=== | | Other stains:<ref name=pmid9793207>{{Cite journal | last1 = Guccion | first1 = JG. | last2 = Patterson | first2 = RH. | last3 = Nayar | first3 = R. | last4 = Saini | first4 = NB. | title = Papillary eccrine adenoma: an ultrastructural and immunohistochemical study. | journal = Ultrastruct Pathol | volume = 22 | issue = 3 | pages = 263-9 | month = | year = | doi = | PMID = 9793207 }}</ref> |
| Features:<ref name=pmid7678545/>
| | *Vimentin +ve. |
| *Nests. | | *CEA +ve. |
| *Apocrine snouts - "decapitation secretion" | | *[[EMA]] +ve. |
| | *S-100 +ve. |
|
| |
|
| DDx:
| | ===Sign out=== |
| *[[Paget disease of the breast]]/[[Extramammary Paget disease]].
| | <pre> |
| | SKIN LESION, LEFT PARIETAL SCALP, BIOPSY: |
| | - PAPILLARY ECCRINE ADENOMA. |
| | </pre> |
|
| |
|
| Images:
| | ====Micro==== |
| *[http://commons.wikimedia.org/wiki/File:Apocrine_carcinoma_-_intermed_mag.jpg Apocrine carcinoma - intermed. mag. (WC)].
| | The sections show a well-circumscribed multi-locular superficial dermal lesion with a bilayered epithelium and intracystic papillary projections. The cystic spaces contain amorphous eosinophilic material. The cystic component is surrounded by a dense fibrous stroma with a mixed inflammatory infiltrate, consisting primary of plasma cells and lymphocytes. |
| *[http://commons.wikimedia.org/wiki/File:Apocrine_carcinoma_-_high_mag.jpg Apocrine carcinoma - high mag. (WC)].
| |
|
| |
|
| ===Stains===
| | There is no significant nuclear atypia and no mitotic activity is appreciated. The overlying epidermis matures appropriately. A granular layer is present. |
| Features:<ref name=pmid7678545/>
| |
| *PAS +ve.
| |
| *PASD +ve.
| |
| | |
| ===IHC===
| |
| *GCDFP-15 (gross cystic disease fluid protein-15) +ve.<ref name=pmid7678545/>
| |
|
| |
|
| =See also= | | =See also= |
