Difference between revisions of "Dermatologic neoplasms"

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Dermatologic neoplasms (view source)

Revision as of 17:22, 4 September 2011

2,910 bytes added ,  17:22, 4 September 2011
→‎Basal cell carcinoma: more subtypes
(→‎Basal cell carcinoma: more subtypes)
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*Very common.
*Very common.
*Sun exposed skin.
*Sun exposed skin.
*Very rarely metastasizes - so rare... some don't think this is really a malignancy.
*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>


====Clinical====
====Clinical====
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====As part of a syndrome====
====As part of a syndrome====
*[[Nevoid basal cell carcinoma syndrome]] (NBCCS), AKA ''Gorlin 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>
*[[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===
===Microscopic===
Features:<ref name=Ref_PBoD8_1180-1>{{Ref PBoD8|1180-1}}</ref>
Features:<ref name=Ref_PBoD8_1180-1>{{Ref PBoD8|1180-1}}</ref><ref name=Ref_Derm390>{{Ref Derm|390}}</ref>
*Nest of hyperchromatic (i.e. blue) cells (similar in appearance to basal cells) with:
*Basaloid cells - similar in appearance to basal cells:
**Palisading of cells at the edge of the cell nests.
**Moderate blue/grey cytoplasm.
**Artefactual separation of cells (forming the nests) from the underlying stroma.
**Dark ovoid/ellipsoid nucleus with uniform chromatin.
*Palisading of cells at the edge of the cell nests.
*Artefactual separation of cells (forming the nests) from the underlying stroma - '''key feature'''.
*Surrounded by blue (myxoid) stroma - '''key feature'''.


Notes:
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.
*Palisading = the long axes of the cells are alined and the axes are perpendicular to the interface between the (basaloid cell) nests and stroma.
*There are various subtypes: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970110-3 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970110-3].
*Key elements in a list: Artefactual clefting (of nests), Basaloid cells, Peripheral palisading, Myxoid stroma.


DDx:
DDx:
*[[Trichoepithelioma]] - no artefactual cleft.<ref name=Ref_PBoD8_1180-1>{{Ref PBoD8|1180-1}}</ref>
*[[Trichoepithelioma]] - no artefactual cleft.<ref name=Ref_PBoD8_1180-1>{{Ref PBoD8|1180-1}}</ref>
Images:
*[[WC]]:
**[http://en.wikipedia.org/wiki/File:Basal_cell_carcinoma_pathology.jpg BCC - crappy (WC)].
*www:
**[http://missinglink.ucsf.edu/lm/DermatologyGlossary/img/Dermatology Glossary/Glossary Histo Images/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>
====Subtypes====
Many patterns exist:<ref name=Ref_Derm392-5>{{Ref Derm|392-5}}</ref>
{| class="wikitable sortable" style="margin-left:auto;margin-right:auto"
! Pattern
! Key histologic feature
! Other histologic features
| Other
|-
| Superficial pattern
| connected to epidermis
|
|
|-
| Nodular pattern
| nodules
| partial detachment from epidermis
| subgroup ''micronodular'' = nests equal size ~ 0.2 mm dia., >=25% of lesion
|-
| Morpheaform (sclerosing) pattern
| stroma sclerosis
|
| often seen with ''infiltrative pattern''
|-
| Infiltrative pattern
| small irregular cell aggregates
|
| often also sclerosing or morpheaform
|-
| Fibroepitheliomatous pattern
| cords and columns of basaloid cells
| fibrous stroma
| name of pattern comes from ''fibroepithelioma of Pinkus''
|-
| Infundibulocystic pattern
| small keratocysts (keratin cysts)
| usu. small, often in cords
| usu. indolent
|-
| Adenoidal pattern
| cribriform / pseudoglandular arch.
| 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"
! Differentiation / unique cell
! Key histologic feature
! Other histologic features
| Other
|-
| Pigmented cells
| '''any pattern''' can have pigmentation
|
| DDx: collision lesion with [[melanocytic lesion]]
|-
| Squamous differentiation (metatypical BCC)
| pink cytoplasm, keratinization
|
| assoc. with ulceration/tumour recurrence
|-
| Eccrine differentiation
| focal duct formation
|
| very rare, DDx: BCC engulfing sweat ducts
|-
| Clear cells (Clear cell BCC)
| clear cytoplasm
|
| due to glycogen
|}


==Squamous cell carcinoma==
==Squamous cell carcinoma==
Michael
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