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Dermatologic neoplasms (view source)

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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.   


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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==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''.
*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.
 
Risk factors:<ref name=Ref_PBoD8_1180>{{Ref PBoD8|1180}}</ref>
*Sun exposure.
*Immune suppression (e.g. organ transplant recipients).
 
Notes:
*[[Keratoacanthoma]].
**Some don't believe this entity exists.
***These people sign this entity as ''low grade squamous cell carcinoma, keratoacanthoma type''.<ref>RS. 17 May 2010.</ref>
 
===Microscopic===
*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.†
*Clark level IV/V = reticular dermis or deeper.
*>=2 mm thickness -- measured from ''granular layer'' (stratum granulosum) ''or'' ulcer base to deepest aspect.
*[[Lymphovascular invasion]].
*Perineural invasion.
*Poorly differentiated.
 
Note:
* † 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:
*[[Inverted follicular keratosis]].
*[[Bowen disease]].
*[[Malignant melanoma]].
*[[Paget disease of the breast]].
*[[Eccrine carcinoma]]
 
====Bowen disease====
'''Bowen disease''' is ''[[squamous cell carcinoma]] in situ'' of the skin. 
*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.
 
Histologic DDx of Bowen disease:
*Benign Toker cell hyperplasia.
*[[Malignant melanoma]].
*[[Paget disease of the breast]].
*[[Eccrine carcinoma]].
 
=====Images=====
<gallery>
Image:Bowen_disease_%281%29.jpg | Bowen disease - 1. (WC)
Image:Bowen_disease_%282%29.jpg | Bowen disease - 2. (WC)
Image:Bowen_disease_%283%29.jpg | Bowen disease - 3. (WC)
</gallery>
===IHC===
Bowen's disease panel:
*CK5/6 +ve.<ref>RS. May 2010.</ref>
**Usu. -ve in [[Paget disease of the breast]]/[[Extramammary Paget disease]].
*S100 -ve, HMB-45 -ve.
**Both typically +ve in melanoma.
*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.
**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>
 
===Sign-out===
====Invasive SCC====
<pre>
SKIN, SITE, BIOPSY:
- MODERATELY-DIFFERENTIATED INVASIVE SQUAMOUS CELL CARCINOMA, SEE COMMENT.
- NEGATIVE FOR LYMPHOVASCULAR INVASION.
- NEGATIVE FOR PERINEURAL INVASION.
 
COMMENT:
The nearest margin (lateral margin) is 1 mm.  The tumour is 9 mm in maximal dimension.
</pre>
 
<pre>
SKIN LESION, SITE, EXCISION:
- INVASIVE SQUAMOUS CELL CARCINOMA, MODERATELY-DIFFERENTIATED.
-- TUMOUR GREATEST DIMENSION: ___ CM.
-- TUMOUR THICKNESS: ___ MM.
-- LATERAL MARGINS: NEGATIVE FOR IN SITU CARCINOMA AND INVASIVE CARCINOMA.
-- DEEP MARGIN: NEGATIVE FOR INVASIVE CARCINOMA.
-- NEAREST MARGIN: 1 MM, LATERAL MARGIN.
-- NEGATIVE FOR LYMPHOVASCULAR INVASION.
-- NEGATIVE FOR PERINEURAL INVASION.
- EXTENSIVE SOLAR ELASTOSIS.
</pre>
 
<pre>
SKIN, SITE, BIOPSY:
- INVASIVE SQUAMOUS CELL CARCINOMA, SEE TUMOUR SUMMARY.
 
TUMOUR SUMMARY:
Histologic type: squamous cell carcinoma, type not otherwise specified.
Histologic grade: moderately differentiated.
Greatest dimension: ___ cm.
Tumour thickness: ___ mm.
Peripheral margin: negative for invasive carcinoma and in situ carcinoma.
Deep margin (invasive component): negative for invasive carcinoma.
Closest margin: deep margin, ___ mm.
Lymphovascular invasion: not identified.
Perineural invasion: not identified.
</pre>
 
====Bowen's disease====
<pre>
SKIN LESION, RIGHT EAR, BIOPSY:
- SQUAMOUS CELL CARCINOMA IN SITU (BOWEN'S DISEASE), INCOMPLETELY EXCISED.
 
COMMENT:
Complete excision of the lesion is recommended.
</pre>


==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:
**Loosely cohesive; mix of small nests of cells, single cells.
**Usu. mixed of spindle and ovoid cell morphology.
**+/-Occasional large binucleated cells.
**+/-Cytoplasm: brown pigment (melanin).
**+/-Prominent (large) red nucleoli (like in ''serous carcinoma'' of the ovary).
**Often marked nuclear pleomorphism - variation in cell size, shape & staining (like in ''serous carcinoma'' of the ovary).
**[[Nuclear pseudoinclusions]] (like in ''papillary thyroid carcinoma'').


=Less common malignant=
=Less common malignant=
==Dermatofibrosarcoma protuberans==
==Dermatofibrosarcoma protuberans==
*Abbreviated ''DFSP''.
*Abbreviated ''DFSP''.
===General===
{{Main|Dermatofibrosarcoma protuberans}}
*Dermal location.
*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'''.
 
 
DDx:
*[[Dermatofibroma]] - main DDx - has entrapment of collagen bundles at the edge of the lesion.
*[[Dermatomyofibroma]].<ref name=Ref_Derm504>{{Ref Derm|504}}</ref>
*[[Nodular fasciitis]].
 
DDx of storiform pattern:
*DFSP.
*Dermatofibroma.
*[[Solitary fibrous tumour]].
*[[Undifferentiated pleomorphic sarcoma]].
 
====Images====
<gallery>
Image:SkinTumors-P9280838.JPG | DFSP with fat entrapped. (WC)
Image:SkinTumors-P9270829.JPG | DFSP - high mag. (WC)
Image:Storiform_pattern_-_intermed_mag.jpg | DFSP - storiform pattern - intermed. mag. (WC/Nephron)
Image:Storiform_pattern_-_very_high_mag.jpg | DFSP - storiform pattern - very high mag. (WC/Nephron)
</gallery>
www:
*[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==
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==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 - without accompanying edema.
**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====
<gallery>
Image:Cutaneous_T-cell_lymphoma_-_very_high_mag.jpg | CTCL - very high mag. (WC/Nephron)
Image:Cutaneous_T-cell_lymphoma_-_intermed_mag.jpg | CTCL - intermed. mag. (WC/Nephron)
</gallery>
www:
*[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==
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==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==
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==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><ref name=pmid23319144>{{Cite journal  | last1 = Tchernev | first1 = G. | last2 = Tronnier | first2 = M. | last3 = Ananiev | first3 = J. | last4 = Taneva | first4 = T. | last5 = Patterson | first5 = JW. | last6 = Gulubova | first6 = M. | last7 = Trafeli | first7 = JP. | last8 = Gegova | first8 = A. | last9 = Harrell | first9 = M. | title = Atypical fibroxanthoma-a diagnosis of exclusion! | journal = Wien Med Wochenschr | volume = 163 | issue = 15-16 | pages = 380-386 | month = Aug | year = 2013 | doi = 10.1007/s10354-012-0173-1 | PMID = 23319144 }}</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) - deeper than the dermis.
*[[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).
 
===Sign out===
====Incompletely excised====
<pre>
SKIN LESION, MID BACK, SHAVE BIOPSY:
- ATYPICAL SPINDLE CELL NEOPLASM, SEE MICRO AND COMMENT.
 
COMMENT:
The diagnosis of atypical fibroxanthoma (AFX) is favoured.  The main differential
diagnosis is pleomorphic undifferentiated sarcoma.
 
The extent of the lesion cannot be determined, as it is present at the deep margin.
 
This lesion should be re-excised, as it could represent an aggressive malignancy.
</pre>


=Benign=
=Benign=
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*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 444: Line 149:


Images:
Images:
*[http://archive.ispub.com/journal/the-internet-journal-of-dermatology/volume-7-number-1/cutaneous-mixed-tumor.article-g01.fs.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://archive.ispub.com/journal/the-internet-journal-of-dermatology/volume-7-number-1/cutaneous-mixed-tumor.article-g02.fs.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====
<gallery>
Image:Dermal_cylindroma_intermed_mag.jpg | Dermal cylindroma. (WC/Nephron)
Image:Dermal_cylindroma_intermed_mag_deep.jpg | Dermal cylindroma - high mag. (WC/Nephron)
</gallery>
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==
Line 510: Line 180:
==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>
*Muliple trichilemmomas associated with [[Cowden syndrome]].<ref name=Ref_Derm386>{{Ref Derm|386}}</ref>
 
===Microscopic===
Features:<ref name=Ref_Derm386>{{Ref Derm|386}}</ref>
*Superficial dermal lesion contiguous with the epidermis:
**Core of lesion:
***Cuboidal cells with round nuclei, eosinophilic-clear cytoplasm.
**Periphery of lesion:
***Surrounded by hyaline band.
***Peripheral palisading.


DDx:
==Poroma==
*[[Trichilemmal carcinoma]].
{{Main|Poroma}}
*[[Basal cell carcinoma]].
*[[Inverted follicular keratosis]].
 
Images:
*[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>
*[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==
===General===
*Benign tumour arising from the distal sweat duct.
*Erythematous - gross.
 
===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>
*Broad sheets of basaloid cells - attached to the epidermis - containing ductal structures - '''key feature'''.
*Biphasic stroma:
*#Edematous stroma.
*#Sclerotic stroma.
*Moderate nuclear pleomorphism.
*+/-Occasional mitoses.
 
Notes:
*Area above gland appears crusted.
 
DDx:
*[[Trichilemmoma]].
*[[Nodular hidradenoma]].
 
Images:
*[http://www.flickr.com/photos/40981620@N04/3808316834/in/photostream/ Eccrine poroma - low mag. (flickr.com)]
*[http://www.flickr.com/photos/40981620@N04/3807502071/in/photostream Eccrine poroma - intermed. mag. (flickr.com)].


==Nodular hidradenoma==
==Nodular hidradenoma==
*[[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>
*[[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>
===General===
{{Main|Nodular hidradenoma}}
*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>
 
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]].
 
====Images====
<gallery>
Image:Nodular_hidradenoma_-_low_mag.jpg | Nodular hidradenoma - low mag. (WC/Nephron)
Image:Nodular_hidradenoma_-_intermed_mag.jpg | Nodular hidradenoma - intermed. mag. (WC/Nephron)
Image:Nodular_hidradenoma_-_very_high_mag.jpg | Nodular hidradenoma - very high mag. (WC/Nephron)
</gallery>
===IHC===
Features:<ref name=pmid9537017/>
*CAM5.2 +ve.
*AE1/AE3 +ve.
*EMA +ve.
*S100 -ve.
*Desmin -ve.


==Trichoblastoma==
==Trichoblastoma==
*[[AKA]] ''trichoepithelioma''.
{{Main|Trichoblastoma}}
**''Trichoepithelioma'' is considered a superficial version of trichoblastoma; WHO lumps the two entities together.<ref name=Ref_Derm383>{{Ref Derm|383}}</ref>
===General===
*Benign.
**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===
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>
*Well-circumscribed cell nest in the superficial dermis.
*Surrounding by a fibrous stroma.
*Basaloid cells with [[peripheral palisading]].
*+/-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:
*[[Basal cell carcinoma]] - usu. mitoses, [[myxoid stroma]] and '''no''' papillary-mesenchymal bodies.
*[[Dermal cylindroma]] - has hyaline stroma.
*[[Trichofolliculoma]].
*[[Sebaceous carcinoma]], well-differentiated - has some cells with clear vacuolated cytoplasm.
 
====Images====
<gallery>
Image:Trichoepithelioma_-_low_mag.jpg | Trichoepithelioma - low mag. (WC/Nephron)
Image:Trichoepithelioma_-_high_mag.jpg | Trichoepithelioma - high mag. (WC/Nephron)
</gallery>
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>
*[http://www.dermnetnz.org/common/image.php?path=/pathology/img/t/trichoepitheliomafigure3.jpg Trichoepithelioma (dermnetnz.org)].
 
===Sign out===
<pre>
SKIN LESION, NOSE, BIOPSY:
- TRICHOBLASTOMA, COMPLETELY EXCISED.
</pre>
 
====Micro====
The sections show well-circumscribed dermal nests of basaloid cells with peripheral palisading surrounded by a dense fibrous stroma. There is no artefactual clefting between the stroma and basaloid cell nests.  Mitotic activity is minimal. Smaller hyperchromatic spindled-to-epithelioid cells in clusters (papillary-mesenchymal bodies) are found within the basaloid cells nests.
 
The epidermis show maturation to the surface and does not have basal atypia.
 
The lesion is completely excised in the plane of section.


==Trichofolliculoma==
==Trichofolliculoma==
{{Main|Trichofolliculoma}}


===General===
*Benign.
===Microscopic===
Features:<ref name=Ref_Derm382>{{Ref Derm|382}}</ref>
*Irregular hair follicle (basilar nest of cells with an acellular hair shaft) with:
**Smaller satellites (follicles) consisting of well-circumscribed basilar cells.
Note:
*Lack artificial clefting between the (basilar) nests and stroma (seen in [[BCC]]).
*Surrounding stroma does not have a basophilic tingle (seen in [[BCC]]).
DDx:
*[[Trichoblastoma]].
*[[Basal cell carcinoma]].
====Images====
www:
*[http://www.dermatopathonline.com/trichofolliculoma2.html Trichofolliculoma - several images (dermatopathonline.com)].
<gallery>
Image:SkinTumors-P6190340.JPG | Trichofolliculoma. (WC)
</gallery>
==Apocrine carcinoma of the skin==
==Apocrine carcinoma of the skin==
===General===
===General===
Line 699: Line 219:


===IHC===
===IHC===
*GCDFP-15 (gross cystic disease fluid protein-15) +ve.<ref name=pmid7678545/>
*[[GCDFP-15]] (gross cystic disease fluid protein-15) +ve.<ref name=pmid7678545/>


==Dermatomyofibroma==
==Dermatomyofibroma==
Line 743: Line 263:


Note:
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>
*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===
Line 756: Line 276:


DDx:
DDx:
*Digital papillary adenocarcinoma - location important.
*[[Digital papillary adenocarcinoma]] - location important.
*[[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>
*[[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>


Line 772: Line 292:
*Vimentin +ve.
*Vimentin +ve.
*CEA +ve.
*CEA +ve.
*EMA +ve.
*[[EMA]] +ve.
*S-100 +ve.
*S-100 +ve.


Michael
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