2. PATIENT DETAILSPATIENT DETAILS
Mr. Vijayaragavan
77 years / Male
MR/17/007209
Biopsy No.: 93/17
Nature of specimen: Excision biopsy
H/o : Swelling in the anterior abdominal wall x 40 years
L/E: 5x4 cm, pedunculated mass, firm, non – fluctuant, bleeds on
touch
Clinical diagnosis: ?Abdominal wall papilloma
3. Gross examinationGross examination
Container labeled papilloma –
Right thorax
• Received single skin
covered soft tissue mass
measuring 7x5x4 cm
• External surface - nodular
with ulceration
4. • Cut section through nodular
areas show a well-defined
grey white tumor with
cystic spaces filled with
haemorrhage.
• Cut section of tumor shows
areas of dense
haemorrhage and necrosis.
• Tumor is 1.5 cm away from
DRM, 0.2 cm away from all
margins
14. IMPRESSIONIMPRESSION
• Locally infiltrating Basal Cell Carcinoma with varied
features including proliferating trichilemmal tumor
component
• Lateral margins, deep resected margin (Pedicle) –
free of tumor
15. BASAL CELL CARCINOMABASAL CELL CARCINOMA
• Also known as Basal cell epithelioma, basalioma, rodent ulcer
• Derives its name from cytologic similarity of these tumor to
normal basal cells of epidermis
16. Cell of originCell of origin
• Germinal epithelial cell Basal keratinocytes
OR
• outer root sheath of hair follicle
OR
• Pleuripotent embryonal cells with adnexal differentiation
17. Basal cell carcinomaBasal cell carcinoma
• Most frequent form of skin cancer
• Caucasians
• Slow growing, locally destructive tumor
• As a rule, BCC s do not metastasize
SITE
– 85% on the head (face) and neck; 20-30% lesions occur on
nose alone
– 10-15% in sun protected parts of the body, mainly upper
trunk and legs.
– Except in the nevoid basal cell carcinoma syndrome
(Gorlin syndrome), rarely occur on the palms or soles.
18. CLINICAL PRESENTATIONSCLINICAL PRESENTATIONS
• Different Variants of BCC have different clinical presentation:
1. Nodular or nodulocystic, noduloulcerative
2. Superficial BCC
3. Morphea – like, fibrosing BCC
4. Fibroepithelioma (Pinkus)
19. Nodular or nodulocystic, noduloulcerativeNodular or nodulocystic, noduloulcerative
• Commonest
• Pearly papules or nodules with
telangiectasia at the borders
• Occasionally may have bleeding,
crusting or ulceration
• Pigmented BCC – nodular with brown
pigmentation
20. Superficial BCCSuperficial BCC
• Occurs predominantly on the trunk
• One or several lesions
• Erythematous, scaling, only slightly infiltrated patches that
slowly increase in size by peripheral extension
• Common in DM ,CRF, HIV
21. Morphea –like , fibrosing BCCMorphea –like , fibrosing BCC
• Clinical resemblance to
localized scleroderma or
morphea.
• Solitary, flat or slightly
depressed, indurated,
yellowish plaque.
• Surface is smooth and shiny.
• Border is often ill defined.
• Ulceration
22. Fibroepithelioma (Pinkus):
• Most common location is
the back
• Raised, moderately firm,
slightly pedunculated
nodules, covered by
smooth, slightly reddened
skin.
• Clinically, they resemble
fibromas..
23. Histopathological typesHistopathological types
NODULAR BCC
• Common basal cell carcinoma has a lobulated appearance
with masses of small keratinocytes
• An outer layer of palisaded larger cells.
• The stroma can be fibroblastic or have inflammatory cells
• Retraction artifacts are observed around tumor lobules.
• Extensive intralobular and stromal collections of basophilic
mucin may be present. The tumor cells are uniform, although
mild atypia, mitosis +
• Necrosis, apoptosis, calcification, and mucin production are
variable
36. Trichoblastoma
Symmetrical tumor with uniform basaloid tumor islands, primary hair germs, distinct
tumor stroma separated from normal connective tissue by clefting. No connection
with epidermis
37. • The stroma of trichoepitheliomas and
trichoblastomas is CD34 positive,
• but that around basal cell carcinomas is CD34
negative.
• Bcl-2 staining of basal cell carcinomas shows
diffuse uptake throughout the tumor
aggregate, but trichoepitheliomas stain only
along the outermost epithelial Layer.
39. Proliferating trichilemmal tumor
• Uncommon appendageal skin tumor
• Elderly women
• Arises from the external root sheath of the hair follicle
• Most commonly observed on the scalp
Gross
• Multinodular, may be huge
• May coexist with trichilemmal cyst
Microscopy
• Solid with pushing borders and lobulated contour, usually involves
epidermis but may open into skin surface
• Bands of squamous epithelium with trichilemmal-type abrupt
keratinization
• May have prominent atypia, focal stromal invasion
Low power view _ Cribriform or microcystic pattern of arrangement of cells. Peripheral palisading.
fibrous septa
clefting and areas of abrupt keratinization
monomorphic basaloid cells with scanty cytoplasm and large vesicular nuclei. tumor giant cells
CD10 expression supports hair follicle derivation
Pigmented BCC: more common in blacks presents as hyperpigmented (Brown to black) nodular lesions
Pigmented BCC: more common in blacks presents as hyperpigmented (Brown to black) nodular lesions
Basaloid cells (like cylindroma) that form primitive hair follicle-germ structures with fibromyxoid stroma
Cells are often in fronds, may have 2 or more layers of basaloid cells, may have papillary mesenchymal bodies
Desmoplastic trichoepithelioma Extensive fibrous stroma surrounds epithelial islands
Symmetrical tumor with uniform basaloid tumor islands, primary hair germs, distinct
tumor stroma separated from normal connective tissue by clefting. No connection
with epidermis
