Basal-cell carcinoma

From patholines.org
Jump to navigation Jump to search

Author: Mikael Häggström [note 1]

Nodular basal-cell carcinoma.

Basal-cell carcinoma (BCC):

Fixation

  • Generally: Buffered 4% formaldehyde.[1]

Microscopic evaluation

Broadly consists of determining the following:

  • Whether it is basal-cell carcinoma or a differential diagnosis.
  • Aggressiveness pattern
  • Radicality

Optionally, further subtyping of basal-cell carcinoma can be made.

Characteristics

Cells appearing similar to epidermal basal cells, and are usually well differentiated.[2]

Differential diagnoses

Main histological differential diagnoses of basal cell carcinoma:[3]
Differential diagnosis Pathological Features Image
Trichoblastoma Absence of cleft, rudimentary hair germs, papillary mesenchymal bodies. Micrographs of trichoblastoma.jpg
Adenoid cystic carcinoma Lack of basaloid cells disposed in peripheral palisades; adenoid-cystic lesion without connection to the epidermis; absence of artefactual clefts Micrograph of adenoid cystic carcinoma.jpg
Microcystic adnexal carcinoma Bland keratinocytes, keratin cysts, ductal differentiation. BerEp4- (in 60% of cases)[4], CEA+, EMA+
Trichoepithelioma[notes 1] Rims of collagen bundles, calcification, follicular/sebaceous/infundibular differentiation and cut artefacts. Cytokeratin (CK)20+, p75+, Pleckstrin homology-like domain family A member 1 + (PHLDA1+), common acute lymphoblastic leukemiaantigen + (CD10+) in tumor stroma, CK 6-, Ki-67- and Androgen Rceptor- (AR-) Trichoepithelioma (1338537528).jpg
Merkel cell carcinoma Cells arranged in a diffuse, trabecular and/or nested pattern, involving also the subcutis. Mouse Anti-Cytokeratin (CAM) 5.2+, CK20+, S100-, human leukocyte common antigen- ( LCA-), thyroid transcription factor 1- (TTF1-) Micrographs of a typical merkel cell carcinoma.jpg

Aggressiveness

There are mainly three patterns of aggressiveness, based mainly the cohesion of cancer cells:

Low-level aggressive pattern Moderately aggressive pattern Highly aggressive pattern

Optionally: Further subtyping

At least, attempt to suggest or exclude morpheaform (also known as "cicatricial" or "morphoeic") basal-cell carcinoma, since it is more aggressive.

Morpheaform basal-cell carcinoma.
Morpheaform basal-cell carcinoma

It has narrow strands and nests of basaloid cells, surrounded by dense sclerotic stroma.[6]

Nodular basal-cell carcinoma

Nodular basal-cell carcinoma (also known as "classic basal-cell carcinoma") accounts for 50% of all BCC.[3]

It has aggregates of basaloid cells with well-defined borders, showing:[3]

Central necrosis with eosinophilic, granular features may be also present, as well as mucin. The heavy aggregates of mucin determine a cystic structure. Calcification may be also present, especially in long-standing lesions.[3] Mitotic activity is usually not so evident, but a high mitotic rate may be present in more aggressive lesions.[3] Adenoidal BCC can be classified as a variant of the nodular subtype, characterized by basaloid cells with a reticulated configuration extending into the dermis.[3]

Further information: Evaluation of tumors

Reporting

  • Aggressiveness pattern if possible
  • Whether the excision is radical

Optionally, subtype of basal-cell carcinoma

  See also: General notes on reporting


Notes

  1. Desmoplastic tricoepithelioma is particularly similar to basal-cell carcinoma.
  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. Katarzyna Lundmark, Krynitz, Ismini Vassilaki, Lena Mölne, Annika Ternesten Bratel. Handläggning av hudprover – provtagningsanvisningar, utskärningsprinciper och snittning (Handling of skin samples - Instructions for sampling, cutting and incision. KVAST (Swedish Society of Pathology). Retrieved on 2019-09-09.
  2. Robert S Bader. Which histologic findings are characteristic of basal cell carcinoma (BCC)?. Medscape. Updated: Feb 21, 2019
  3. 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Paolino, Giovanni; Donati, Michele; Didona, Dario; Mercuri, Santo; Cantisani, Carmen (2017). "Histology of Non-Melanoma Skin Cancers: An Update ". Biomedicines 5 (4): 71. doi:10.3390/biomedicines5040071. ISSN 2227-9059. 
  4. Inskip, Mike; Magee, Jill (2015). "Microcystic adnexal carcinoma of the cheek—a case report with dermatoscopy and dermatopathology ". Dermatology Practical & Conceptual 5 (1). doi:10.5826/dpc.0501a07. ISSN 21609381. 
  5. Yonan, Yousif; Maly, Connor; DiCaudo, David; Mangold, Aaron; Pittelkow, Mark; Swanson, David (2019). "Dermoscopic Description of Fibroepithelioma of Pinkus with Negative Network ". Dermatology Practical & Conceptual: 246–247. doi:10.5826/dpc.0903a23. ISSN 2160-9381.  Creative Commons Attribution License
  6. East, Ellen; Fullen, Douglas R.; Arps, David; Patel, Rajiv M.; Palanisamy, Nallasivam; Carskadon, Shannon; Harms, Paul W. (2016). "Morpheaform Basal Cell Carcinomas With Areas of Predominantly Single-Cell Pattern of Infiltration ". The American Journal of Dermatopathology 38 (10): 744–750. doi:10.1097/DAD.0000000000000541. ISSN 0193-1091. 

Image sources