bromochloroacetic-acid and Facial-Neoplasms

Basal cell nevus syndrome, also known as Gorlin-Goltz syndrome, is an autosomal dominant inherited disorder which is characterised by the presence of multiple maxillary keratocysts and facial basal cell carcinomas, along with other less frequent clinical characteristics such us musculo-skeletal disturbances (costal and vertebrae malformations), characteristic facies, neurological (calcification of the cerebral falx, schizophrenia, learning difficulties), skin (cysts, lipomas, fibromas), sight, hormonal, etc. On occasions it can be associated with aggressive basal cell carcinomas and malignant neoplasias, for which early diagnosis and treatment is essential, as well as family detection and genetic counselling. Currently there are new lines of investigation based on biomolecular studies, which aim at identifying the molecules responsible for these cysts and thus allowing an early diagnosis of these patients. In its clinical management and follow up, the odonto-stomatologist, the maxillofacial surgeon and several other medical specialists are involved. In this paper a review of the literature, and six cases of patients affected by multi-systemic and varied clinical expression of basal cell nevus syndrome, are presented.

Topics: Adolescent; Adult; Basal Cell Nevus Syndrome; Facial Neoplasms; Female; Humans; Jaw Cysts; Keratins; Male; Skin Neoplasms

A 63-year-old man presented with a signet ring cell basal cell carcinoma of the right infraorbital area. This is the third reported case of this rare variant of basal cell carcinoma characterized by tumor cells containing large, hyalinized, eccentric, intracytoplasmic inclusions that compress nuclei into crescent or ring-shaped forms. Antibodies to both high and low molecular weight cytokeratins were strongly positive, staining the inclusions in a uniform fashion. Vimentin and actin antibodies did not stain the inclusions. These results support previous electron microscopic studies that show the inclusions to be aggregates of intermediate filaments blending into tonofilaments at their periphery. Although speculative, the formation of signet ring cells does not appear to be a degenerative or necrotic phenomenon, but probably a peculiar aberrant form of individual cell keratinization.

Topics: Carcinoma, Basal Cell; Diagnosis, Differential; Facial Neoplasms; Humans; Immunohistochemistry; Keratins; Male; Microscopy, Electron; Middle Aged

Microcystic adnexal carcinoma (MAC), syringomatous carcinoma (SC) and "Squamoid eccrine ductal carcinoma" (SEDC) are rare sclerosing adnexal tumours.. To understand the histogenesis of these tumours and possible clinical implications.. We conducted a retrospective study of 30 cases, 18 MAC, 5 SC and 7 SEDC reviewed and classified by a panel of dermatopathology experts, with immunohistochemical analysis of keratins, including K77, a new keratin specific of eccrine ducts, and PHLDA1 expressed in adnexal structures.. There was a strong female predominance, with only five cases occurring in men. Patients with MAC and SC were younger (mean age 56 and 47 years) than those with SEDC (mean age 81 years). The most common localization was the cheek in SC and SEDC and the periocular area in MAC. Two cases of SEDC were found in organ transplant patients. No recurrence or metastases were observed after complete surgery of MAC, or SC (mean follow-up 7.2 years and 4.7 years), whereas one case of SEDC recurred and another could not be fully excised. MAC and SC had similar histological features, except for cysts. In MAC, calcifications, granulomas, connection to follicles, keratin expression pattern, PHLDA1 positivity and K77 negativity indicated a follicular histogenesis, whereas in SC, K77 positivity and keratin expression pattern were consistent with a differentiation towards eccrine apparatus. SEDC was composed of strands centred by ducts and nests with squamous differentiation and displayed K77 ductal positivity in all cases, a finding consistent with an eccrine origin.. Our study demonstrated that MAC and SC have similar clinical characteristics, although histogenesis differs and show arguments for the individualization of SEDC.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma; Facial Neoplasms; Female; Humans; Keratins; Male; Middle Aged; Neoplasm Recurrence, Local; Retrospective Studies; Sweat Gland Neoplasms; Transcription Factors; Young Adult

The application of immunocytochemistry in the field of Mohs micrographic surgery (MMS) is well established. This study evaluates the use of pan-cytokeratins (AE1/AE3, MNF116 and AE1/AE3+PCK26) in the assessment of basal cell carcinoma (BCC) on frozen tissue debulk specimens. Fifty-five cases of BCC, all from head and facial sites, were assessed in the study. In addition to staining all cases for the three cytokeratin antibodies under investigation, sections were also stained with haematoxylin and eosin (H&E) to demonstrate tumour architecture and morphology. All sections for immunocytochemistry were stained on a Roche Ventana BenchMark Ultra automated platform employing a rapid frozen section protocol. Results were assessed based on the intensity of staining of keratinocytes (scale: 0-100%), as well as sensitivity of staining determined by the total percentage of keratinocytes stained within the tissue section. AE1/AE3 demonstrated the most consistent staining both in terms of intensity of staining and sensitivity, with a mean of 99.1% and 99.9%, respectively. AE1/AE3+PCK26 average results indicated scores of 70.6% for intensity and 87.2% for sensitivity, with MNF116 scoring 92.9% for intensity but only 57.3% for sensitivity. The data indicate that AE1/AE3 is the best pan-cytokeratin antibody to use in the assessment of BCC in MMS. The use of cytokeratin immunocytochemistry is justified in morphologically complex cases of BCC, or in cases where dense inflammatory infiltrate surrounding any suspicious cells make identification of small numbers of tumour cells difficult to determine with just an H&E stain. The significant rationale is that cytokeratin staining is a valuable adjunct in the study of tumour cell assessment in cases of MMS for BCC. In addition, the use of anti-AE1/AE3 cytokeratin antibodies provides the most consistent staining results for such cases.

Topics: Biomarkers, Tumor; Carcinoma, Basal Cell; Facial Neoplasms; Frozen Sections; Humans; Immunohistochemistry; Keratins; Mohs Surgery; Sensitivity and Specificity; Skin Neoplasms

A combined squamomelanocytic tumor is an exceedingly rare occurrence; little is known about its pathogenesis. A definitive diagnosis can only be made via histological examination. We describe herein an 83 year-old man who was discovered to have this combined tumor and recommend the appropriate management for such a lesion.

Topics: Aged, 80 and over; Biomarkers, Tumor; Carcinoma, Squamous Cell; Facial Neoplasms; gp100 Melanoma Antigen; Humans; Keratins; Male; MART-1 Antigen; Melanins; Melanoma; Melanoma-Specific Antigens; Neoplasms, Multiple Primary; S100 Proteins; Skin Neoplasms

This is a case report of a cutaneous horn, which was difficult to diagnose as benign or malignant. It demonstrates how these lesions can be approached in terms of diagnosis and management.

Topics: Carcinoma, Squamous Cell; Cheek; Diagnosis, Differential; Facial Neoplasms; Humans; Keratins; Keratoacanthoma; Male; Middle Aged; Radiotherapy, Adjuvant; Skin Neoplasms

Topics: Adenocarcinoma, Clear Cell; Aged; Facial Neoplasms; Humans; Immunohistochemistry; Keratins; Ki-67 Antigen; Male; Membrane Proteins; Mucin-1; S100 Proteins; Sweat Gland Neoplasms

Topics: Aged; Diagnosis, Differential; Epidermal Cyst; Facial Neoplasms; Filaggrin Proteins; Hamartoma; Humans; Intermediate Filament Proteins; Keratins; Male; Sebaceous Glands; Skin Diseases

We report a case of exceedingly rare cutaneous neoplasm with histological features of malignancy and uncertain biological potential. The nodular, darkly pigmented facial tumor with central exulceration, size 12 x 10 x 7 mm, of the skin 61-year-old man preauricular left was completely exised. Histologically tumor consists of atypical squamous cells, which express signs of moderate to significant pleomorphism, mitotically active, with foci forming of parakeratotic horn cysts ("pearls"). Characteristically tumor also consists of large number of atypical melanocytes with multifocal pattern, inserted between atypical squamous cells, and which contain large amount of dark brown pigment melanin. Immunohistochemically, squamous cells stain positively with keratin (CK116), melanocytes were stained with S -100 protein, HMB 45, and vimentin, but failed to stain with CK 116. To our knowledge this is the sixth reported case in world literature. The follow-up time of four years no evidence of recurrence or metastasis, similar all reported cases, but it is too short period in estimation to guarantee a benign course. However, it appears that this group of neoplasm may have different prognosis from pure squamous carcinoma or malignant melanoma.

Topics: Carcinoma, Squamous Cell; Cell Differentiation; Facial Neoplasms; Humans; Keratins; Male; Medical Oncology; Melanocytes; Melanoma; Middle Aged; S100 Proteins; Skin Neoplasms; Vimentin

Topics: Aged; Biomarkers, Tumor; Facial Neoplasms; False Positive Reactions; Head and Neck Neoplasms; Histiocytoma, Benign Fibrous; Humans; Keratins; Male; Neoplasm Proteins; Scalp; Skin Neoplasms

Topics: Facial Neoplasms; Humans; Keratins; Male; Middle Aged; Neoplasm Proteins; Neoplasms, Basal Cell

Topics: Epithelial Cells; Facial Neoplasms; Follow-Up Studies; Humans; Keratins; Male; Mesothelioma; Middle Aged; Pleural Neoplasms; Skin Neoplasms; Tongue Neoplasms; Vimentin

We report a case of lymphoepithelioma-like carcinoma of the skin on the right cheek of a 67-year-old man. Histologically, the entire dermis was occupied by multiple lobules of atypical epithelial tumor cell nests surrounded by inflammatory cells. Immunohistochemical examination showed that the epithelial tumor cells were positive for cytokeratin and epithelial membrane antigen. The inflammatory cells were positive for leukocyte common antigen and T-cell marker. Among the tumor nests, small ductal structures were positive for carcinoembryonic antigen. Ultrastructurally, these epithelial tumor cells had well-developed desmosomes and were joined to each other; no tonofilaments were observed in the cytoplasm. These findings strongly suggest that these tumor cells tended to differentiate to the adnexa of the skin.

Topics: Aged; Antigens, Differentiation, T-Lymphocyte; Carcinoembryonic Antigen; Carcinoma, Squamous Cell; Cheek; Cytoplasm; Desmosomes; Epithelium; Facial Neoplasms; Humans; Immunohistochemistry; Intermediate Filaments; Keratins; Leukocyte Common Antigens; Male; Mucin-1; Skin Neoplasms

A 58-year-old Japanese male presented with a cutaneous mixed tumor containing ossification and hair matrix differentiation on the left side of the chin. Histologically, the tumor consisted almost exclusively of apocrine-type epithelial ductal structures and chondroid stroma. Strands and aggregation of basaloid cells which contained keratinous cystic structures with a column of shadow cells arising from basophilic basaloid cells, sebaceous duct-like structures, and ossification in the stroma were also evident. These findings suggest that cutaneous mixed tumors with ossification and hair matrix differentiation are related to both the whole hair follicle and the sweat apparatus.

Topics: Adenoma, Pleomorphic; Apocrine Glands; Cell Differentiation; Chin; Epithelium; Facial Neoplasms; Hair; Hair Follicle; Humans; Keratins; Male; Middle Aged; Ossification, Heterotopic; Sebaceous Glands; Skin Neoplasms

We report two cases of microcystic adnexal carcinoma showing extensive sebaceous differentiation. Multiple cellular nests and strands within a moderately sclerotic stroma involving the full thickness of the dermis were observed. Clusters of basaloid cells with extensive sebaceous differentiation were present. Foci of sebaceous ductal differentiation were observed in the more superficial areas. Neither strikingly atypical cells nor mitotic figures were present. Perineural invasion was present in the deep areas of both tumors. Clinically, the lesions were solitary whitish-pink papules with a central dell on the faces of 2 men (aged 78 and 73 years old). We propose a relationship between these tumors and other cytologically bland but locally aggressive adnexal carcinomas. Sebaceous differentiation itself in a poorly circumscribed neoplasm does not indicate conventional extraocular sebaceous carcinoma. We propose a simple classification of locally aggressive adnexal carcinomas that takes into account the full range of adnexal differentiation that can occur in such lesions.

Topics: Aged; Carcinoembryonic Antigen; Carcinoma, Skin Appendage; Cell Differentiation; Elastic Tissue; Epidermis; Facial Neoplasms; Follow-Up Studies; Glycosaminoglycans; Humans; Keratins; Male; Mitosis; Neoplasm Invasiveness; Neurons; S100 Proteins; Sclerosis; Sebaceous Glands; Skin Diseases; Skin Neoplasms

Topics: Facial Neoplasms; Histiocytoma, Benign Fibrous; Humans; Keratins; Kidney Transplantation; Male; Middle Aged; Neoplasm Recurrence, Local; Skin Neoplasms; Vimentin

We report a cutaneous tumor characterized by follicular differentiation and adamantinoid features that we consider to be part of the histopathologic spectrum of trichoblastoma. Previously, similar lesions have been reported in the medical literature as cutaneous lymphadenoma or lymphoepithelial tumor of the skin.

Topics: Antigens, Neoplasm; Carcinoembryonic Antigen; Cell Differentiation; Facial Neoplasms; Humans; Keratins; Lymphoma; Male; Middle Aged; Mucin-1; Neoplasms, Basal Cell; Neoplasms, Glandular and Epithelial; Skin Neoplasms

A case of solitary fibrous tumour of the cheek is described.. The lesion is documented by immunohistochemistry.. The patient is a 55 year old man and the tumor is constituted by a nodule measuring 2 cm in its greatest axis. The neoplastic cells are spindle shaped and arranged in a storiform pattern. They stain for vimentin and CD34.. The differential diagnosis from morphologically similar lesions, such as leiomyoma, schwannoma, benign fibrohistiocytoma and myoepithelioma of the salivary glands was taken in consideration. The present case, together with those reported in the literature, indicates that solitary fibrous tumours arise in any site of the organism.

Topics: Antigens, CD34; Biomarkers, Tumor; Cheek; Facial Neoplasms; Humans; Keratins; Male; Middle Aged; Neoplasm Proteins; Neoplasms, Muscle Tissue; S100 Proteins; Vimentin

An 82-year-old Caucasian man developed an ulcerated mass on the anterior mandibular gingiva. Five years previously he had been treated for a Merkel cell carcinoma (MCC) on his right cheek. Histopathologic examination showed small tumor cells with scanty cytoplasm, suggestive of malignancy. Immunohistochemical studies were performed with the use of nine antibodies. S-100 protein and leukocyte common antigen were helpful in ruling out melanoma and lymphoma. Pronounced reaction was shown for cytokeratin 20, a new histodiagnostic marker whose expression is almost entirely confined to Merkel cells, the gastric epithelium, and urothelium. The tentative diagnosis of metastasis of MCC was confirmed. Immunohistochemical studies are useful diagnostic aids in the establishment of the diagnosis of Merkel cell carcinoma.

Topics: Aged; Aged, 80 and over; Carcinoma, Merkel Cell; Cheek; Cytoplasm; Diagnosis, Differential; Facial Neoplasms; Gingival Neoplasms; Humans; Keratins; Lymphoma; Male; Mandibular Neoplasms; Melanoma; Skin Neoplasms

Primary neuroendocrine carcinoma of the skin (PNECS) is a rare cutaneous tumor occurring predominantly on sun-exposed skin of elderly people. This histomorphological appearance of this aggressive tumor can be highly variable depending on the predominating growth pattern. We present an unusual case of PNECS: the tumor masked by a dense lymphoid infiltrate with a well-formed follicular growth pattern. In these cases of PNECS, the differential diagnosis must be extended to lymphoid neoplasms as well as lymphoepithelial neoplasms.

Topics: Aged; B-Lymphocytes; Carcinoma, Neuroendocrine; Carcinoma, Squamous Cell; Cell Nucleus; Chromogranin A; Chromogranins; Cytoplasm; Diagnosis, Differential; Facial Neoplasms; Female; Humans; Immunohistochemistry; Keratins; Lymphocytes; Lymphoid Tissue; Neurofilament Proteins; Phosphopyruvate Hydratase; Skin; Skin Neoplasms

Topics: Aged; Aged, 80 and over; Antigens, Neoplasm; Carcinoma, Merkel Cell; Cheek; Facial Neoplasms; Fatal Outcome; Female; Humans; Keratins; Membrane Glycoproteins; Mucin-1; Mucins; Phosphopyruvate Hydratase; Skin Neoplasms

Adenoid cystic carcinoma of the skin was studied. Histologically, tumor cells were arranged in a tubular and a cribriform pattern, mainly int he reticular dermis. Immunohistochemically, epithelial membrane antigen was reactive with the tumor cells, but S-100 protein, vimentin, and carcino-embryonic antigen were not. On electron microscopy, we confirmed the findings of previous reports; tumor cells were arranged to form luminal structures; most of them were pseudolumina containing fine mucin granules, basal laminae, and collagen fibers, but some were true lumina with numerous microvilli and junctional complexes. New findings of this study were bizarre-shaped, electron-dense, net-like structures within the true lumina which were considered to be a type of mucin.

Topics: Aged; Antigens, Neoplasm; Carcinoembryonic Antigen; Carcinoma, Adenoid Cystic; Collagen; Cytoplasm; Cytoplasmic Granules; Facial Neoplasms; Humans; Immunohistochemistry; Keratins; Male; Membrane Glycoproteins; Microvilli; Mucin-1; S100 Proteins; Skin Neoplasms; Vimentin

Brooke-Spiegler syndrome is an autosomal dominantly inherited disease characterized by the development of multiple trichoepitheliomas and cylindromas. Among other neoplasms that may also occur in Brooke-Spiegler syndrome are basal cell carcinomas and spiradenomas. Spiradenomas and cylindromas have so many features in common that they have been regarded as variants of the same neoplasm. This assumption was supported by the occurrence of both types of lesions in Brooke-Spiegler syndrome. We report a case of Brooke-Spiegler syndrome in which spiradenomas were found in the immediate vicinity of trichoepitheliomas and in continuity with follicles. Because of the embryonic relationship between follicles and apocrine glands, these features indicate that spiradenomas are apocrine neoplasms. We conclude that Brooke-Spiegler syndrome is an inherited disease that affects the folliculosebaceous apocrine unit.

Topics: Adenoma, Sweat Gland; Adult; Carcinoembryonic Antigen; Carcinoma, Adenoid Cystic; Cell Nucleus; Cytoplasm; Facial Neoplasms; Female; Humans; Keratins; Neoplasms, Multiple Primary; Neoplastic Syndromes, Hereditary; S100 Proteins; Skin Neoplasms

Two additional cases of cutaneous lymphadenoma (CL) are reported. The lesions presented as single nodules of many years' duration on the face. Histologically, the neoplasms consisted of irregularly shaped lobules immersed in a dense fibroblastic stroma involving the whole dermis and extending into the subcutaneous fat. Duct-like structures suggesting an eccrine differentiation were recognized. The lobules were composed of a rim of basaloid cells surrounding large epithelioid cells and lymphocytes. In some areas the basaloid lobules were only partly replaced by the inflammatory cells. Immunohistochemically, the intralobular inflammatory component was composed of a mixed B- and T-cell population and S-100-positive dendritic cells. The observation of these cases suggests that CL is not a distinct entity but may represent a basal cell carcinoma, possibly with pilar or eccrine differentiation, in which an immune host reaction pattern is exceedingly unusual.

Topics: B-Lymphocytes; Carcinoma, Basal Cell; Cheek; Diagnosis, Differential; Epithelium; Facial Neoplasms; Female; Fibroblasts; Humans; Keratins; Lymphoma; Male; Middle Aged; S100 Proteins; Skin Neoplasms; T-Lymphocytes

Seven cases of sweat-gland carcinomas showing eccrine ductal differentiation (ductal carcinomas) are presented. The tumors had a variable histological appearance, but were basically characterized by the following histological elements: (a) tubular structures, sometimes cystic or having a "tadpole" appearance; (b) solid islands of squamous, basaloid, or clear cells; (c) periodic acid-Schiff-positive endoluminal and/or intracellular material; and (d) infiltrating growth. Immunocytochemically, tumor cells were positive for keratin and negative for actin. Endoluminal material contained carcinoembryonic antigen in five of seven cases. Although it is not yet clear whether carcinomas exhibiting eccrine ductal differentiation may represent a specific histotype or a group encompassing several distinct clinicopathological entities, the histological analysis of the cases suggested that the wide spectrum of their histological appearances may be due to variable grades of differentiation.

Topics: Adenocarcinoma; Aged; Aged, 80 and over; Carcinoembryonic Antigen; Eccrine Glands; Facial Neoplasms; Female; Humans; Keratins; Lip Neoplasms; Male; Middle Aged; Scalp; Skin Neoplasms; Sweat Gland Neoplasms; Thoracic Neoplasms

Seven cases of desmoplastic trichilemmoma (DT), a recently described pseudomalignant variant of trichilemmoma, are reviewed. The tumor generally occurs in men after the fifth decade of life and presents as a small solitary nodule on the face. It is frequently misdiagnosed clinically as a basal cell carcinoma or a papilloma. Histologically DT displays a superficial lobular growth arranged about a central prominent desmoplastic stroma. At the periphery, the tumor lobules show the typical features of trichilemmoma. In contrast, at the center the cells assume a more random pattern of cords and strands traversed by the hyaline stroma, mimicking invasive carcinoma. The tumor's architectural pattern, in particular the perilobular hyaline mantle, enables DT to be differentiated from basal cell carcinoma and malignant trichilemmoma. Immunohistochemical analysis failed to demonstrate human papilloma virus (HPV), epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), and alpha-lactalbumin in tumor epithelium. Keratin was expressed by the central pseudoinvasive epithelial cords. Neither factor XIIIa nor keratin expression was found in the stromal cells, which stained only for vimentin. These findings suggest that DT is not an HPV-induced epithelial proliferation and that the stroma is not the result of degenerative changes in tumor epithelium. Instead, there appears to be a fibroblast-mediated, dendrocyte-independent, stromal reaction producing this appearance.

Topics: Aged; Antigens, Neoplasm; Antigens, Viral; Carcinoembryonic Antigen; Cell Nucleus; Child; Cytoplasm; Facial Neoplasms; Female; Humans; Immunoenzyme Techniques; Keratins; Lactalbumin; Male; Membrane Glycoproteins; Middle Aged; Mucin-1; Papillomaviridae; Skin Neoplasms; Transglutaminases; Vimentin

Eight cases of apocrine (tubular branching lumina) type cutaneous mixed tumors with follicular and sebaceous differentiation are presented. All eight tumors arose on facial skin; six patients were male and two were female. The lesions showed a cystic or nodular clinical appearance and were surgically excised. Histopathological examination confirmed the diagnosis of apocrine type of cutaneous mixed tumor in each case. Follicular differentiation consisted of (a) keratinous cysts with infundibular keratinization (infundibular differentiation); (b) hair bulbs with papillary mesenchyma, matricial differentiation with basophilic, transitional, and shadow cells, trichohyaline granules, vellous hair shafts, and clear cells of the outer root sheath (anagen differentiation); and (c) epithelial columns composed of inner cells with plump oval nuclei and scant cytoplasm, and similar cells at the periphery that were arranged in a palisade, resembling the inferior segment of a normal hair follicle in telogen. Sebaceous differentiation was represented by mature sebaceous cells, either as single cells or as small islands, within epithelial tracts of the tumor. The proportion of the areas showing these different types of differentiation varied among lesions, but some follicular differentiation was always present, whereas three cases lacked sebaceous differentiation. Immunohistochemical analysis in three cases with respect to their eccrine or apocrine differentiation showed contradictory results as in a previously reported series of cutaneous mixed tumors. The presence of follicular and sebaceous differentiation in the apocrine (tubular branching lumina) type of cutaneous mixed tumor is a confirmation of the apocrine nature of this neoplasm as well as an expression of the common embryologic derivation of all elements of the folliculosebaceous-apocrine unit.

Topics: Adenoma, Sweat Gland; Adult; Aged; Antigens, Neoplasm; Apocrine Glands; Carcinoembryonic Antigen; Cell Nucleus; Cytoplasm; Cytoplasmic Granules; Epidermis; Epithelium; Facial Neoplasms; Female; Hair; Humans; Intermediate Filament Proteins; Keratins; Male; Membrane Glycoproteins; Middle Aged; Mucin-1; Nose Neoplasms; Protein Precursors; S100 Proteins; Sebaceous Glands; Sweat Gland Neoplasms

A hair matrix tumor showing an unusual tumor cell arrangement was found at the base of a solitary trichoepithelioma. Coexisting with solid epithelial islands and immature hair follicle-like stroma resembling the Verocay bodies of neurilemmoma or "ripplemarks" on waves were found. In other areas myxomatous degeneration of the stroma changed the rippling into a cribriform pattern. In some parts of the tumor there was a dense melanin pigment associated with MEL5 stained melanocytes. S-100 and CD1 (OKT6) antigen stains demonstrated Langerhans cells scattered in the parenchyma and less frequently in the stroma. The majority of tumor cells were considered immature pilar cortical cells because of the following: 1. HKN-6 was strongly positive; 2. a large number of melanocytes were associated with tumor cells in some foci; 3. ultrastructurally immature tumor cells, which had electron-dense tonofilaments and many desmosomes, were transformed without production of trichohyalin granules into semikeratinized cells which showed nuclear degeneration and loss of electron density in tonofilaments. This tumor, however, has not attained the degree of differentiation observed in trichoblastoma (1) another example of an immature cortical cell tumor. Squamous eddy-like or horn pearl-like foci of incomplete keratinization and large keratin-filled cysts were also present within the immature parenchyma, indicating that some immature cells were differentiating toward non-cortical cells, as found in the outer sheath. We would like to designate this tumor "rippled pattern trichomatricoma", a new entity.

Topics: Adult; Antibodies, Monoclonal; Biopsy; Cell Differentiation; Facial Neoplasms; Female; Hair Diseases; Humans; Immunohistochemistry; Keratins; Langerhans Cells; Microscopy, Electron

We report the light and electron microscopic findings of an unusual, locally aggressive cutaneous clear cell carcinoma involving extensively the left cheek and upper lip of a 61-year-old woman. The patient remained free of recurrence 5 years after wide local excision. Microscopically, the tumor was a poorly circumscribed and deeply invasive clear cell neoplasm characterized by large lobules and convoluted trabeculae of polygonal and columnar cells with palisading of the peripheral cells rimmed by thick basement membranes, and horn microcysts with tricholemmal keratinization. The tumor infiltrated the muscle and the salivary glands. Only slight cytologic atypia and a few mitotic figures were present. No definite ductal differentiation was found. Immunoperoxidase staining for carcinoembryonic and epithelial membrane antigens was negative. Ultrastructurally, the tumor cells were joined by desmosomes, and surrounded by thick basal lamina. The cytoplasm contained large pools of glycogen. Peculiar whorls of tonofilaments and aggregates of needle-shaped and club-shaped structures were observed in a small keratinizing focus. The tumor showed features resembling the outer root sheath of the hair follicle microscopically. Furthermore, the lack of duct-like structures and immunoreactivity of carcinoembryonic antigen tend to favor tricholemmal over sweat gland differentiation in this tumor which possibly represents a rare example of tricholemmal carcinoma.

Topics: Adenocarcinoma; Basement Membrane; Cell Differentiation; Diagnosis, Differential; Facial Neoplasms; Female; Glycogen; Humans; Keratins; Microscopy, Electron; Middle Aged

A 51-year-old man with microcystic adnexal carcinoma of the face is reported. In addition to extensive soft tissue invasion by the cancer, there was direct bone invasion into the marrow of the mandible as well as perineural spread along the mental and inferior alveolar nerves. This represents the first case of microcystic adnexal carcinoma with documented bone invasion. Recognition of the aggressive nature of this cancer with potential for invasion into the skull is important for proper evaluation and treatment.

Topics: Bone Marrow; Carcinoma; Cysts; Cytoplasm; Facial Neoplasms; Humans; Keratins; Lip Neoplasms; Male; Mandibular Neoplasms; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local

A case of superficially invasive well-differentiated cutaneous squamous cell carcinoma containing numerous mucin-producing cells both within the epidermal and dermal components is reported. Histological, histochemical and immunohistochemical overlap exists between these cells and those of extramammary Paget's disease. The presence of mucinous metaplasia within this tumor supports an intraepidermal origin for extramammary Paget's disease.

Topics: Biopsy; Carcinoma, Squamous Cell; Epidermis; Facial Neoplasms; Humans; Keratins; Male; Metaplasia; Middle Aged; Mucins; Staining and Labeling

We performed studies on the lectin-binding pattern in epithelial tumor cell components of 4 cases of mixed tumor of the skin developing on the face in addition to identification of keratin and carcinoembryonic antigen (CEA), compared with those of normal sweat glands. Normal eccrine glands showed specific labelling with Dolichos biflorus agglutinin (DBA) and soybean agglutinin (SBA), whereas none of the studied lectins reacted specifically with normal apocrine glands. In mixed tumors the dark cells, which form the inner layer of the tubuloalveolar and ductal structure, showed the presence of keratin and CEA, as well as of specific sugar structures that bind to DBA and SBA. On the other hand the light cells that form the outer layer of the tubular structures or the solid epithelial cell nests gave only a faint to moderate staining of keratin, and no staining of CEA or lectins. It is probable that the inner dark cells differentiate toward the cells that have the same sugar structures on the cell surface as those of the normal eccrine gland cells, while the outer light cells appear to be immature or in a less differentiated state.

Topics: Adult; Aged; Carcinoembryonic Antigen; Epithelium; Facial Neoplasms; Female; Humans; Immunoenzyme Techniques; Keratins; Lectins; Male; Neoplasms, Germ Cell and Embryonal; Skin Neoplasms

Topics: Animals; Antibodies; Diagnosis, Differential; Face; Facial Neoplasms; Fluorescent Antibody Technique; Histological Techniques; Humans; Immune Sera; Keratins; Microscopy, Fluorescence; Mouth; Mouth Neoplasms; Rabbits

Inverted follicular keratosis, a benign tumor of the skin believed to arise from the infundibular portion of the hair follicle that can involve perioral skin, has a unique histologic picture. It can be confused with forms of skin cancer; with knowledge of this entity, oral and maxillofacial surgeons may be able to avoid unnecessary surgery. The clinical and microscopic findings of 12 cases of inverted follicular keratosis are reported.

Topics: Adult; Aged; Darier Disease; Diagnosis, Differential; Epithelium; Facial Dermatoses; Facial Neoplasms; Humans; Keratins; Keratosis; Lip Diseases; Male; Middle Aged

The histological and ultrastructural features of a sclerosing epithelial hamartoma are described. By electron microscopy, epithelial cords formed by basal-like cells and epithelial cysts with a pattern of keratinization similar to that of normal epidermis or of follicular infundibula were seen. By conventional light microscopy, continuities were found between the epithelial cords and the overlying epidermis. The stroma was found to be fibrous and contained some fibroblasts or possibly myofibroblasts with bundles of microfilaments. The data are interpreted with respect to the origin of the neoplasm, its line of differentiation, and its sclerosing behavior.

Topics: Actin Cytoskeleton; Adult; Biopsy; Cheek; Facial Neoplasms; Female; Fibroblasts; Hamartoma; Humans; Keratins; Sclerosis; Skin; Skin Neoplasms

Histological, histochemical and immunohistochemical findings were studied in 40 cutaneous biopsies from 7 patients with Cowden's disease. Most facial biopsies showed a spectrum of trichilemmomas and related follicular malformations, including cylindrical trichilemmomas, lobulate trichilemmomas (14 lesions), and a keratinizing type sharing features with inverted follicular keratosis. One facial growth showed trichilemmomal changes without apparent follicular origin. Studies for common papilloma virus structural antigens were negative, apart from a typical common wart in one patient. Immunohistochemical studies in 6 facial trichilemmomas and acral keratoses, using a panel of anti-keratin antibodies, disclosed only abnormal differentiation with lack of large keratins in the lobulate trichilemmomas. Nine biopsies revealed a distinctive type of fibroma characterized by an organized pattern of interwoven fascicles of collagen bundles with a laminated or tortuous appearance, embedded in abundant mucin. A number of fibromas showed striking hyalinization; these may represent a second microscopic hallmark of Cowden's disease in addition to facial trichilemmomas.

Topics: Antigens, Viral; Biopsy; Facial Neoplasms; Fibroma; Hamartoma; Humans; Keratins; Skin; Skin Neoplasms; Staining and Labeling; Syndrome

A case of a malignant neoplasm with features suggestive of both malignant melanoma and squamous cell carcinoma is reported. The neoplastic cells were positive for both S-100 protein and keratin when stained by the indirect peroxidase-antiperoxidase method. The literature on other instances of bi- or multidirectional differentiation of neoplastic cells is reviewed. The significance of these findings for terminology of neoplasms is discussed.

Topics: Aged; Carcinoma, Squamous Cell; Facial Neoplasms; Female; Humans; Keratins; Melanoma; Neoplasms, Multiple Primary; S100 Proteins

The ultrastructural features of a chondroid syringoma (mixed tumor of skin) are presented. The tumor consisted of groups of epithelial cells, ductal structures, and cells lying individually within a cartilaginous matrix. Many of these latter cells were indistinguishable morphologically from true chondrocytes. Some of these chondroid cells showed positive staining for cytokeratin using the immunoperoxidase technique. Transitional cells with characteristics intermediate between epithelial and chondroid cells are noted.

Topics: Biopsy; Cytoskeleton; Facial Neoplasms; Humans; Keratins; Male; Microscopy, Electron; Middle Aged; Neoplasms, Germ Cell and Embryonal; Skin; Skin Neoplasms

Topics: Adolescent; Adult; Aged; Basophils; Calcinosis; Child; Child, Preschool; Citrulline; Epithelial Cells; Eyelid Neoplasms; Facial Neoplasms; Female; Granulation Tissue; Hair; Humans; Infant; Keratins; Male; Sex Factors; Skin Neoplasms; Staining and Labeling; Syndrome