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Basal Cell Carcinoma

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Basal Cell Carcinoma

  1. 1. ACADEMIC REVIEWACADEMIC REVIEW Dr. Shameera BegumDr. Shameera Begum
  2. 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. 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. 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
  5. 5. Scanner View
  6. 6. Cleft Abrupt keratinisation
  7. 7. IMPRESSIONIMPRESSION • Locally infiltrating Basal Cell Carcinoma with varied features including proliferating trichilemmal tumor component • Lateral margins, deep resected margin (Pedicle) – free of tumor
  8. 8. 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
  9. 9. Cell of originCell of origin • Germinal epithelial cell Basal keratinocytes OR • outer root sheath of hair follicle OR • Pleuripotent embryonal cells with adnexal differentiation
  10. 10. 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.
  11. 11. 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)
  12. 12. 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
  13. 13. 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
  14. 14. 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
  15. 15. Fibroepithelioma (Pinkus): • Most common location is the back • Raised, moderately firm, slightly pedunculated nodules, covered by smooth, slightly reddened skin. • Clinically, they resemble fibromas..
  16. 16. 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
  17. 17. Nodular bccNodular bcc
  18. 18. • Variants of nodular BCC: – Nodulo-cystic Bcc – Pigmented BCC – Clear cell bcc – Adenoid bcc – with differentiation (pilar,sebaceous,sweat gland) – Granular bcc
  19. 19. PIGMENTED BCCPIGMENTED BCC
  20. 20. Clear cell BCC
  21. 21. Superficial spreading BCC Small epithelial buds arise from epidermis and extend into superficial dermis, mimicking hair germs.
  22. 22. Fibrosing/sclerosing (Morpheaform) BCC Narrow tumor bands (2–3 cells thick) with dense cell-rich stroma.
  23. 23. Fibroepithelioma of Pinkus
  24. 24. Micronodular BCC
  25. 25. Basosquamous BCC
  26. 26. Differential diagnosis • Trichoblastoma • Desmoplastic trichoepithelioma • Squamous cell carcinoma with basaloid features • Proliferating trichilemmal tumor
  27. 27. Desmoplastic tricoepitheliomas Symmetrical, centrally-depressed basaloid tumor with cells in strands and forming horn-filled microcysts; does not extend beneath mid-dermis
  28. 28. 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
  29. 29. • 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.
  30. 30. Squamous cell carcinoma
  31. 31. 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
  32. 32. Proliferating trichilemmal tumor

Hinweis der Redaktion

  • nests or islands
  • 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

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