Adnexal Proliferations Research Articles

Contiguous verrucous proliferations in syringocystadenoma papilliferum: A retrospective analysis with additional evaluation via mutation-specific BRAFV600E immunohistochemistry.

Syringocystadenoma papilliferum (SCAP) is an uncommon cutaneous adnexal proliferation. There have been several reports describing collision lesions of SCAP and verruca, although little is known about the frequency of this association. Molecular testing has revealed the BRAFV600E mutation in a large proportion of SCAP cases, although its expression pattern has not been previously evaluated. In this retrospective analysis, we explored the potential histopathological association between verruca and SCAP. We also evaluated mutation-specific BRAFV600E expression in these lesions by immunohistochemistry. Cases of SCAP diagnosed over a 7-year period were closely reviewed for the presence of contiguous verrucous proliferations. Additional sections were cut and stained using the BRAFV600E-specific clone VE1 antibody. Contiguous verrucous proliferations were identified in 9 out of 12 identified cases. Furthermore, expression of the BRAFV600E mutation was identified in 7 out of 12 cases. Interestingly, in SCAP associated with endophytic verrucous proliferations (n = 4), expression of BRAFV600E was found in both the glandular and the contiguous hyperplastic squamous epithelium. Overall, these findings suggest that contiguous verrucous proliferations in SCAP are common. Both components of the neoplasm may express the BRAFV600E mutation, which is suggestive of a common origin.

Superficial papular neuroma: Case series of a new entity

Dermal neural lesions arise in various circumstances and may be difficult to classify. We describe the clinical, histopathologic and immunophenotypic features of a series of terminally differentiated neural lesions not described previously, to our knowledge. Four cases from men aged 58 to 66 years were included. Some lesions reportedly bled, but no inciting trauma or prior biopsies were reported. None recurred after biopsy, with follow-up ranging from 19 to 113 months. All lesions were papular, with vertically oriented S100-positive spindled cells and nerve fibers in the papillary dermis. Slight epidermal hyperplasia, dilated superficial thin-walled vessels and minimal to mild inflammation were seen in each. Fibers were uniformly fine in 3 cases, with slightly thicker central fibers in the fourth. Three had parakeratotic scale. None were associated with dermal fibrosis or adnexal proliferation. Neurofilament stained axons in each. EMA was negative in all cases. CD34, melan-A and HMB45 were negative when performed. We report a small series of benign neural lesions and propose the name "superficial papular neuroma" for this distinct entity. Awareness is important to understand the clinical significance of these lesions and avoid misinterpretation that could lead to overtreatment, unnecessary work-up and increased cost.

Epidermal panfolliculoma: an adnexal proliferation with advanced follicular differentiation confined to the epidermis

Follicular differentiation can be exhibited by a variety of epidermal lesions. We report an example of panfolliculoma purely confined to the epidermis. The lesion presented as a verrucous plaque on the leg of a 55-year-old man. Histopathologic sections showed an acanthoma with follicular differentiation including areas mimicking the follicular germ, matrix, root sheath and infundibular components.

Trichodysplasia spinulosa: A benign adnexal proliferation with follicular differentiation associated with polyomavirus

Trichodysplasia spinulosa is a rare polyomavirus-associated cutaneous eruption occurring in the setting of immunosuppression. Clinically it is characterised by multiple centrofacial folliculocentric papules with spinous protuberances. The histopathology is distinct and treatment with antiviral agents appears to be the most effective.

Immunohistochemical Study of Calretinin in Normal Skin and Cutaneous Adnexal Proliferations

Calretinin is a calcium-binding protein member of the EF-hand family. The presence of calretinin has been demonstrated in certain stages of the cellular cycle in a wide variety of normal and neoplastic tissues. The main aims of our study were (1) to investigate what structures of the normal skin and cutaneous adnexal proliferations express immunoreactivity for calretinin and (2) to determine the value of immunohistochemical expression for calretinin as a marker for follicular, sebaceous, apocrine, and eccrine differentiation in cutaneous adnexal proliferations. We studied 139 biopsy specimens, including 10 cases of normal skin of different locations and 129 benign and malignant cutaneous adnexal proliferations. In normal skin, we found that calretinin is expressed in the innermost cell layer of the outer root sheath in anagen hair follicle, in both the duct and sebolemma of the sebaceous gland, in the secretory portion of eccrine glands, and in mast cells of the stroma. In cutaneous adnexal proliferations, we found strong immunoreactivity for calretinin in tricholemmal cysts, tricholemmomas/inverted follicular keratoses, tumors of follicular infundibulum, and in some basal cell carcinomas. Focal positivity was also seen in trichoadenomas, trichoblastomas/trichoepitheliomas, pilomatricomas, proliferating tricholemmal tumors, pilar sheath acanthomas, trichofolliculomas, follicular hybrid cysts, cutaneous mixed tumors, steatocystomas, sebaceous hyperplasias, and sebaceomas. These results demonstrate that immunohistochemical study for calretinin may be helpful to identify the innermost cell layer of the outer root sheath in anagen hair follicle and the cutaneous adnexal proliferations showing differentiation toward this structure. Calretinin immunoreactivity supports eccrine differentiation in some sweat gland neoplasms, and it is also useful in identifying neoplasms with ductal sebaceous differentiation.

Distinction of Benign Sebaceous Proliferations From Sebaceous Carcinomas by Immunohistochemistry

Sebaceous lesions, including sebaceous hyperplasia, sebaceomas, and sebaceous adenomas and carcinomas, are histologically distinctive adnexal proliferations with a spectrum of biological behavior ranging from benign to frankly malignant. The histologic distinction between sebaceous adenomas and carcinomas may be challenging, especially in cases showing atypical features and in small or partial biopsies. We studied multiple oncogenic and therapeutic related proteins by immunohistochemistry to identify differences in expression between benign and malignant sebaceous proliferations. A total of 27 cases, including 9 sebaceous adenomas, 4 sebaceomas, 8 sebaceous carcinomas, and 6 cases of sebaceous hyperplasia, were examined by immunohistochemistry, with antibodies directed against Ki-67 (MIB-1), bcl-2, p53, p21WAF1, p27Kip1, c-erbB-2 (Her-2/neu), CD117 (c-kit), cyclin D1, MDM2, CD99, MLH-1, and MSH-2. We found that sebaceous adenomas and sebaceomas stained like sebaceous hyperplasia did, whereas carcinomas had statistically significantly increased levels of p53 (50% versus 11%, respectively) and Ki-67 (30% versus 10%). The carcinomas also had significantly reduced levels of bcl-2 (7% versus 56%, respectively) and p21 (16% versus 34%) compared to the adenomas. Thus, a combination of several of these markers may be diagnostically useful in challenging cases. In addition, we found little or no Her-2/neu and CD117 staining, indicating that immunotherapy with Herceptin or Gleevac would likely not be useful for sebaceous carcinomas. Moreover, these results show that sebaceous adenomas and carcinomas are distinct neoplasms and provide no support for the theory that all sebaceous adenomas are truly malignant.

Epidermal basaloid proliferation in cutaneous myxomas.

Basaloid epidermal proliferations, which histologically resemble basal cell carcinoma, have been described overlying dermatofibromas. Several etiologies have been proposed. Cutaneous myxomas are also benign mesynchymal tumors. Basaloid proliferations have been noted overlying cutaneous myxomas. We have undertaken a study to attempt to differentiate whether these are basal cell carcinomas or benign basaloid proliferations. Thirty cases of cutaneous myxomas were included in this study. The lesions were stained with hematoxylin-eosin and alcian blue. Immunohistochemical staining for both epidermal growth factor receptor (EGF-r) and p53 protein was performed on the cutaneous myxomas with epidermal basaloid proliferation. Of the 30 cases of cutaneous myxomas, nine were found to have an associated overlying basaloid proliferation. The basaloid proliferations were limited to the epidermis overlying the myxoid changes within the dermis. Mitotic figures were rare. Staining for p53 protein showed scattered positive staining in the basal cells in both the basaloid proliferations and adjacent epidermis. EGF-r showed positive staining of the overlying epidermis and basaloid proliferation in five cases. We report basaloid proliferations overlying cutaneous myxomas and propose that these represent benign adnexal proliferations rather than superficial basal cell carcinoma and are analogous to the basaloid proliferations overlying dermatofibromas.

Dermatopathology calendar

Microscopy courses June 7, 2003 Course A: The best of 5 year melanocytic referrals Course B: Granulomatous skin disease July 5, 2003 Course A: Benign or malignant adnexal proliferation? Course B: Lymphoma or not? August 2, 2003 Course A: Lichenoid dermatoses Course B: Metabolic disorders & deposits Contact address for detailed information: Dr. Bernhard Zelger, Department of Dermatology, University of Innsbruck, Innsbruck, Anichstraße 35, A‐6020 Innsbruck, Austria, Tel: +43 512 504 2971, Fax: +43 512 504 2990, e‐mail:Bernhard.Zelger@uibk.ac.atOrDr. Bettina Zelger, Institute of Pathology, University of Innsbruck, Innsbruck, Müllerstraße 44, A‐6020 Innsbruck, Austria, Tel: +43 512 507 3663, Fax: +43 512 582 088, e‐mail:Bettina.Zelger@uibk.ac.at July 7–10, 2004 Xth World Congress of Pediatric Dermatology This Scientific Meeting will be organized by the International Centre for Study and Research in Dermatology, Department of Dermatolgy of the Catholic University of Sacred Heart and with the aid of the Italian Group of Pediatric Dermatology (GIDEP), the Italian Society of Dermatology and Venereology (SIDEV), and the European Society of Pediatric Dermatology (ESPD).The official language for all Scientific Session will be English. Scientific Secretariat Prof. Carlo Gelmetti, MD, Deparment of Pediatric Dermatology, University of Milan, Via Pace, 9, 20122 Milan, Italy, Tel: +39 02 5503 5200, Fax: +39 02 5503 5118, e‐mail: carlo.gelmetti@libero.it Congress Secretariat Prof. Giuseppe Fabrizi, MDDeparment of Pediatric Dermatology, Catholic University of Sacred Heart, Largo A. Gemelli, 8, 00168 Rome, Italy, Tel: +39 06 301 3250, Fax: +39 06 301 3250, e‐mail: fabrizidermo@virgilio.it Organizing Secretariat Triumph Congressi, Via Lucilio, 60, 00136 Rome, Italy, Tel: +39 06 355 301, Fax: +39 06 3534 0213, e‐mail:dermo@gruppotriumph.it