Article

Differential expression of PHLDA1 (TDAG51) in basal cell carcinoma and trichoepithelioma

Departments of Dermatology and Pathology, University of California, San Francisco, CA, U.S.A.
British Journal of Dermatology (Impact Factor: 4.1). 09/2012; 167(5). DOI: 10.1111/j.1365-2133.2012.11165.x
Source: PubMed

ABSTRACT Background A recent small series demonstrated perfect sensitivity and specificity utilizing immunostaining for PHLDA1, a marker of follicular stem cells, in the distinction of desmoplastic trichoepithelioma and morphoeiform basal cell carcinoma (BCC) in small biopsy specimens.
Objectives To assess this result more broadly.
Methods We performed immunoperoxidase staining of BCCs (superficial n = 16, nodular n = 15, micronodular n = 15, infiltrative n = 17, morphoeiform n = 16, infundibulocystic n = 14) and trichoepitheliomas (conventional n = 19, desmoplastic n = 16) with PHLDA1.
Results Morphoeiform BCCs typically lacked PHLDA1 staining (88% demonstrated no staining and 12% of cases had staining in < 25% of the tumour), while in contrast 74% of classical and 88% of desmoplastic trichoepitheliomas demonstrated strong PHLDA1 staining in over half of the tumour. However, micronodular BCCs demonstrated focal to diffuse positive staining in a third of the cases.
Conclusions Based upon our staining results, we discuss the biological significance of PHLDA1 expression and the limits in its diagnostic utility.

0 Followers
 · 
103 Views
 · 
0 Downloads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Until the 1990s, basal cell carcinoma (BCC) was viewed as the most common epithelial neoplasm developing in association with nevus sebaceus (NS). Currently, trichoblastoma is thought of as the most prevalent basaloid neoplasm in NS. The follicular stem cell marker pleckstrin homology-like domain, family A, member 1 (PHLDA1) also known as T-cell death-associated gene 51 (TDAG51) labels trichoepithelioma (TE) but not BCC. Therefore, we explored its usefulness in basaloid neoplasms developing in NS. We studied immunohistochemically PHLDA1 in 10 nodular BCCs, 11 TEs, 11 trichoblastomas and 25 NS with basaloid tumors. Additionally, we examined the expression of BCC marker BerEP4 and the distribution of Merkel cells that function as surrogate markers for benign follicular neoplasms. Nineteen of the 25 basaloid tumors in NS were PHLDA1-negative comparable to BCC arising de novo and six tumors were PHLDA1-positive comparable to solitary trichoblastomas and TEs. Fewer Merkel cells were seen in BCCs associated with NS when compared with trichoblastoma. BerEP4 did not discriminate between the neoplasms. We raise concern that the unquestioned assessment that basaloid tumors developing in association with NS represent mostly trichoblastomas and not BCC may not be true. This influences clinical care, as it is paramount in the decision of whether to excise these lesions or not.
    Journal of Cutaneous Pathology 03/2013; 40(5). DOI:10.1111/cup.12107 · 1.56 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Context.-Because the skin and modified mucosal surfaces of the vulvar region contain dense apocrine glands and anogenital mammary-like glands, in addition to eccrine glands and folliculosebaceous units, benign as well as malignant lesions derived from these adnexal structures are, not surprisingly, found in the vulva. However, their incidence occurring in the vulva has not been reported, to our knowledge. Objective.-To determine the incidence of various vulvar adnexal lesions. Design.-We performed a retrospective review (1978-2010) of the cases at our institution. Results.-A total of 189 vulvar adnexal lesions were identified. Most of these lesions were benign (133 of 189; 70%), with hidradenoma papilliferum being the most common, followed by syringoma and various types of cysts. Rare cases of tubular adenoma, poroma, spiradenoma, hidradenoma, cylindroma, sebaceoma, and trichoepithelioma were identified. Malignant adnexal neoplasms comprised the remaining 30% (56 of 189) of the cases. Extramammary Paget disease was the most common (49 of 56), and 29% (14 of 49) demonstrated an invasive component. Rare cases of basal cell carcinoma, sebaceous carcinoma, apocrine carcinoma, adenoid cystic carcinoma, and spiradenocarcinoma were identified. Conclusions.-In this retrospective review, we identified several benign entities that have not been previously reported on the vulva, namely pilomatricoma, poroma, spiradenoma, and sebaceoma. Hidradenoma papilliferum and extramammary Paget disease were the most common benign and malignant adnexal neoplasms, respectively. The spectrum of various vulvar adnexal lesions appears to reflect the frequency of the underlying glandular elements.
    Archives of pathology & laboratory medicine 09/2013; 137(9):1237-46. DOI:10.5858/arpa.2012-0434-OA · 2.88 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Nevus sebaceus is commonly associated with the development of secondary neoplasms. Data on the frequency of malignant tumors vary considerably in published reports. We sought to analyze the distribution of secondary neoplasm in nevus sebaceus. A retrospective analysis of all cases of nevus sebaceus diagnosed at the Ackerman Academy of Dermatopathology from 1999 to 2012 was conducted. A total of 706 patients (707 specimens) were included in the study. Trichoblastoma was the most frequent benign tumor (n = 52, 7.4%) followed by syringocystadenoma papilliferum (n = 33, 5.2%). Malignant tumors were present in 2.5% of the specimens with basal cell carcinoma being the most common (n = 8, 1.1%) followed by squamous cell carcinoma (n = 4, 0.57%). The incidence of secondary neoplasms was statistically related to age and anatomic site (P < .05). Almost all malignant tumors were seen in adults. Some of our cases were referred for second opinion and there may be a bias in our data toward unusual secondary neoplasms. Our study confirms that most of the secondary neoplasms arising in association with nevus sebaceus are benign. As no malignant tumors were seen in children, we believe it is reasonable to delay surgical management until adolescence.
    Journal of the American Academy of Dermatology 11/2013; 70(2). DOI:10.1016/j.jaad.2013.10.004 · 5.00 Impact Factor
Show more