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Path Quiz Case-84: Diagnosis-
Dr Sampurna Roy
MD
 Site created by Dr Sampurna Roy MD
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Benign sweat gland tumours Cysts: Hydrocystoma -Eccrine/Apocrine Porokeratotic eccrine ostial naevus Benign Neoplasms: Syringocystadenoma Papilliferum Chondroid Syringoma (benign mixed tumour) Low grade: Primary extramammary Paget’s disease Intermediate grade: Digital papillary adenocarcinoma High grade: |
| Sebaceous tumours |
| Lichen planus-like lesions |
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Epidermal tumours: Epidermal Naevus ; Inflammatory linear verrucous epidermal nevus |
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Cutaneous Infections and Infestations 1 : Bacterial, Rickettsial and Chlamydial Infections |
Syn: Pilomatricoma ; Calcifying epithelioma of Malherbe Pilomatrixoma
is a very common benign adnexal tumour with matrical differentiation. Dermatopathology Case No 23 (Images) Most cases are associated with beta-catenin gene mutations. Clinical presentation: Solitary and rarely multiple rubbery nodules (usually 5mm to 2cm in diameter). The tumour usually occurs in the first two decades of life. Often diagnosed as epidermoid/pilar cysts. May be associated with Gardner's syndrome or myotonic dystrophy- (multiple lesions). Site:
Located on head, neck or
forehead .
Image
Link1
DermAtlas-clinical image link Well circumscribed lobular sometimes cystic tumours ; Composed of proliferating basaloid (resemble matrical cells of the follicular bulb) and eosinophilic shadow keratinised cells (represent attempted cortical and inner root sheath differentiation) ; Dystrophic calcification and giant cell reaction to keratin and shadow cells ; sometimes osseous metaplasia; cystic pilomatrixoma shows more basaloid cells ; solid lesions are usually devoid of basaloid cells and there are more shadow cells, calcification and giant cell reaction. Proliferating Pilomatrixoma: A distinctive proliferative variant of pilomatrixoma ; This is a relatively large lesion in the dermis which sometimes extend to the subcutis ; Composed of lobular proliferation of basaloid cells in association with adjacent focal areas containing eosinophilic, cornified material with shadow cells ; in some cases there are relatively large areas of shadow cells whereas, in others there are only small foci of shadows cells ; basaloid cells show variable nuclear atypia and mitotic figures ; Architectural pattern of the neoplasms is different from that of a large fully developed pilomatrixoma with a cystic character and basaloid cells predominantly aligned at the periphery. Differential
diagnosis: Matricoma, basal-cell carcinoma with matrical
differentiation, and matrical carcinoma (pilomatrical carcinoma). Pilomatrix Carcinoma: Dermatopathology Case No 29 (Images) Pilomatrix carcinoma is a neoplasm of low-grade malignancy. The architectural features are those of a malignant neoplasm - asymmetry and poor circumscription, presence of several markedly sized and variably shaped basaloid aggregations, and ulceration. . Composed of pleomorphic basaloid cells with prominent nucleoli and frequent atypical mitoses accompanied by central areas with keratotic material, shadow cells, and foci of necrosis. Tumour nests are surrounded by a desmoplastic stroma ; There is infiltration into the adjacent tissues. Differential diagnosis: Should be distinguished from the- Conventional pilomatrixoma and its variant proliferating pilomatrixoma ; Matricoma ; Basal cell carcinoma with matrical differentiation. Clinicians and pathologists should be aware of the occurrence of pilomatrix carcinoma because of its potential for distant metastases. Malignant pilomatrixoma carries a high risk of metastases to the bones, lungs, and lymph nodes. Surgical wide
resection is the recommended treatment. |
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Histopathology-India.net
diagnostichistopathology. blogspot.com Environmental Pathology Online
E-book - History of Medicine with special reference to India. |
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Tumours of the Hair Follicle Hair Germ Differentiation: Desmoplastic Trichoepithelioma
Cutaneous lymphadenoma
Tumour of Follicular Infundibulum Outer root
sheath differentiation: |
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Myxoid
Tumours of Soft Tissue Classification of Soft Tissue Tumour Gross examination of soft tissue specimen A practical approach to histopathological reporting of soft tissue tumours Grading of soft tissue tumours Fibroblastic/Myofibroblastic tumours |
| Melanocytic tumours |