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Pathology of Desmoplastic


Dr Sampurna Roy MD        





Desmoplastic trichoepithelioma is a benign neoplasm considered to have follicular differentiation.

Related post: Trichoepithelioma

Its sweat gland- or sebaceous-lines of differentiation have been also reported.

The cells in desmoplastic trichoepithelioma are suggested to be in close association with the basal cells in the outer root sheath.

Diagnosis of this lesion is important because it may be mistaken for Microcystic adnexal carcinoma clinically and histologically.

This condition should not be diagnosed on shave, curettage or punch biopsies.

Deep biopsy is necessary to identify subcutaneous involvement.

Clinical presentation:  Presents as a solitary, small indurated often depressed plaque on the face.

Microscopic features: 


Symmetrical well-circumscribed ;  

Lesions are usually located in the mid and upper dermis;

Tumour consists of cords and small nests of uniform basaloid cells in a dense fibrotic stroma ;

Superficially, small horn cysts and keratin granulomas may be present ;

No ductal differentiation.

Differential Diagnosis:

1. Syringoma - Usually periorbital and multiple lesions ; Narrow strands of tumour cells ;  Horn cysts, foreign body granulomas or calcifications are rare.

2. Morpheic Basal Cell Carcinoma - Form clefts between the nests and the stroma ; Coexisting nodular basal cell carcinoma; Mitoses and apoptotic bodies are common; Foreign body granulomas and ruptured keratinous cysts are rare.

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

ii) PHLDA1 (TDAG51) is a follicular stem cell marker and differentiates between morphoeic basal cell carcinoma and desmoplastic trichoepithelioma.

iii) Desmoplastic trichoepithelioma versus morphoeic basal cell carcinoma: a critical reappraisal of histomorphological and immunohistochemical criteria for differentiation.

3. Microcystic adnexal carcinoma  

4. Metastatic breast carcinoma

Further reading:

The immunohistochemical differential diagnosis of microcystic adnexal carcinoma, desmoplastic trichoepithelioma and morpheaform basal cell carcinoma using BerEP4 and stem cell markers.

Expression of p75 neurotrophin receptor in desmoplastic trichoepithelioma, infiltrative basal cell carcinoma, and microcystic adnexal carcinoma.

A case of desmoplastic trichoepithelioma with ossification.

Dermoscopy of desmoplastic trichoepithelioma reveals other criteria to distinguish it from basal cell carcinoma.

Microcystic adnexal carcinoma of the upper lip misdiagnosed benign desmoplastic trichoepithelioma.

Microcystic adnexal carcinoma versus desmoplastic trichoepithelioma: a comparative study.

Desmoplastic trichoepithelioma: report of a unique periocular case.

Desmoplastic trichoepithelioma with perineural involvement: a series of seven cases.

Neurotropism in association with desmoplastic trichoepithelioma.





Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)








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