Basal cell carcinoma with neuroid type nuclear palisading: a report of three cases

Nuclear palisading is a characteristic feature which is typically seen in neural tumours such as neurilemmoma, and also in some other tumours. We report here three patients with basal cell carcinoma who showed histological patterns similar to nuclear palisading. To our knowledge, this is the first such case report in the medical literature; we apply the term 'neuroid-type nuclear palisading' to these cases. In our patients, the spindle-shaped tumour cells were tightly packed and the nuclei were arranged uniformly to form this rare feature.     

Basal cell carcinoma with monster cells

A case of basal cell carcinoma with "monster cells" is reported. Clinically, the lesion presented as a red nodule on the forearm of a 58-year-old male. The histologic picture was striking, with large, "monstrous" nuclei scattered throughout a well defined nodule. Basal cell carcinoma with monster cells appears to represent a histologic variant of nodular basal cell carcinoma. The prognostic significance of the monster cells remains to be established.     

Inguinal keratotic Basal cell carcinoma mimicking giant solitary trichoepithelioma

Keratotic basal cell carcinoma may not only clinically but also histologically share more or less the same features with giant solitary trichoepithelioma. It can be difficult to distinguish these two entities from each other, even for an experienced dermatopathologist. We present an unusual case of inguinal keratotic basal cell carcinoma mimicking giant solitary trichoepithelioma in a 56-year-old woman with a finger-like tumor of 20 years duration. The patient presented with an asymptomatic, skin colored, firm, nonulcerative, nodular lesion. Scanty mitotic activity and apoptotic cells were the histopathologic findings against basal cell carcinoma, whereas absence of papillary mesenchymal bodies, presence of peritumoral lacunae detected only around the solid areas, and accumulation of amyloid-like hyalinized material were the findings in favor of basal cell carcinoma. This case illustrates that keratotic basal cell carcinoma must be taken into account in the differential diagnosis of inguinally located solitary, polypoid masses, especially giant solitary trichoepithelioma.     

Basal cell carcinoma with tumor epithelial and stromal giant cells: a variant of pleomorphic basal cell carcinoma.

A case of basal cell carcinoma with giant cells of the central epithelial and surrounding stromal components is presented. The lesion was an 8-mm dome-shaped papule on the ear of a 66-year-old man. The giant cells of the epithelial component shared the immunophenotype of the more typical cells of the basal cell carcinoma (keratin, smooth muscle actin, and bcl-2 positive), whereas the stromal giant cells were positive only for bcl-2. This case represents a peculiar variant of pleomorphic basal cell carcinoma, the significance of which is unknown.     

Basal cell carcinoma mimicking rhinophyma. Case report and literature review

An 82-year-old man presented with rapid enlargement of a long-standing rhinophyma. Following an uncomplicated excision of rhinophyma, histologic examination showed that the enlargement was entirely due to basal cell carcinoma. Radiotherapy was administered, and the nose has now healed satisfactorily. There are few reports of an association between rhinophyma and basal cell carcinoma; but it is claimed that it occurs more frequently than is expected by chance. The evidence for this is reviewed. Previous reports were anecdotal or contained biases that prevent generalization of the results and, in addition, a statistical analysis was incorrect. There is insufficient evidence to claim an association between basal cell carcinoma and rhinophyma.     

Basal cell carcinoma with ossification

Background: Osteoma cutis, the presence of lamellar bone in the skin, is relatively common. This process is divided into two categories: primary osteoma cutis and secondary osteoma cutis. Objective: The purpose of this study was to describe the clinical and histopathologic features of patients in whom lamellar bone developed in cutaneous basal cell carcinoma. Methods: We evaluated the features of five cases of osteoma cutis associated with basal cell carcinoma and obtained detailed clinical information from those patients. Results: All five patients had significant underlying medical conditions, including two patients who were receiving interferon alfa-2b therapy. Three patients had been previously treated with electrodesiccation and curettage. The amount of sun exposure experienced by these patients varied. Histologically, the basal cell carcinomas were of the nodular or micronodular variety. Bone was found both in the stroma and intratumorally. Conclusion: The presence of bone within basal cell carcinomas is not uncommon and may be more prevalent in patients with an underlying medical disorder. (J Am Acad Dermatol 1998;38:906-10.)     

Basal cell carcinoma with follicular differentiation

A distinctive form of basal cell carcinoma with follicular differentiation was studied in 15 biopsy specimens. The neoplasms differ from other variants of basal cell carcinoma by being situated on the face only, being small and well circumscribed, and having signs of follicular differentiation, namely, numerous tiny infundibular cyst-like structures and aggregations of neoplastic cells that resemble hair follicles in telogen. The diagnostic features of basal cell carcinomas with follicular differentiation are enumerated and illustrated.     

Basal cell carcinoma with myoepithelial differentiation

A lesion from the left cheek of a 48-year-old man showed a neoplasm composed primarily of cells with eccentric crescent-shaped nuclei and abundant, homogenous, eosinophilic cytoplasm resembling signet ring cells. Immunohistochemical studies showed the cells to stain positively for pan cytokeratin and smooth muscle actin, indicating myoepithelial differentiation (MED). Foci of conventional basal cell carcinoma were present, and cells with MED were also admixed within some of the aggregations of basal cell carcinoma. On the basis of these findings, we interpreted this lesion to represent basal cell carcinoma with MED. A review of the existing literature of basal cell carcinomas with similar morphologic features is also presented.     

Basal cell carcinoma with sebaceous differentiation

Some authors have used sebaceous epithelioma as a synonym for basal cell carcinoma (BCC) with sebaceous differentiation. However, our review of the literature revealed that definite cases of BCC with sebaceous differentiation that provide adequate clinical and histopathologic information are scarce. We present the case of a 72-year-old woman with a pigmented nodular lesion on her right ala nasi region, clinically diagnosed as pigmented BCC. Histopathologically, this nodular lesion, which was completely excised, showed typical features of BCC. It was noteworthy that within one aggregation of the presented BCC, tiny and small duct-like structures lined by cornified layers with a crenulated inner surface were seen. Vacuolated cells were scattered within a few aggregations, and they had foamy, bubbly cytoplasm and starry nuclei. The vacuolated cells were immunohistochemically positive for epithelial membrane antigen (EMA). These histopathologic findings demonstrated unquestionable sebaceous differentiation in this BCC, namely BCC with sebaceous differentiation, which should be distinguishable from both sebaceoma and sebaceous carcinoma. The small duct-like structures lined by eosinophilic cuticle, indicating apocrine differentiation, were also observed in this BCC.     

Basal cell carcinoma with massive ossification

We report a case of basal cell carcinoma with massive ossification in a 66-year-old white man. Ossification in various benign and malignant neoplasms have been reported including basal cell carcinomas, in which ossifications are seen in small foci or peripheral rim of the tumor. However, in our case, massive ossification is seen throughout the tumor, and only small areas of the periphery of the tumor show diagnostic histology. Therefore, this case might have presented a diagnostic difficulty or been misdiagnosed as an osteoma cutis if a smaller incisional or punch biopsy had been performed. The phenomenon of bone formation itself is not specific for any diagnostic entity, and therefore an underlying lesion should be carefully sought in case of secondary ossification.     

Comparison of risk factors of single Basal cell carcinoma with multiple Basal cell carcinomas

Background:

Basal cell carcinoma (BCC) is the most common malignant skin tumor. Although mortality attributable to BCC is not high, the disease is responsible for considerable morbidity. There is evidence that the number of patients who develop more than one BCC is increasing.

Aims:

The aim of this study was to elucidate possible risk factors for developing Multiple BCC.

Patients and Methods:

Patients with histologically proven BCC (n = 218) were divided into two groups (single BCC and Multiple BCC) according to the number of their tumors and their profile were reviewed. Probable risk factors were compared between these two groups.

Results:

Among 33 evaluated risk factors, mountainous area of birth, past history of BCC, history of radiotherapy (in childhood due to tinea capitis), abnormal underlying skin at the site of tumor, and pigmented pathologic type showed significant differences between the two groups.

Conclusions:

The high rate of additional occurrences of skin cancers among patients with previously diagnosed BCC emphasizes the need of continued follow-up of these individuals. Those with higher risk require closest screening.