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      A rare development of basal cell carcinoma on trichoepithelioma in a chemical burn scar tissue : A case report

      case-report
      , MD a , , MD b , , MD, PhD b , , MD, PhD b , , MD, PhD b ,
      Medicine
      Wolters Kluwer Health
      basal cell carcinoma, chemical burn, trichoepithelioma

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          Abstract

          Rationale:

          Trichoepithelioma (TE) is a rare benign skin tumor that originates from the hair follicle epithelium. Although skin lesions arising from scar tissues are mostly malignant, the development of a benign tumor such as TE is a rare event.

          Patient concerns:

          A 28-year-old male patient who had a scar on the left cheek which arose 10 years ago because of a chemical burn visited our hospital. Scar revision was performed under local anesthesia.

          Diagnosis:

          Histological examination identified the specimen as a TE with malignant foci suspicious of basal cell carcinoma (BCC) at the lateral margin of the specimen.

          Interventions:

          A second stage operation was planned to excise the BCC with a 4 mm margin of the normal skin around the previous lesion.

          Outcomes:

          No complication or recurrence was noted during the 1-year follow-up period after surgery, and the appearance of the scar improved.

          Lessons:

          The correct differential diagnosis between TE and BCC is very important. So follow up at regular intervals is recommended for evaluation of recurrence or transformation into BCC in patients with tumors arising from chemical burn scars. And the concomitant development of TE and BCC should also be considered from a chemical burn scar.

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          Most cited references14

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          An immunohistochemical study of basal cell carcinoma and trichoepithelioma.

          The histologic distinction between tricheopithelioma and basal cell carcinoma may be difficult in small biopsies. Immunohistochemical stains have been used to help make this distinction; however, published studies have generally been limited to a few antibodies. To this end we performed a comprehensive immunohistochemical analysis of 20 basal cell carcinomas and 10 tricheopitheliomas from our files, in search of a consistent pattern of reactivity to distinguish the neoplasms in biopsies. The antibodies used were: low molecular weight keratin (Cam 5.2), Cytokeratin 7, (CK7), Cytokeratin 20, (CK20), Carcino-embryonic antigen (CEA), CD30 (Ki-1), bcl-2, Ham 56, HPCA-I (CD34), and Ulex Europaeus type I. In our study, bcl-2 stained all but one basal cell carcinoma in a diffuse pattern, whereas all tricheopitheliomas showed staining of the outermost epithelial layer. No other stain proved to be an independent marker for either neoplasm and no consistent immunohistochemical profile for either neoplasm emerged. Thus, we conclude that bcl-2 may be of some value in distinguishing basal cell carcinoma from tricheopithelioma, limited by the quantitative nature of the difference in staining. Histologic criteria applied to H&E-stained sections remain the cornerstone of histologic diagnosis.
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            Clear cell adenocarcinoma arising from endometriosis in abdominal wall cesarean section scar: a case report and review of the literature.

            Malignancy arising in association with endometriosis is a rare but well-documented phenomenon that was first described in the literature as early as 1925. Cutaneous endometriosis with subsequent malignant transformation is even more uncommon, and high clinical suspicion is required for diagnosis. The clinical differential diagnosis of these lesions includes a wide variety of entities, ranging from benign cysts to malignancies such as melanoma. We report a case of clear cell adenocarcinoma arising from endometriosis in a cesarean section scar in a 47-year-old woman, and we complete a review of the literature regarding this unusual entity. Copyright © 2012 John Wiley & Sons A/S.
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              Immunohistologic differential diagnosis of basal cell carcinoma, squamous cell carcinoma, and trichoepithelioma in small cutaneous biopsy specimens.

              The distinction between squamoid basal cell carcinoma and basaloid squamous cell carcinoma (or between BCC and trichoepithelioma variants) is usually made readily on the basis of defined histological criteria. However, these differential diagnoses occasionally can pose difficult morphological problems. The stated distinctions are clinically important because the risk of progressive disease is significantly higher with squamous carcinoma of the skin than with basal cell carcinoma (BCC), and a trichoepithelioma misinterpreted as BCC burdens the patient with an inaccurate diagnosis that may result in inappropriate surgery. Recent reports have suggested that reactivity with the monoclonal antibody Ber-EP4 is capable of separating histologically similar basal cell and squamous carcinomas, and that the expression of bcl-2 or CD34 antigen is able to distinguish BCC from trichoepithelioma. However, corroborative studies of these contentions are few in number. In order to investigate the usefulness of the stated immunostains in the above-cited differential diagnoses, the authors analyzed 45 basal cell carcinomas and 22 squamous carcinomas, as well as 36 trichoepitheliomas. The monoclonal antibodies Ber-EP4, My10 (CD34), and anti-bcl-2 were applied to formalin-fixed paraffin sections in all cases, using a standard avidin-biotin-peroxidase complex method. Most BCCs demonstrated strong, diffuse cytoplasmic labeling with Ber-EP4 and anti-bcl-2. In contrast, the squamous carcinomas were uniformly negative for the former marker and only focally reactive for the latter in four examples. 'Peripheral' bcl-2 staining of trichoepitheliomas was noted in 24 of 33 of the immunoreactive tumors, but the remainder were marked diffusely and similarly to most BCCs. Among the latter, immature trichoepitheliomas were diffusely reactive for this marker in 6 of 8 cases. Labeling of epithelium for CD34 failed to discriminate between any of the tumor types under evaluation, whereas staining of peritumoral stroma was characteristic of the majority of trichoepitheliomas and more than one-third of metatypical basal cell carcinomas. These data support the suggestion that Ber-EP4 and bcl-2 are useful in the separation of BCC from squamous carcinomas. Nevertheless, they also serve to caution against reliance upon bcl-2 and CD34 immunostains in attempting to distinguish BCC from trichoepithelioma in histologically enigmatic cases. There is currently no certain method other than conventional microscopy that can be applied successfully to the latter problem.
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Wolters Kluwer Health
                0025-7974
                1536-5964
                September 2018
                21 September 2018
                : 97
                : 38
                : e12252
                Affiliations
                [a ]Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul
                [b ]Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea.
                Author notes
                []Correspondence: Sam Yong Lee, Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwang Ju 61469, Korea (e-mail: sylee@ 123456chonnam.ac.kr ).
                Article
                MD-D-18-03442 12252
                10.1097/MD.0000000000012252
                6160086
                30235669
                2b5b3360-54ff-470b-b7f6-d9b4aa3c9c3f
                Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

                History
                : 15 May 2018
                : 14 August 2018
                Categories
                7100
                Research Article
                Clinical Case Report
                Custom metadata
                TRUE

                basal cell carcinoma,chemical burn,trichoepithelioma

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