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Case Number : Case 836 - 30th August Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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71 years old male. 25 year scaly, sore, purple, plaque in groin, gradual increase in size. Some red and indurated areas. Has psoriasis. ?MF

Case posted by Dr. Richard Carr


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My differential diagnosis would be :
Fibroepithelioma of Pinkus
Tumor of the follicular infudibulum
Trichoepithelioma
clinically Fibroepithelioma of pinkus fits more ,
the connection to the epidermis would exlude trichoepithelioma
the proliferation of basalod cell and not keratinocytes would favor a diagnosis of Pinkus which the pt could have for years, any way this is a punch biopsy and complete excision would be more helpful with immunos.

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Guest Amira Tawdy

Posted

acrosyringial nevus vs syringocyctadenoma papilliferum vs fibroepithelioma of pinkus but i favour the first two because of the presence of ducts

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Guest Giovanni Falconieri

Posted

Agree, favor Pinkus FE due to pronounced reticulated pattern plus fibromucinous surrounding stroma. Small cysts filled with keratin and lacking granular cell layer might suggest infundibulocystic BCC at an odd site.

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Mark A. Hurt MD

Posted

I think this is a fibroepitheliomatous basal cell carcinoma (in Ackerman's terminology, a kind of trichoblastic carcinoma).

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Robledo F. Rocha

Posted

I found this lesion hard to classify, but I think three diagnosis are possible, all of them characterized by anastomosing epithelial strands connected to the undersurface of the epidermis.

[url="http://journals.lww.com/amjdermatopathology/Abstract/1994/12000/Fibroepithelioma_of_Pinkus__Eccrine_Duct_Spread_of.2.aspx"]Fibroepithelioma of Pinkus with eccrine duct spreading[/url].
Supportive findings: basaloid cells; peripheral palisading.
Adverse findings: lesion is not typically located on the trunk; there’s no persuasive specific follicular stroma; follicular papillae are lacking.

[url="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3120003/pdf/ad-23-70.pdf"]Syringofibroadenoma[/url].
Supportive findings: fibrovascular mucinous stroma with lymphocytic infiltrate; ductal elements within strands; areas of squamous cells.
Adverse findings: peripheral palisading.

[url="http://journals.lww.com/amjdermatopathology/pages/articleviewer.aspx?year=2009&issue=10000&article=00002&type=abstract"]Tumor of the follicular infundibulum with ductal differentiation[/url].
Supportive findings: peripheral palisading.
Adverse findings: lesion is not typically located on the face; cells have scant rather than abundant pale eosinophilic cytoplasm; strands are not parallel to the skin surface.

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Guest Jim Davie MD

Posted

BCC, FEP-type
The basaloid neoplasm focally involves a normal eccrine duct , has cytologic atypia, peripheral palisading, mucinous stroma and infundibulocystic squamous metaplasia.

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Eman El-Nabarawy

Posted

Favor Fibroepithelioma of Pinkus with eccrine duct spreading.

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Dr. Richard Carr

Posted

I reported this as a fibroepithelioma-(Pinkus-)like BCC. The lesion lacks the stromal condensations of papillary mesenchymal cells and longer fenestrations of a bona fide Pinkus tumour. Immunos were helpful as the lesion lacked reactive Merkel cells and CD10 stromal cells that are always seen in Pinkus tumour (a fenestrated trichoblastoma). I would therefore agree with the designation of infundibulocystic BCC, Pinkus-like.

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