11/10/2015

9(109): Basal cell Carcinoma, Review of Slides nodular type

Jason Stratton MD Fundamentals of Mohs Pathology Histology: November second, 2015 • Large dermal basaloid nodules • Cleft formation • Central necrosis • Myxoid degeneration • Focal dropout Duplicate 7(107): Basal Cell Carcinoma, superficial and nodular typeor

Histology: • Large dermal basaloid nodules • No cleft left formation • Central necrosis • Focal myxoid degeneration • Focal dropout • Superficial component Distribute Not Do

1 11/10/2015

4(104): BCC Nodular and Infiltrative

Histology: Clinically: • Large dermal basaloid nodules • Upper back and face most • Cleft formation common • No central necrosis • Poorly defined plaque • Prominent myxoid degeneration • Infiltrative nests without dense Perineural invasion is more fibrosis common Duplicate 6(106): BCC Nodular and Follicular or

Histology: • Variable sized dermal nodules • Focal cleft formation • Contain an arborizing pattern without the dispersion or fibrosis of micronodular

2(101): BCC NodulocysticDistribute Not

Histology: • Large sized dermal nodules with central myxoid degeneration or necrosis. As a term Nodulocystic includes both Do nodular and Cystic varieties

2 11/10/2015

5(105): BCC Nodulocystic

Histology: • Variably sized dermal nodules • Myxoid degeneration with mucin accumulation • Alcian Blue positive at pH 2.5 Duplicate 3(102): BCC, Fibroepitheliomatous type or

Histology: • Arborizing networks and cords of basaloid • Variably basaloid with cleft formation

Distribute 1(100): BCC, Matrical type

Not Histology: • Typical basal cell growth patten • Ghost cells similar to pilomatricoma without • Circumscribed growth pattern • Granulomatous response Do • “Burnt out areas”

3 11/10/2015

Duplicate 25(132): BCC Pleomorphic or

Histology: • Increased mitotic rate and pleomorphism • More eosinophilic • Increased apoptotic cells • Similar behavior

22(123): BCC&EICDistribute Not

• Common lesions are sometimes common together • Such lesions are problematic in Mohs because often only one of the lesion is represented in the Do original biopsy

4 11/10/2015

23(125): BCC&Merkel Cell Carcinoma

• BCC and MCC collision tumors are well documented in the literature • MCC – Disease of the elderly and immunosupresed – Associated with the Merkel cell Polyoma virus in 70 or more percent of cases – Problematic in Mohs as it may not be represnted in the biopsy and local exision is not curative many cases Duplicate or

Histology: Histology: • On higher power • Once called trabecular • Little cytoplasm carcinoma of the skin due to its • Numerous mitoses and architecture apoptotic cells

Distribute 21(122):BCC&SCC Not Histology: • Variable sized basaloid nodules • Cleft formation • Myxoid degeneration Histology: • Superficial nests • Neuroendocrine stippled chromatin pattern Do •

5 11/10/2015

Histology: • Actinic keratosis with infiltrative strands of eosisnophilic cells invading the dermis with keratin production • No direct collision is present • Could be on a different plane of section. Duplicate 10(110): SCC, Non Keratinizing or

Histology: • Basaloid cells • Lacks the peripheral palisade • Prominent atypia Nonkeratinizing Vulvar SCC • Areas of more prominent associated with HPV eosinophilic cytoplasm

Distribute14(114): SCC, of Basaloid Type Not • Used to be called Cloacogenic • 2‐3% of all GI cancers • More common in females • 6th decade • Presents with bleeding, pain and change in habits Do • Occur above the dentate line

6 11/10/2015

Histology: Histology: • Basaloid cells • Basaloid cells • Often has a prominent • Often has a prominent peripheral palisade with peripheral palisade with central necrosis central necrosis Duplicate 8(108): Basaloid Follicular Hamartoma or

Histology: Clinical: • Disturbed follicular bulbs Small skin colored papule • Symmetrical low power Familial or aquired growth Bazex‐Dupre Christol Syndrome • Less clefting with Merkel cells X‐linked, Mult BCCs, Hypertrichosis, • No fibrosis follicular atrophoderma • Less Ki‐67, peripheral BCL2 Assoc: MG, allopecia, SLE, CF

11(111): TrichoblastomaDistribute

Histology: Not • Well circumscribed • Non‐encapsulated • Recapitulates hair bulb • Subepidermal nest of basaloid cells Clinical: • Palasade with little retraction Slow growing tumor of the head and neck • Fibromyxoid stroma Broad age of presentation Do • No pleomorphism

7 11/10/2015

Pigmented trichoblastoma

Duplicate 20(121): Clear Cell Hidradenoma or

Histology: • Circumscribed nonencapsulated nodule in upper dermis • Biphasic cell population Clinical: • Round poliginal cells with Slow growing tumor of the head and neck eosinophilic cytoplasm Broad age of presentation • Cells with cleared cytoplasm Eccrine/apocrine differentiation and ecentric CRTC1/MAML2 Translocation in 50% of cases • Ducts and occasional mits

Distribute 17(118): Cylindroma Not

Clinical: Slow growing tumor of the head and neck Brooke‐Spiegler syndrome(with ES, TE, millia) Do Mutations in CYLD

8 11/10/2015

Histology: • No conection to the epidermis • Dermal nodules surrounded by eosinophilic BM material • PAS positive • Droplets of material in nodules • 2 cell populations • Smaller basophilic and larger pale Duplicate 13(113): Desmoplastic Trichilemmoma or

Histology: Small uniform cells with cytoplasmic Clinical: clearing, vacuolization, and nuclear Warty nodule, head and neck of palisading older adults PAS positive Multiple in Cowden’s disease(breast, Desmoplastic variant: similar histology thyroid Ca, and hamartomas) with sclerotic center, cords of PTEN mutations eosinophilic material Desmoplastic variant sporadic

Distribute24(131): Microcystic Adnexal Carcinoma Not Clinical: Wide age range Slow growing yellow‐red plaque Often misdiagnosed initially Locally aggressive 30‐40% recurrence, better with Do Mohs

9 11/10/2015

Histology: Poorly circumscribed deeply infiltrating tumor with duct formation Keratocyst formation superficially Perineural invasion EMA, CEA Duplicate 18(119): Cutanious Mixed Tumor or

Histology: Nodule in deep dermis Chondroid areas with Epithelial componint with eosinophilic cells, duct forming Myoepithelial, spindled or Clinical: cleared cellsthat forms Slow growing nodule, head and chondroid matrix neck Distribute Not

Immunohistochemistry: Epitheliod: keratin, EMA, CEA Do Myoepithelial‐ S100, SMA

10 11/10/2015

16(117): Cutaneous Mucinous Carcinoma

Histology: Clinical: Dermal tumor of compartmentalized lakes of Slow growing nodule on head and mucin with islands of tumor neck (rarely elsewhere) cells. Wide age range, more common in Cuboidal pink cells with cuboidal elderly nuclei, Keratin, ER/PR Indolent Duplicate or

15(115): Glomus tumorDistribute Not Clinical: Histology: Arises from glomus body Normal endothelial lined vessels with a mantle of cuboidal Hands, but can occur anywhere Circumscribed 3‐4th decade Malignant Painful blue nodule increased or atypical mitoses Familial cases associated with GLMN Do mutations, or NF1 deep and more than 2cms

11 11/10/2015

12(112): Endocrine mucin producing sweat gland carcinoma

Clinical: Eyelid of 70 year old female May be on a spectrum with cutaneous mucinous carcinoma Duplicate or

Histology: Multinodular tumor Papilary archatecture Abundant cytoplasm Stipled chromatin Atypia, and mitoses 50% have areas of mucinous carcinoma Neuroendocrine markers

19(120): Follicular InductionDistribute Not Do

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Duplicate or

Distribute Not Do

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