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Simple Approach to Histological Diagnosis of Common Skin Adnexal Tumors

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Simple Approach to Histological Diagnosis of Common Skin Adnexal Tumors Journal name: Pathology and Laboratory Medicine International Article Designation: REVIEW Year: 2017 Volume: 9 Pathology and Laboratory Medicine International Dovepress Running head verso: Alhumidi Running head recto: Histological diagnosis of common skin adnexal tumors open access to scientific and medical research DOI: http://dx.doi.org/10.2147/PLMI.S139767 Open Access Full Text Article REVIEW Simple approach to histological diagnosis of common skin adnexal tumors Ahmed A Alhumidi Abstract: Most adnexal neoplasms are uncommonly encountered in routine practice, and pathologists can recognize a limited number of frequently encountered tumors. In this review, Department of Pathology, College of Medicine, King Saud University, I provide a simplified histological approach to be used by general pathologists and residents Riyadh, Saudi Arabia of pathology and dermatology programs. These tumors are classified into 1) tumors connected to epidermis, 2) tumors not connected to epidermis, 3) sebaceous tumors, and 4) dermal cysts. Keywords: skin, adnexal tumors, histology, approach Introduction Tumors of the skin appendages have been classified into four groups that exhibit histologic For personal use only. features analogous to hair follicles, sebaceous glands, apocrine glands, and eccrine glands (Figure 1). Most adnexal neoplasms are relatively uncommonly encountered in routine practice, and pathologists can recognize a limited number of frequently encountered tumors. In this article, I reviewed the histological features of the common skin adnexal tumors with an emphasis on simple diagnostic histological approach. This approach depends generally on the location of the tumor, cell cytoplasm and color of the tumor in a low power. Some tumors are located superficially and predominantly connect to epidermis and others lie deep in the dermis. Peripheral palisading, keratinous cyst, papillary mesen- chymal bodies (primitive hair papilla formation), trichohyaline granules, and ghost cells are features associated with hair follicle differentiation. Vacuolated cytoplasm indicates sebaceous differentiation. Tubular and glandular structures are seen in sweat gland tumors. Apical snouts or decapitation secretion indicates apocrine origin. Clear cells can be seen Pathology and Laboratory Medicine International downloaded from https://www.dovepress.com/ by 54.70.40.11 on 27-Nov-2018 in hair follicle tumors (e.g., trichilemmoma [TL]) and sweat gland tumors (e.g., clear cell hidradenoma) and should not be misinterpreted as vacuolated cells of sebaceous tumors. Review Tumors predominantly with epidermal connection Poroma, trichilimmoma, Syringocystadenoma papilliferum with their malignant coun- terparts are tumors that predominantly attach to epidermis. Tumors with dilated pore are included in this section because of their epidermal connection Epidermal connection + basaloid (blue) tumor + cuticle formation = poroma and Correspondence: Ahmed A Alhumidi Department of Pathology, College of porocarcinoma Medicine, King Saud University, PO Box 2925, Riyadh 11461, Saudi Arabia Poroma is a benign adnexal neoplasm with terminal ductal differentiation. Although Email [email protected] historically considered a neoplasm of eccrine differentiation, poromas can show either submit your manuscript | www.dovepress.com Pathology and Laboratory Medicine International 2017:9 37–47 37 Dovepress © 2017 Alhumidi. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work http://dx.doi.org/10.2147/PLMI.S139767 you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Powered by TCPDF (www.tcpdf.org) 1 / 1 Alhumidi Dovepress Adnexal tumors With no With epidermal Sebaceous epidermal Cysts connection tumors connection Figure 1 General approach to adnexal tumors. Predominantly with epidermal connection + Basaloid (blue) + Clear or eosinophilic + Dilated follicular tumor + cuticle cytoplasm + peripheral + Ducts, glands, and + Vaculated orifice formation nuclear palisading papillae cytoplasm Syringocystadenoma papilliferum Poroma Trichilemmoma porocarcinoma For personal use only. Trichofolliculoma Sebaceous tumor Pilar sheath acanthoma Dilated pore of Winer Figure 2 Tumors that predominantly connect to epidermis. Pathology and Laboratory Medicine International downloaded from https://www.dovepress.com/ by 54.70.40.11 on 27-Nov-2018 eccrine or apocrine lineage. Histologically, poroma arises growth pattern, with infiltrative borders. The neoplastic cells within the lower portion of the epidermis, from where it show varying degrees of nuclear atypia and necrosis.2 emanates downward into the dermis as tumor masses that often consist of broad, anastomosing bands of epithelial cells Epidermal connection + clear or eosinophilic cytoplasm + punctuated by focal ducts and occasional cysts. The stroma peripheral nuclear palisading = Trichilemmoma (TC) and surrounding poromas is often richly vascular (Figures 2 tumor of follicular infundibulum and 3A, B). Architecturally, this tumor shows a spectrum of change from predominately intraepidermal lesions (hidro- TL is a benign tumor that arises from the outer root sheath acanthoma simplex) to primarily dermal-based neoplasms of the hair follicle occurring frequently on the face of adults. (dermal duct tumor).1 Multiple facial TLs are specifically associated with Cowdens Porocarcinomas are usually found on the lower extremi- disease.3 Most cases of TL present as a sharply circumscribed ties. They are associated with an eccrine poroma and are superficial exo-endophytic proliferation with a papillated sur- histologically characterized by asymmetrical, solid, nodular face. The dominating histological pattern of TL is that of one 38 submit your manuscript | www.dovepress.com Pathology and Laboratory Medicine International 2017:9 Dovepress Powered by TCPDF (www.tcpdf.org) 1 / 1 Dovepress Histological diagnosis of common skin adnexal tumors or several lobules that are seen descending from the surface and stromal. Low-power microscopic examination shows epidermis into the dermis. A variable number of tumor cells keratin-filled cyst lined by squamous epithelium associated have the appearance of clear cells because of their content with secondary hair follicles (Figures 4A and B). Differential of glycogen (Figure 3C). At the periphery, pale columnar diagnosis of TF includes pilar sheath acanthoma. Histologically, cells are arranged in a palisade, bordered by PAS-positive it has a superficial broad invagination of cells, which often have basement membrane. Desmoplastic trichilemmoma is a eosinophilic or clear (glycogenated) cytoplasm, producing a variant of TL-characterized irregular extensions of cells of crater-like cavity (Figure 4C). Dilated pore of Winer shows the outer root sheath type that project into sclerotic collagen invagination of the surface epithelium, lined by relatively thin bundles and mimic invasive carcinoma. Unlike carcinomas, stratified squamous epithelium and lacking the hair follicles desmoplastic TLs stain with CD34.1,4 (Figure 4D). In trichodiscoma/fibrofolliculoma, the lesion is Tumor of the follicular infundibulum usually occurs as a characterized by dilated cyst, from which there is proliferation solitary, flat, keratotic papule on the face. Histologically, it of thin, trabeculated strands of basophilic epithelium within is composed of plate-like growth of anastamosing epithelial a prominent fibrous stroma. Multiple lesions are seen in cells connected to the overlying epidermis with peripheral Birt–Hogg–Dubé syndrome, which is an autosomal dominant nuclear palisading. The centrally located cells show clear condition and is associated with benign and malignant renal cytoplasm that contain glycogen material.1 neoplasms, lung cysts, and spontaneous pneumothorax.5 Epidermal connection + dilated orifice= trichofolliculoma, Epidermal connection + ducts, glands, and papillae = syrin- pilar sheath acanthoma, and dilated pore of Winer gocystadenoma papilliferum Trichofolliculoma (TF) occurs in adults as a solitary lesion, Syringocystadenoma papilliferum is a benign adnexal neo- usually on the face but occasionally on the scalp or neck. TF plasm that occurs predominantly in scalp and is associated with is a symmetrical, well-circumscribed, vertically oriented lesion nevus sebaceous in at least one-third of cases. Histologically, composed of three components: infundibulocystic, follicular, one or several cystic invaginations extend downward from For personal use only. ABC Figure 3 Predominantly epidermal tumors with basophilic, eosinophilic or clear cytoplasms. Notes: (A) Poroma: basaloid tumor that is primarily connected to epidermis (H&E stain original magnification ×20). (B) Poroma: on a high power, small cuticle (ductile) can be seen (H&E stain original magnification× 400). (C) TL: eosinophilic tumor connected to overlying epidermis with peripheral nuclear palisading (magnification ×200). Abbreviations: H&E, hematoxylin and eosin; TL, trichilemmoma. Pathology and Laboratory Medicine International downloaded from https://www.dovepress.com/
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