Dermatologie

050721

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Présentation clinique

 

Clinical Setting

 

F 60 ans, Lésion nodulaire du visage, évoluant depuis quelques semaines.

 

60 yo Female, Nodular lesion of the face, of few weeks duration.

Résection chirurgicale

 

Surgical Excision

 

 

PAS

 

     

EMA

 

Ber EP4

 

 

 

 
 

Ber EP4

 

 

Ber EP4

 
 

 

 

 
 

 

 

Diagnostic proposé:

 

CARCINOME BASOCELLULAIRE, DE TYPE METATYPIQUE ? INFILTRANT ?

 

Proposed Diagnosis:

 

BASAL CELL CARCINOMA, METATYPICAL ? INFILTRATING TYPE ?

 

Arguments:

The vast majority of cases show some attachment to the undersurface of the epidermis. Ulceration is not infrequent in larger lesions.

Islands of tumor cells are surrounded by a stroma, which is newly formed and different from the adjacent dermis. This stroma contains variable amounts of acid mucopolysaccharicles.

The tumor cells in basal cell carcinoma resemble epidermal basal cells, they do stain diffusely for Ber EP4, unlike squamous cell carcinomas, which are always negative;

Although the term 'metatypical' is sometimes applied to tumors with ixed basaloid and squamous features, it should be reserved for the rare basal cell carcinoma composed of nests and strands of cells maturing into larger and paler cells. Peripheral palisading is often lost. Peripheral palisading is less obvious than usual, and the stroma is often prominent. This variant is regarded by some as having metastatic potential.

Infiltrating type

This non-sclerosing variant has an infiltrative rather than an expansile pattern of growth. It accounts for approximately 5% of all tumors, although this figure is higher in some patient groups. The histological features are distinctive, with elongated strands of basaloid cells, cells thick, infiltrating between collagen bundles. Sometimes, even narrower strands are present, with spiking projections. There may be a slight increase in fibroblasts, but there is no significant fibrosis. Often there is a solid pattern superficially with the infiltrating nests at the periphery or base of the lesion. Sometimes a focal infiltrative pattern is seen in the re-excision specimen of a biopsy proven solid (nodular) basal cell carcinoma. These changes are limited to the region of the biopsy scar and appear to represent a scar induced phenomenon without any sinister connotations.

 

Réference: see more in,

BASAL CELL CARCINOMA

(Skin Pathology, D. Weedon, 2nd Ed. Churchill-Livingstone)

BerP4 features on the erythematous borders of the nodular lesion

 

Les recoupes profondes objectivent sur l'une des sections, une composante superficielle multifocale.

 

Deeper sections discloses in one fragment, a superficial multifocal component. Ber EP4