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Year : 2016  |  Volume : 7  |  Issue : 2  |  Page : 121-123  

A firm plaque on the cheek

1 Ackerman Academy of Dermatopathology, Section of Dermatopathology, New York, USA
2 Department of Dermatology, Polley Clinic of Dermatology and Dermatologic Surgery, Wilson, North Carolina, USA

Date of Web Publication4-Mar-2016

Correspondence Address:
Dr. Dirk M Elston
Professor and Chairman, Department of Dermatology and Dermatologic Surgery Medical University of SC; MSC 578 135 Rutledge Avenue; 11th Floor, Charleston, SC 29425-5780
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2229-5178.178101

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How to cite this article:
Torres KT, Elston DM, Polley DC, Ferritto F. A firm plaque on the cheek. Indian Dermatol Online J 2016;7:121-3

How to cite this URL:
Torres KT, Elston DM, Polley DC, Ferritto F. A firm plaque on the cheek. Indian Dermatol Online J [serial online] 2016 [cited 2020 Apr 6];7:121-3. Available from: http://www.idoj.in/text.asp?2016/7/2/121/178101

   Dermpath Quiz Top

A 22-year-old African-American male patient presented to his dermatologist with an asymptomatic, solitary, firm, plaque on his left cheek of unknown duration [Figure 1]. The lesion had a central depression and raised borders. The patient denied any use of topical medications on the lesion, and the past history was unremarkable. The patient was immunocompetent and denied trauma to the site. No other skin lesions were present elsewhere. An excision biopsy was performed. The dermatopathological sections revealed collections of basaloid cells arranged as small nests and narrow cords, horn cysts, focal areas of calcification, and a desmoplastic stroma. Clefts were present within the stroma, but not between tumor nests and stroma [Figure 2],[Figure 3],[Figure 4]. Of concern were the noted tumor cells seen peripheral to an arrector pili-muscle [Figure 5].
Figure 1: Solitary, firm, white to erythematous, annular plaque on the left cheek

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Figure 2: At scanning view, the biopsy shows prominence of horn cysts (H and E, X20)

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Figure 3: At low-power view, the biopsy again shows prominence of horn cysts (H and E, X40)

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Figure 4: A high-power view shows basaloid cells arranged as small nests and as narrow cords, desmoplastic stroma, and focal calcification (H and E, X100)

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Figure 5: Another high-power view shows tumor cells at the periphery of an arrector pili muscle (H and E, X200)

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The neoplasm most likely represents:

  1. Morpheaform basal cell carcinoma
  2. Microcystic adnexal carcinoma
  3. Desmoplastic trichoepithelioma
  4. Syringoma
  5. Folliculosebaceous cystic hamartoma.

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   References Top

Ackerman AB, de Viragh PA, Chongchitnant N. Neoplasma with Follicular Differentiation. Philadelphia: Lea and Febinger; 1993. p. 573-602.  Back to cited text no. 1
Costache M, Bresch M, Böer A. Desmoplastic trichoepithelioma versus morpheic basal cell carcinoma: A critical reappraisal of histomorphological and immunohistochemical criteria for differentiation. Histopathology 2008;52:865-76.  Back to cited text no. 2
Brownstein MH, Shapiro L. Desmoplastic trichoepithelioma. Cancer 1977;40:2979-86.  Back to cited text no. 3
McFaddin C, Sirohi D, Castro-Echeverry E, Fernandez MP. Desmoplastic trichoepithelioma with pseudocarcinomatous hyperplasia: A report of three cases. J Cutan Pathol 2015;42:102-7.  Back to cited text no. 4
Takei Y, Fukushiro S, Ackerman AB. Criteria for histologic differentiation of desmoplastic trichoepithelioma (sclerosing epithelial hamartoma) from morphea-like basal-cell carcinoma. Am J Dermatopathol 1985;7:207-21.  Back to cited text no. 5
Wada M, Hanada K, Kanehisa F, Asai J, Takenaka H, Katoh N. A case of desmoplastic trichoepithelioma with ossification. Indian J Dermatol 2013;58:164.  Back to cited text no. 6
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Jedrych J, Leffell D, McNiff JM. Desmoplastic trichoepithelioma with perineural involvement: A series of seven cases. J Cutan Pathol 2012;39:317-23.  Back to cited text no. 7
McCalmont TH, Humberson C. Neurotropism in association with desmoplastic trichoepithelioma. J Cutan Pathol 2012;39:312-4.  Back to cited text no. 8
Elson DM, Ferringer T. Requisites in Dermatopathology. 2nd ed. China: Elsevier Saunders; 2014. p. 67.  Back to cited text no. 9
Goldstein DJ, Barr RJ, Santa Cruz DJ. Microcystic adnexal carcinoma: A distinct clinicopathological entity. Cancer 1982;50:566-72.  Back to cited text no. 10
Hoang MP, Dresser KA, Kapur P, High WA, Mahalingam M. Microcystic adnexal carcinoma: An immunohistochemical reappraisal. Mod Pathol 2008;21:178-85.  Back to cited text no. 11
Kato H, Mizuno N, Nakagawa K, Furukawa M, Hamada T. Microcystic adnexal carcinoma: A light microscopic, immunohistochemical and ultrastructural study. J Cutan Pathol 1990;17:87-95.  Back to cited text no. 12
Moynihan GD, Skrokov RA, Huh J, Pardes JB, Septon R. Desmoplastic trichoepithelioma. J Am Acad Dermatol 2011;64:438-9.  Back to cited text no. 13


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]


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