Diagnostic utility of immunohistochemistry in distinguishing trichoepithelioma and basal cell carcinoma: evaluation using tissue microarray samples

Mod Pathol. 2012 Oct;25(10):1345-53. doi: 10.1038/modpathol.2012.96. Epub 2012 Jun 8.

Abstract

Trichoepithelioma is a benign neoplasm that shares both clinical and histological features with basal cell carcinoma. It is important to distinguish these neoplasms because they require different clinical behavior and therapeutic planning. Many studies have addressed the use of immunohistochemistry to improve the differential diagnosis of these tumors. These studies present conflicting results when addressing the same markers, probably owing to the small number of basaloid tumors that comprised their studies, which generally did not exceed 50 cases. We built a tissue microarray with 162 trichoepithelioma and 328 basal cell carcinoma biopsies and tested a panel of immune markers composed of CD34, CD10, epithelial membrane antigen, Bcl-2, cytokeratins 15 and 20 and D2-40. The results were analyzed using multiple linear and logistic regression models. This analysis revealed a model that could differentiate trichoepithelioma from basal cell carcinoma in 36% of the cases. The panel of immunohistochemical markers required to differentiate between these tumors was composed of CD10, cytokeratin 15, cytokeratin 20 and D2-40. The results obtained in this work were generated from a large number of biopsies and resulted in the confirmation of overlapping epithelial and stromal immunohistochemical profiles from these basaloid tumors. The results also corroborate the point of view that trichoepithelioma and basal cell carcinoma tumors represent two different points in the differentiation of a single cell type. Despite the use of panels of immune markers, histopathological criteria associated with clinical data certainly remain the best guideline for the differential diagnosis of trichoepithelioma and basal cell carcinoma.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antibodies, Monoclonal, Murine-Derived / metabolism
  • Biomarkers, Tumor / metabolism
  • Biopsy
  • Carcinoma, Basal Cell / diagnosis*
  • Carcinoma, Basal Cell / metabolism
  • Child
  • Diagnosis, Differential
  • Female
  • Hair Diseases / diagnosis*
  • Hair Diseases / metabolism
  • Hair Follicle / metabolism
  • Hair Follicle / pathology*
  • Humans
  • Immunohistochemistry / methods*
  • Keratin-15 / metabolism
  • Keratin-20 / metabolism
  • Male
  • Middle Aged
  • Neprilysin / metabolism
  • Skin Neoplasms / diagnosis*
  • Skin Neoplasms / metabolism
  • Stromal Cells / metabolism
  • Stromal Cells / pathology
  • Tissue Array Analysis
  • Young Adult

Substances

  • Antibodies, Monoclonal, Murine-Derived
  • Biomarkers, Tumor
  • Keratin-15
  • Keratin-20
  • monoclonal antibody D2-40
  • Neprilysin

Supplementary concepts

  • Trichoepitheliomas, Multiple Desmoplastic