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Non-Melanoma Skin Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Irene De Francesco, Sean Whittaker, Stephen L. Morris
EMPD is a rare intra-epithelial adenocarcinoma, characterized by the presence of malignant Paget cells lying within the epidermis of the skin. The etiology is unknown. It is usually a primary tumor but may be associated with an underlying adjacent or distant invasive carcinoma. Approximately 25% of cases have an underlying cutaneous adnexal carcinoma, and 10–15% have an subjacent or distant internal carcinoma.279 In the later stages, the epidermal pagetoid cells are thought to represent metastases, and the prognosis is associated with the underlying malignancy, with a mortality rate of 50% or higher.
Breast
Published in Joseph Kovi, Hung Dinh Duong, Frozen Section In Surgical Pathology: An Atlas, 2019
Joseph Kovi, M.D. Hung Dinh Duong
To distinguish Paget’s disease from harmless acute dermatitis in a representative frozen section is no serious problem. Paget’s disease must also be differentiated from Bowen’s disease and the so-called “pagetoid type” of malignant melanoma in situ. Both of these conditions rarely affect the nipple. Paget cells are large, rounded cells devoid of intercellular bridges, and possess a prominent nucleus and pale-staining cytoplasm.62 In Bowen’s disease there is an obvious transition between the large, atypical, vacuolated cells and the keratinocytes of the epidermis. In contrast to Paget cells, the atypical cells in Bowen’s disease possess intercellular bridges.90 Paget cells may contain some melanin. To differentiate Paget’s disease from the “pagetoid type’’ of malignant melanoma in situ, the following is of importance: intraepidermal clusters of Paget cells are separated from the dermis by a clear but compressed layer of basal cells. Melanoma cells are in direct contact with the epidermis.62
Onychopathology of common nail diseases
Published in Archana Singal, Shekhar Neema, Piyush Kumar, Nail Disorders, 2019
There is a slight to moderate increase in the number of matrix melanocytes (10–31 per mm).45 They are non-atypical, arranged in single units and located mainly in the basal layer, and also in the immediate suprabasal layer.46 There is usually no pagetoid extension. If present, it is mild, focal, and always caused by non-atypical cells.42 The epidermal rete ridges are less prominent than in skin lentigo. Mild cytologic atypia can be seen. Pigmentation is usually limited to the lower third of the nail epithelium but can be seen throughout the thickness. Melanophages may be seen in the superficial dermis.45–47
Misdiagnosis of sebaceous carcinoma
Published in Acta Chirurgica Belgica, 2022
Gino Vissers, Jérôme Corthouts, Carole Van Haverbeke, Sabine Declercq, Marianne Mertens
When a sebaceous carcinoma cannot be ruled out based upon clinical grounds, a biopsy should be taken. However, misdiagnosis also occurs at histopathological level. Initial incorrect histopathological diagnosis has been reported in 40–75% of the cases, in which the tumour was often misdiagnosed as squamous cell carcinoma, basal cell carcinoma or other more common malignancies [5]. Special care must be taken with frozen section examination as the differentiation between vacuolisation of the cytoplasm and freezing artefacts can be challenging. Furthermore, pagetoid spread of malignant cells can be easily missed on frozen section examination, which may result in false negative outcomes as described in this case report. On definitive pathological examination, immunohistochemical stains can be used for differentiating sebaceous carcinoma from basal cell and squamous cell carcinomas. The most useful immunostains in this differential diagnosis are androgen receptor (AR), adipophilin, epithelial membrane antigen (EMA) and Ber-Ep4. The expression of AR and adipophilin supports the diagnosis of a sebaceous carcinoma, rather than a basal cell carcinoma or squamous cell carcinoma [7]. Sebaceous carcinomas are mostly composed of basaloid cells with only a small proportion of mature sebocytes. There is histologic overlap between the basaloid cells of sebaceous carcinoma and those of basal cell carcinoma. Epithelial membrane antigen highlights most mature sebocytes in sebaceous carcinoma, whereas its expression is uncommon in basal cell carcinoma. These diagnostic techniques allow us to diagnose sebaceous carcinoma in an early stage and thereby improving prognosis. With adequate diagnosis, five-year and 10-year survival is estimated to be 92% and 79%, respectively [8].
Vulvar acrochordons arranged in a linear pattern
Published in Journal of Obstetrics and Gynaecology, 2018
Sanjay Singh, Alok Kumar Sahoo, Neetu Bhari, Savita Yadav
Characteristic histological feature is normal or hyperplastic epidermis surrounding a core of fibrovascular tissue with loose or dense collagen fibres. Fat cells could be present, if abundant, the lesion was overlap with naevus lipomatous superficialis. Focal pagetoid dyskeratosis may be an incidental finding in keratinocytes. Long-standing skin tags may become vascularised, fibrous or ischaemic.
Noninvasive imaging for the diagnosis of melanocytic conjunctival tumor
Published in Expert Review of Ophthalmology, 2020
Elisa Cinotti, Marco Campoli, Damien Grivet, Jean Luc Perrot, Pietro Rubegni
In 11 cases of MM, our group found large (>20 µm) hyperreflective cells, roundish or dendritic, in the epithelium and/or the stroma, corresponding to malignant melanocytes (Figure 3(d,e)) [34,35]. These cells were uneven in size and sometimes enlarged nuclei were visible as central hyporeflective areas [34]. Large pagetoid cells were also sometimes visible [34,35].