A Clinicopathological Study of the Multiple Trichoepitheliomas / 대한피부과학회지

ABSTRACT

BACKGROUND: The diagnostic dilemma in differentiation between multiple and solitary trichoepitheliomas from basal cell carcinoma(BCC) is well documented. Some authors reported that up to 35% of trichoepitheliomas were misdiagnosed initially as BCC, especially the keratinizing variant. OBJECTIVE: The purpose of this study was to review the clinicopathological characteristics of the multiple trichoepitheliomas and to suggest specific findings and useful special staining methods for differentiating from BCC. METHODS: We reviewed 14 cases of multiple trichoepitheliomas from a clinicopathological aspect. We performed H&E, periodic acid Schiff, Giemsa, Fite, and alcian blue staining using the formalin-fixed paraffin-embedded samples of multiple trichoepitheliomas. RESULTS: The average age at onset was 24.7 and 78.6% of the cases showed autosomal dominant inheritance patterns. The sites of frequent involvement were the nasolabial folds and nose, and the average size of the lesions was 4.3 x 4.3 mm. The most important histopathological finding in differentiation was papillary mesenchymal tissue, and this was well observed with the Giemsa stain. Several other findings were also useful in differentiation, such as stellate structures in cystic walls, parakeratosis and eosinophilic necrotic bodies in the cystic walls, primitive hair follicles, epidermal connections, and mast cell infiltration. CONCLUSION: Several staining methods, such as the Giemsa, periodic acid Schiff, Fite, and alcian blue stains, were useful in differentiating the trichoepitheliomas from BCCs.