05/10/2016                1:30 PM                Suffix - Tissue Types                                       HI026782B/16
          1 - Skin Biopsy                                                               2 - Skin Biopsy
  
  Report sequence 1                           Authorised                                                                             04/11/2016 16:21
                                                                                    By     Dr T Bracey                                                             CELLPATH (Tim's laptop)
NATURE OF SPECIMEN:
1.   Excision lesion left wrist.
2.   Excision lesion mid back.
CLINICAL DETAILS:
1.   ?SCC
2.   ?BCC
GROSS DESCRIPTION:
1.   An ellipse of skin measuring 34 x 20 x 6 mm, bearing an ill-defined, crested, brown lesion which measures 7 x 6 x 2 mm.
S2 1B SK KW
2.   An ellipse of skin measuring 27 x 16 x 7 mm, bearing an ill-defined, crusted debris pigmented lesion which measures 7 x 7 x 2 mm.
S2 1B SK KW
HISTOLOGY:
1.   Excision of sun damaged skin showing an ulcerated carcinoma arising from the epidermis measuring 7 mm diameter and 3 mm in maximum thickness.   The lesion has a biphasic appearance, partly resembling basal cell carcinoma with prominent follicular differentiation and horn cysts.   The other part of the lesion has a more squamoid appearance with a greater degree of nuclear pleomorphism, prominent nucleoli and extremely prominent brown cytoplasmic pigment.   Immunohistochemistry shows diffuse positivity for BerEP4 and patchy positivity for EMA and CK 5.   S-100 is negative, and MelanA shows very prominent benign melanocytic colonisation, with dendritic processes surrounding the tumour cells.
Melanocytes colonisation is well described in skin tumours showing pilar/pilomatrix differentiation. Pilar/pilomatrix carcinoma is rare and while it is reported to have a higher rate of local recurrence, metastases are infrequent.   This lesion has a cohesive growth pattern at the base, being at least 4 mm from the deep margin and 4.5 mm from the nearest peripheral margin.   There is no vascular or nerve invasion.
Conclusion
1.      Excision left wrist - carcinoma with hair follicle differentiation and melanocytic colonisation (see text)


2016-11-02_0001.jpg

Author: Dr Tim Bracey

2016-11-02_0001.jpg

Author: Dr Tim Bracey

2016-11-02_0001.jpg

Author: Dr Tim Bracey

2016-11-02_0001.jpg

Author: Dr Tim Bracey

2016-11-02_0001.jpg

Author: Dr Tim Bracey

2016-11-02_0001.jpg

Author: Dr Tim Bracey

2016-11-02_0001.jpg

Author: Dr Tim Bracey

MelanA


BEREP4


EMA




MELANA

S100

Histopathology 2006-48-213.pdf

Author: Dr Tim Bracey
Histopathology 2006-48-213.pdf