Author(s) : Noriyuki MISAGO, Toshimi SATOH, Yutaka NARISAWA , Division of Dermatology, Department of Internal Medicine, Department of Pathology, Faculty of Medicine, Saga University, Nabeshima 5‐1‐1, Saga 849‐8501, Japan .
Summary : The object of this study was to elucidate the clinicopathological and immunohistochemical features of BCC with tubular structures. From the examination of 600 BCC specimens, we selected 10 cases of BCC with tubular structures. Immunohistochemistry was performed in these ten cases using antibodies against cytokeratins. All 10 BCCs (3 men and 7 women) were located on the face and scalp, particularly on the eyelid. The tubular structures could be classified histopathologically into ductal structures and glandular structures, which was supported by the results of the immunohistochemical study. The ductal structures represented various types and forms, small to medium‐sized (the most common form), tiny, dilated, well‐differentiated or acrosyringeal types. The glandular structures in one case suggested the features of apocrine secretion. BCC with tubular structures affected women more than men, and the favored location was the eyelid. The tubular structures in these BCCs differentiated toward either ductal or glandular structures, presumably of apocrine nature.
Figure 1.Histopathological features of ductal
structures in BCCs.A, BSmall to medium-sized type
(case 2).C, DTiny type (case 2). Exceedingly minute
ductal structures are indicated by arrows(D).E, FDilated type (case 6). Note the ductal structures
with luminal (cuticular) cells (arrows) in contrast to pseudo
adenoid structures due to mucin deposition (asterisks)(F).G, HWell-differentiated type (case
7). Medium-sized type (arrow heads) and well-differentiated type
(arrows) within aggregation(G). A close-up view of
the well-differentiated type(H).IAcrosyringeal type (case 10). Note the presence of keratohyaline
granules.JCytoplasmic vacuoles grouped in an
alveolar pattern (case 5).KCytoplasmic vacuoles
forming a ductal structure (case 1). (H-E stain; A × 190,
B × 600, C × 150, D × 600,
E × 80, F 300, G × 80, H × 800,
I × 340, J × 200, K × 240).
Figure 2.Histopathological features of glandular
structures in BCCs.A-CThe glandular structure
without decapitation secretion (case 9). Many associated ductal
structures are seen within the aggregations of BCC(A). Two connected and dilated glandular structures(B). A glandular structure characterized by large
cuboidal or columnar luminal cells with ample, eosinophilic
cytoplasm and large round nuclei(C).D, EThe glandular structure with decapitation secretion (case 10).
Both the glandular (small arrow) and dilated ductal structures
(large arrow) are seen within the aggregations of BCC(D). Evidence of apocrine differentiation of the
glandular structure demonstrating decapitation secretion(E). (H-E stain; A × 100, B × 200,
C × 400, D × 100, E × 400).
Figure 3.Immunohistochemical features of tubular
structures in BCCs.ATubular structures highlighted
by positive staining for CEA (case 2).BPositive
staining for EMA in authentic tubular structures, documenting a
clear distinction from the negative staining pseudo adenoid
structures caused by mucin deposition (see Fig. 1E, F, case 6).CPositive staining for CEA in the cuticular borders of
the cytoplasmic vacuoles (case 5).DCK10 positive for outer cells and surrounding squamous
cells in the ductal structure (case 2).ECK14 positive for luminal and outer cells in the ductal
structure (case 1).FCK14 positive for luminal
and outer cells, and surrounding squamous cells in the ductal
structure (case 9).GCK7 positive for glandular
structures (case 9).HCK8/18 positive for
glandular structures and decapitation secretion (case 10).ICK7 clearly positive for a glandular structure (arrow)
and negative for a ductal structure (arrowhead) (case 9).
(Immnohistochemical stain; A × 200, B × 120,
C × 300, D × 400, E × 400, F 360,
G × 200, H × 300, I × 200).
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