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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 5  |  Issue : 1  |  Page : 114-116

Adenoid basal cell carcinoma: A rare variant and a diagnostic dilemma


1 Department of Pathology, BMCHRC, Jaipur, Rajasthan, India
2 Department of Oncosurgery, BMCHRC, Jaipur, Rajasthan, India

Date of Submission26-Mar-2020
Date of Decision26-Apr-2020
Date of Acceptance06-Jun-2020
Date of Web Publication19-Feb-2021

Correspondence Address:
Neha Sethi
Department of Pathology, BMCHRC, Jaipur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CDR.CDR_46_19

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  Abstract 


Basal cell carcinoma (BCC) constitutes the most common malignancy of the skin, accounting around 70% of all skin malignancies, especially in sun-exposed areas. The adenoid variant is a very uncommon subtype which accounts for approximately 1.3% of all BCCs. A 65-year-old male presented with ulcer and swelling on the left side of the nose and cheek with rolled borders for the past 2 years. Based on the histopathology and immunohistochemistry, the diagnosis of the adenoid type of BCC was made. One should be aware of its close mimics such as primary cutaneous adenoid cystic carcinoma before diagnosing adenoid BCC as they differ in prognosis and treatment modalities.

Keywords: Adenoid, basal cell carcinoma, BerEP4


How to cite this article:
Sethi N, Sharma A, Singh C, Pandia K, Gupta A. Adenoid basal cell carcinoma: A rare variant and a diagnostic dilemma. Clin Dermatol Rev 2021;5:114-6

How to cite this URL:
Sethi N, Sharma A, Singh C, Pandia K, Gupta A. Adenoid basal cell carcinoma: A rare variant and a diagnostic dilemma. Clin Dermatol Rev [serial online] 2021 [cited 2021 Apr 18];5:114-6. Available from: https://www.cdriadvlkn.org/text.asp?2021/5/1/114/309763




  Introduction Top


Basal cell carcinoma (BCC) constitutes the most common malignancy of the skin, accounting around 70% of all cases, especially in sun-exposed areas.[1] The most common presentation is the ulceronodular type.[2] The adenoid variant is a very uncommon subtype which resembles primary cutaneous adenoid cystic carcinoma (PCACC) and accounts for approximately 1.3% of all BCCs.[2]

Here, we present a rare interesting case of adenoid BCC in a 65-year-old male.


  Case Report Top


A 65-year-old male presented with ulcer and swelling on the left side of the nose and cheek with rolled borders for the past 2 years [Figure 1]. He also complained of pain in the nose for the past 2 months.
Figure 1: Clinical picture of lesion showing rolled borders of the tumor

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Fine-needle aspiration cytology showed malignant neoplasm suggestive of sebaceous carcinoma.

Histopathologically, basaloid cells were arranged in reticulated and gland-like growth pattern with cyst-like spaces in subepithelial tissue just below the epidermis; cells had peripheral palisading with stromal retraction [Figure 2] and [Figure 3]. Cysts-like spaces show amorphous or colloid-like material. The connection between the dermal tumor mass and the overlying epidermis was evident focally. These basaloid cells are uniform in size and polygonal in shape, with a round to ovoid hyperchromatic nuclei and inconspicuous nucleoli. The cytoplasm is scanty and amphophilic. Mitotic figures were 5–6 per 10 high-power fields. Necrosis was absent.
Figure 2: Reticulated and gland-like growth pattern of the tumor with cyst-like spaces (H and E, ×100)

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Figure 3: Basaloid cells with irregular chromatin and inconspicuous nucleoli (H and E, ×400)

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Focal areas of squamous differentiation were seen along with perineural invasion [Figure 4].
Figure 4: Perineural invasion (H and E, ×400)

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Immunohistochemically, tumor cells were positive for BerEP4 [Figure 5]. However, CEA, CD117, SMA, CK7, CK19, and EMA were negative in tumor cells.
Figure 5: BerEP 4 immunohistochemistry stain showing cell membranous as well as cytoplasmic positivity in tumor cells (×400)

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Based on the histopathology and immunohistochemistry (IHC), a diagnosis of the adenoid type of BCC was made.


  Discussion Top


BCC has many morphological variants which include nodulocystic, morpheaform, infiltrative, keratotic, pigmented, basosquamous, clear cell, granular, fibroepitheilioma, infundibulocystic, and adenoid type.[1],[2] The rare variants account for <10% of all BCCs.[1]

Kossard et al. reported the incidence of adenoid BCC as 6.67% of all BCC.[3]

Most commonly, BCC is found in sun-exposed sites. However, adenoid BCCs are reported at various sites such as the axilla, back, leg, inner canthus of the eye, chin, and forehead. Rare sites include the cervix and prostate.[4],[5],[6]

BCC is known for recurrences. Adenoid BCC is considered a low-grade malignancy compared to other common subtypes.

PCACC is the closest differential of adenoid BCC.[7] It is a slow-growing tumor commonly located on the scalp and chest.

Histopathologically, the absence of nuclear palisading, lack of connection to the epidermis, and lack of retraction spaces help differentiate it from BCC. These tumors are EMA and CEA positive which are negative in adenoid BCC.[8]

Another close differential is primary cutaneous apocrine carcinoma.[1] It is clearly distinguished from adenoid BCC by a lack of nuclear palisading and a lack of connection to overlying epidermis.

Another close differential is desmoplastic trichoepithelioma, but it is distinguished by morpheaform BCC by well circumscription, benign cells with no nuclear atypia, mitotically inactive tumor, and no tumor necrosis. On IHC, they express CK20 and are immunonegative for the androgen receptor and CD10 in contrast to BCC. Bcl2 shows peripheral staining in TE as compared to diffuse staining in BCC.

BCC should also be distinguished from microcystic adnexal carcinoma. In microcystic adnexal carcinoma, basaloid cells show glandular formations with eosinophilic secretions and show rare peripheral clefting. Cells are bland and horn cysts are common. Mitosis is rare. On IHC, they show CK15 positivity and a subset show BER-EP4 positivity. EMA is positive in ductal structures.

Case reports of the adenoid cystic, histological variant of BCC have been published showing less aggressiveness of these tumors.[9],[10]


  Conclusion Top


Adenoid variant of BCC is a rare tumor. One should be aware of its close mimics such as PCACC before diagnosing adenoid BCC as they differ in prognosis and treatment modalities.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Jetley S, Jairajpuri ZS, Rana S, Talikoti MA. Adenoid basal cell carcinoma and its mimics. Indian J Dermatol 2013;58:244.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Bastiens MT, Hoefnagel J. Differences in age, site distribution and sex between nodular and superficial basal cell carcinomas indicate different types of tumors. J Invest Dermatol 1998;110:880-84.  Back to cited text no. 2
    
3.
Kossard S, Epstein EM, Cerio R, Yu LL Weedon D. WHO Classification of Tumors, Pathology and Genetics of Skin Tumors. 1st ed. Lyon: IARC-Press; 2006. p. 13-9.  Back to cited text no. 3
    
4.
Tambe SA, Ghate SS, Jerajani HR. Adenoid type of Basal cell carcinoma: Rare histopathological variant at an unusual location. Indian J Dermatol 2013;58:159.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Hussain I, Soni M, Khan MD. Bcc presentation, histopathological features & correlation with clinical behaviour. Pak J Opthalmol 2011;27:3-7.  Back to cited text no. 5
    
6.
Kim SH, Ko WT, Suh MK, Lee JI. A case of axillary adenoid basal cell carcinoma. Ann Dermatol 2008;20:22-5.  Back to cited text no. 6
    
7.
Patil MR, Kulkarni M. Adenoid basal cell carcinoma A rare variant and a mimic of adenoid cystic carcinoma. IOSR J Dent Med Sci 2015;14:42-5.  Back to cited text no. 7
    
8.
MercuT R, Dast S, Ciurea ME, Margaritescu C, Popescu FD, Manolea HO, et al. Histopathological aspects of some rare forms of facial basal cell car?cinoma. Rom J Morphol Embryol 2017;58:425-32.  Back to cited text no. 8
    
9.
Haji S, Gallouj S, Lamouaffaq A, El Jouari O, Souaf I, Mernissi FZ. Adenoid variant of basal cell carcinoma: A case report of a rare histopathological subtype with dermoscopic aspect. Clin Dermatol Op Acc J 2018;3:1.  Back to cited text no. 9
    
10.
Murkey N, Murkey P, Kalele KP, Patil KP. Adenoid variant of basal cell carcinoma: A case report with a glance at biological behavior of the tumor. Indian J Dermatol 2017;62:103-5.  Back to cited text no. 10
[PUBMED]  [Full text]  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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