CASE REPORT
Year: 2020 • Volume: 3 • Issue: 1 • Page: 20-21
A SKIN COLOURED PLAQUE OVER BACK – MIMESIS OF BENIGN TUMOURS
Paras Choudhary1, Bhushan A Darkase1, Atul M Dongre1, Uday S Khopkar1
1Department of Dermatology, Kem hospital, Parel, Mumbai 400012
Corresponding Author:
Paras Choudhary
Department of Dermatology
Kem hospital, Parel, Mumbai 400012
Email: paras2704@gmail.com
How to cite this article:
Choudhary P, Darkase BA, Dongre AM, Khopkar US. A skin coloured plaque over back – Mimesis of benign tumours. JDA Indian Journal of Clinical Dermatology 2020;3:
Abstract
Fibroepithelioma of Pinkus (FEP) is an uncommon tumour in Indian population. FEP clinically resembles a variety of benign skin tumors which are not routinely excised or biopsied. Diagnostic confirmation is necessary becausethe nature of this tumor remains a subject of debate.
Key words: Fibroepithelioma of Pinkus (FEP)
Introduction
Fibroepithelioma of Pinkus (FEP) is rare and often misdiagnosed clinically as it imitates multiple benign skin tumours . Some authors argue that the relative rareness of this tumour is mainly because of its misdiagnosis. Differential diagnosis in case of FEP is dermal nevus, fibroma, acrochordon, and seborrheic keratosis, which are not routinely excised or biopsied . Dermoscopy and confocal microscopy have emerged as non-invasive tools but histopathology remains the gold standard for diagnosis.
Case report
An 89-year-old male, presented with an asymptomatic skin colored to reddishlesion over back for 6 years. The Lesion had slowly grown to present size over a period of 6years.
Examination revealed a solitary, non-tender skin coloredplaque of size 4×3 cm with non-tender central erythematous nodule.Surrounding the plaque there was a rim of brown-black hyperpigmentation present. [Figure1]
Figure 1 : A solitary, non-tender skin coloured plaque of size 4×3 cm with non-tender central erythematous nodule with a rim of hyperpigmentation.
Figure 2 : Epithelial neoplasm that shows a connection with surface epidermis at several places.
A clinical differential of appendegeal tumor, intradermal nevi was kept in mindand punch biopsy was takenfor further confirmation.
Histopathological examination revealed epithelial neoplasm that shows a connection with surface epidermis at several places [Figure2]. The tumour islands were made up of small round cells that show uniformly stained and dark nuclei no nucleoli.The neoplastic cells were arranged in a proliferation of thinned out rete ridges with small bulbous ends that show hair germ like appearance[Figure3].The surrounding stroma shows fibroplasia [Figire4]. There were no clefts between the stoma and the epithelium.
Discussion
Fibroepithelioma of Pinkus was first described by Hermann Pinkus . It presents as flesh-colored to a pink solitary, sessile or pedunculated papule, plaque or nodule on the trunk often resembling a fibroma, intradermal nevus, seborrhoeic keratosis, achrochordon . But large pedunculated, polypoid or ulcerated
Figure 3 : The neoplastic cells are arranged in a proliferation of thinned out rete ridges with small bulbous ends that show hair germ like appearance.
cases have also been reported . It is commonly reported to occur in adults aged 40–60 years. However, a few cases in the pediatric population have been reported .The strong predilection for the lumbar region and for the female gender differentiates FEP from other BCC subtypes that usually arise on sun-exposed areas andpredominantly in males .
Dermoscopy of FEP demonstrates white streaks and fine arborizing vessels with occasionally dotted vessels. When pigmented, features of FEP also include structure-less gray-brown areas and blue-gray dots. The hallmark of confocal microscopy is a fenestrated pattern demonstrating dark “holes” that correspond to the fibrous stroma surrounding tumour strands .
The gold standard diagnostic test for FEP is a skinbiopsy for histopathologic examination. It consists of basaloid cells.
Figure 4 : The surrounding stroma shows fibroplasia.
arranged in cords and columns, which anastomose with each other. Stroma surrounding these cords and columns is thick and rich with fibrocytes. These columns and cords may show palisading and follicular germ-like structures formation. Many of the cords and columns show connections with the surface epidermis .
Hermann Pinkus initially classified it as a premalignant fibroepithelial tumor .Later on, FEP was classified as a subtype of basal cell carcinoma, although some consider FEPas a variant of trichoblastoma . Some consider it as a benign and unusual counterpart of BCC, while others think it a malignant neoplasm .Finding such as expression of androgen receptor is shared by BCC and FEP, which is minimal in trichoblastomas; whereas FEP and trichoblastomas display Merkel cells, which are usually absentin BCC . In another study, authors found that tumour-specific type of epithelial hyperplasia in FEP that is positive for the stem cell marker PHLDA1 and present a unifying concept of FEP as a subtype of BCC.
Recent research highlights the fact that bcc and trichoepithelioma share common cell origin,which is the epithelial stem cells of the hair follicle. So it is proposed that FEP might be a trichoblastic tumor intermediate between trichoepithelioma and bcc .
There are case reports showing an association of nodular bcc with FEP supporting its malignant nature . So its classification still remains controversial.
Local excision of FEP is recommended treatment of choice and is almost universally curative without recurrence. Our patient 89-year old male also presented as an asymptomatic plaque with central nodule over back. Dermoscopy or confocal microscopy was not done in our case but histopathological examination did demonstrate classic histopathologic features for FEP (Figure 2,3,4). The morphological resemblance to benign skin tumours is one of the cause for its misdiagnosis and relative rareness. In the light of controversial malignant nature of FEP,early diagnosis and curative treatment with complete local excision are mandatory.
Reference
- Pollard CWL, Usaf MC, Grenier MAJLS, Kobayashi CTT, Ret Novel Presentation of Fibroepithelioma of Pinkus on the Ear of a Patient Treated on a Panamanian Humanitarian Mission. 2018;00(March):8-10.
- Mihai MM, Voicu C, Lupu M, et Fibroepithelioma of Pinkus (FeP) Located in the Left Lower Quadrant of the Abdomen – Case Report and Review of the Literature. 2017;5(4):439-444.
- R e g g i a n i C , L o n g o C . C a s e a n d R e v i e w Fibroepithelioma of Pinkus : Case Reports and. 2013: 207-211.
- Dongre AM, Khopkar US, Kalyanpad YN, Gole P Fibroepithelioma of Pinkus in continuity with nodular basal cell carcinoma : A rare presentation. 2016:285-287.
- Longo C, Pellacani G, Tomasi A, Mandel VD, Ponti Fibroepithelioma of Pinkus : Solitary tumor or sign of a complex gastrointestinal syndrome. 2016:797-800.
- Letter N. Fibroepithelioma of Pinkus : A distinctive variant of trichoblastic carcinoma. 2013:2-3.
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The Champions League Round of 16 is set. After thrilling group stage action, the final 16 sides have advanced through to the knockout stages. And there were a few surprises along the way. The Eagles are a more complete team. But the Chiefs defense is actually a little underrated at this point in the season. I’m betting on the best player in the world with two more weeks to rest his ankle to bring another championship to Kansas City. — Nate Tice, NFL writer Napoli topped Group A on goals scored over Liverpool. Gli Azzurri opened their Champions League campaign with a 4-1 win over Liverpool, and have been in amazing form in all competitions. The number of teams of each association entering into the UEFA Champions League is based upon the UEFA coefficients of the member associations. These scores are built by the results of clubs representing each association during the previous five UEFA Champions League and UEFA Europa League seasons. The higher an association’s coefficient, the more teams represent the association in the UCL, and the fewer qualifying rounds the association’s teams must compete in.
© 2023 WherestheMatch Ltd Always be ahead of the game “We are excited to return to the United States for this summer’s preseason trip, our first since before COVID,” said Omar Berrada, chief football operation officer at City Football Club said in a press release. “Our players and coaches cannot wait to play once again in person in front of our American fans, who have shown us such great support and passion.” — Manchester City (@ManCity) April 25, 2022 No other team embodies Premier League success over the last 10 years like Manchester City. Despite just two titles over its first 118 years, Manchester City now holds the fifth-most top-flight titles in the history of English soccer with seven. Manchester City previous match was against Aston Villa in Premier League, the match ended with result 3 – 1 (Manchester City won the match).
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The game will kick off at 20:00 BST and will be shown live on BT Sport 1HD and Ultimate in the UK. Already, it looked to be one of those days for those in Claret and Blue, especially after Leicester City were awarded a penalty late in the first half when Craig Dawson fouled Patson Daka. But the midfielder opened his account in spectacular fashion when he rifled a 20-yard thunderbolt into the top corner. That capped an impressive performance in which he completed 50 of 55 passes and gained possession 11 times – both the highest tallies recorded by any Leicester player. Read match report: Sancho gives Manchester United 1-0 win at Leicester Leicester City scored the equaliser after Nampalys Mendy scored a brilliant goal. James Maddison gave Leicester City the lead after he scored a brilliant goal from Kelechi Iheanacho’s assist. Kelechi Iheanacho extended Leicester City’s lead further to 3-1 after he scored a brilliant goal from Harry Souttar’s assist. Harvey Barnes made it 4-1 for Leicester City after he scored from James Maddison’s assist.
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