The biopsy shows features consistent with basal cell carcinoma. Microscopy revealed a localized basal cell proliferative lesion arranged in islands and cords with focal sclerosis. Basaloid cells showed peripheral palisading and clefts. The diagnosis of basal cell carcinoma was made based on these histological features. Differential considerations included cylindroma and trichilemmal cyst but were excluded.

1. • Age/Sex : 62 /Female
• Hospital OP/ IP No: A18009538
• Biopsy No: 969/18
• Date Of Receiving Specimen : 20/04/2018
• Date Of Report : 26/04/2018
• Clinical Diagnosis : 1) Cylindroma
2) Trichilemmal cyst
• Nature of Specimen : A 6mm punch biopsy taken
from scalp.
.

2. Gross Examination
Container labelled skin biopsy
from scalp
Received single nodular grey
white skin attached soft tissue
bit measuring 0.5x0.5x0.5cm.
External surface show hair
follicles.
Cut surface shows grey white
areas.
All embedded in one block.
.

3. Microscopy
4x
A localized basal cell proliferative cup-shaped lesion with atrophic overlying epidermis.

4. Microscopy
10x
Tumor cells are arranged in the form of islands, cords and groups with focal areas of sclerosis.

5. Microscopy
40x
Clefts and peripheral palisading of basaloid cells of the nests

6. Microscopy
Section studied shows
• A localized basal cell proliferative lesion of the epidermis
arranged in the form of islands, cords and groups with focal
areas of sclerosis.
• The entire lesion is cup shaped with atrophic overlying
epidermis.
• One focus shows a transition from the basal pigment layer to
the basal cell carcinoma.

7. Impression
Biopsy of scalp shows features of basal cell carcinoma.
The edges of the biopsy are free of tumor.

8. Differential Diagnosis
● Well-circumscribed dermal nodules
composed of islands of epithelial cells that
fit together like pieces of jigsaw puzzle and
are separated from each other only by thick
hyaline sheaths.
● Two types of cells are present in the
epithelial islands : -
– Cells with small, dark-staining nuclei at
the periphery of the islands.
– Cells with large light-staining nuclei in
the center of the islands.
● Tubular lumina lined by ductal cells and filled with amorphous material
are often present.
● Drops of eosinophilic hyaline material can be present within the epithelial
islands.
Cylindroma

9. Differential Diagnosis
Trichilemmal cyst
● Calcifications are frequently found.
● Proliferating trichilemmal cystic neoplasm: a low-grade neoplasm
characterized by lobules of eosinophilic epithelial cells (isthmic) and
infiltrative growth pattern
● Benign cyst occurring most
commonly on the scalp as multiple
cystic nodules.
● Cyst contents consist of compact
keratin, and the lining resembles
the isthmus of hair follicle; abrupt
keratinization with absent
granular layer is characteristic.

11. Discussion

12. Basal Cell Carcinoma
• Typically affects older
individuals
• Predilection for sun-
exposed skin (face, hands)
• Small, well-circumscribed,
pearly tan-gray papule
devoid of scale
• Lesions enlarge with time
and tend to ulcerate
• (rodent ulcers)

13. Basal Cell Carcinoma
Histopathology
• Nests and islands of basaloid
cells attached to the
undersurface of epidermis and
extending into the dermis
• Peripheral palisading of
basaloid cells of the nests
• Basaloid cells are typically
uniform with frequent mitotic
activity and abundant
apoptotic cells

14. Basal Cell Carcinoma
Histopathology
• Characteristic retraction artifact
between the palisading cells and the
normal stroma.
• Areas of squamous differentiation
and perineural invasion are seen in
aggressive (infiltrative) forms
• Variants of basal cell carcinoma:
– pigmented,
– morphea-like or sclerosing,
– superficial,
– nodular,
– keratotic,
– adenoid,
– micronodular
– fibroepithelial

15. Basal Cell Carcinoma
Differential Diagnosis
Trichoepithelioma
• Nests of basaloid cells usually
without mitotic activity,
individual cell necrosis, or
separation artifacts.
• Abundant fibrotic stroma.
• Retraction artifacts within a
cellular stroma rather than
around the epithelial nests.
• Evidence of follicular
differentiation in the form of
germs, bulbs, and papillae is
more common.
• CD10-positive stroma.

16. • Basal cell nevus syndrome: multiple basaloid
hamartomas on the cutaneous surface
associated with palmar keratotic pits, jaw
cysts, and basal cell carcinomas in non–sun-
exposed locations.
• BCCs rarely metastasize; when they do, the
primary lesion is usually advanced