The Use of Immunostaining for bcl-2 and CD34 and the Lectin Peanut Agglutinin in Differentiating Between Basal Cell Carcinomas and Trichoepitheliomas

Abstract

Fifteen unequivocal basal cell carcinomas (BCC) and ten unequivocal trichoepitheliomas (TE) were studied using the lectin peanut agglutinin (PNA), and the monoclonal antibodies Q bend 10 and bcl-2 oncoprotein directed against the antigens CD34 and bcl-2, respectively, to see whether these markers could be used to differentiate between the two tumors. Ten percent of TE demonstrated a continuous band-like peritumorous staining with PNA and 80% demonstrated a discontinuous band-like peritumorous staining with PNA, with the comparable figures for BCC being 40% and 20%, respectively. In addition, 40% of BCC showed focal areas of pemphigus-like staining in contrast with only 10% of TE. Using the antibody directed against bcl-2, TE demonstrated weak staining mainly confined to the basal layer of tumor cells in 20% of cases and staining of the cells throughout the tumor in 30% of cases. Similarly, BCC also showed staining of the basal layer of tumor cells in 7% of specimens and staining of cells throughout the tumor mass in 40% of specimens studied. Finally, with the antibody Q bend 10 directed against CD34, staining of the immediate peritumoral spindle-shaped cells was observed in 20% of TE compared with 7% of BCC. Despite reports in the literature, we found that none of these three markers can be reliably used to differentiate between TE and BCC.

Fibroblast-activation protein: a single marker that confidently differentiates morpheaform/infiltrative basal cell carcinoma from desmoplastic trichoepithelioma

“…Immunohistochemical markers putatively useful in reliably differentiating trichoepithelioma (and/or trichoblastoma) and basal cell carcinoma in general and desmoplastic trichoepithelioma and morpheaform/infiltrative basal cell carcinoma in particular include CD34, Bcl-2, CK20, and AR. 3,[7][8][9][10][11][12][15][16][17] Positive peritumoral staining of trichoepithelioma and desmoplastic trichoepithelioma by CD34, shown by Kirchmann et al, in 100% of cases of both with negative staining in all cases of basal cell carcinoma was contradicted by subsequent studies that showed positive peritumoral staining in some cases of basal cell carcinoma and absence of the same in cases of trichoepithelioma. [7][8][9][10] The diffuse staining of bcl-2 in tumor nests of basal cell carcinoma and peripheral staining of tumor nests in cases of trichoepithelioma reported in some studies was refuted by others claiming that the differential expression pattern at the periphery compared with the center of lesional aggregates cannot be assessed reliably, as the epithelial strands are usually thin in the desmoplastic variants of both neoplasms.…”

“…3,[7][8][9][10][11][12][15][16][17] Positive peritumoral staining of trichoepithelioma and desmoplastic trichoepithelioma by CD34, shown by Kirchmann et al, in 100% of cases of both with negative staining in all cases of basal cell carcinoma was contradicted by subsequent studies that showed positive peritumoral staining in some cases of basal cell carcinoma and absence of the same in cases of trichoepithelioma. [7][8][9][10] The diffuse staining of bcl-2 in tumor nests of basal cell carcinoma and peripheral staining of tumor nests in cases of trichoepithelioma reported in some studies was refuted by others claiming that the differential expression pattern at the periphery compared with the center of lesional aggregates cannot be assessed reliably, as the epithelial strands are usually thin in the desmoplastic variants of both neoplasms. 3,[9][10][11][12] Use of expression of the AR, initially shown by Izikson et al, were later reproduced by Costache et al 3 Both groups showed AR expression in 475% of basal cell carcinomas tested and lack of the same in both trichoepithelioma and desmoplastic trichoepithelioma.…”

“…[7][8][9][10] The diffuse staining of bcl-2 in tumor nests of basal cell carcinoma and peripheral staining of tumor nests in cases of trichoepithelioma reported in some studies was refuted by others claiming that the differential expression pattern at the periphery compared with the center of lesional aggregates cannot be assessed reliably, as the epithelial strands are usually thin in the desmoplastic variants of both neoplasms. 3,[9][10][11][12] Use of expression of the AR, initially shown by Izikson et al, were later reproduced by Costache et al 3 Both groups showed AR expression in 475% of basal cell carcinomas tested and lack of the same in both trichoepithelioma and desmoplastic trichoepithelioma. 15 Undermining these results were those obtained by Katona et al who found AR expression in only 65% of basal cell carcinomas tested and also showed AR positivity in 13% of desmoplastic trichoepitheliomas in their series.…”

Diagnostic utility of immunohistochemistry in distinguishing trichoepithelioma and basal cell carcinoma: evaluation using tissue microarray samples

“…[2][3][4][5][6][7][8][9][10][11][12][13][14][15] With exception of D2-40 labeling, 14 the studies present conflicting findings when comparing results for the same immunohistochemical markers. This may be due to the small number of basaloid tumors that comprised their casuistics.…”

An Insight into the Histopathology of Oral Neoplasms with Basaloid Morphology and a Working Classification

“…4 Some authors also believe that "basaloid" patterns occurring anywhere in the body represent attempts at glandular differentiation. 5,6 An exhaustive literature review did not reveal any working classification of oral BCTs. A simple working classification of Oral BCTs is proposed here (Table 1).…”