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CASE REPORT
Year : 2016  |  Volume : 61  |  Issue : 4  |  Page : 443-445
Nodulocystic basal cell carcinoma arising directly from a seborrheic keratosis: A rare case report


Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan

Date of Web Publication7-Jul-2016

Correspondence Address:
Naoko Okiyama
Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.185720

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   Abstract 

Seborrheic keratoses (SKs) are common epidermal tumors composed of benign keratinocytes. Malignant skin tumors including basal cell carcinoma (BCC) rarely arise within SKs. We report a rare case of an 82-year-old man with nodulocystic BCC that appeared at the center of a scaly hyperpigmented SK that had been presented for more than 10 years. It was histologically confirmed that CK19-positive BCC arose directly from the wall of the pseudohorn cyst, a part of the SK. Nodular and/or cystic BCC also rarely arise within SKs while the most common histologic type of BCC within SKs is the superficial type. Careful observation of SKs is important even though it is rarely a background condition for malignant transformation.


Keywords: Basal cell carcinoma, CK19, pseudohorn cyst, seborrheic keratosis


How to cite this article:
Shibao K, Okiyama N, Tanaka R, Maruyama H, Fujisawa Y, Fujimoto M. Nodulocystic basal cell carcinoma arising directly from a seborrheic keratosis: A rare case report. Indian J Dermatol 2016;61:443-5

How to cite this URL:
Shibao K, Okiyama N, Tanaka R, Maruyama H, Fujisawa Y, Fujimoto M. Nodulocystic basal cell carcinoma arising directly from a seborrheic keratosis: A rare case report. Indian J Dermatol [serial online] 2016 [cited 2019 Oct 19];61:443-5. Available from: http://www.e-ijd.org/text.asp?2016/61/4/443/185720

What was known?

  • Seborrheic keratoses (SKs) are common epidermal tumors composed of benign keratinocytes from which malignant skin tumors including basal cell carcinoma (BCC) rarely arise directly
  • The most common histologic type of BCC arising within SKs is the superficial type
  • Immunohistologic observation using anti CK19 antibodies is useful to distinguish BCC and SKs.



   Introduction Top


Seborrheic keratoses (SKs) are common epidermal tumors composed of benign keratinocytes. Malignant skin tumors rarely arise within SKs; this was shown in a retrospective study of 639 cases with histologically confirmed SKs, in which only 2 cases developed basal cell carcinoma (BCC) arising within SKs [1] although some cases of BCC arising within epidermal cysts, epidermoid cysts, and sebaceous nevi have been reported. [2],[3],[4],[5]


   Case Report Top


An 82-year-old Japanese man presented with a red pedunculated, partially transparent nodule in the right buccal region [Figure 1]a. The nodule appeared at the center of a scaly hyperpigmented nodule that had existed for more than 10 years, and it grew rapidly thereafter. Dermoscopic examination with immersion gel revealed telangiectasia on the surface and a few blue-gray globules at the base [Figure 1]b]. The tumor was excised with 2 mm margins. An excisional specimen of the red nodule area [Figure 1]c revealed solid tumor nests composed of basaloid cells palisading at the periphery [Figure 1]d with various-sized cysts filled with stromal mucin [Figure 1]e, and some of which formed lacy structures [Figure 1]e. Thus, the red nodule was diagnosed as a nodulocystic type of BCC with partial adenoid-type changes. The World Health Organization Classification of Tumors 2006 gives eight classifications for the histologic patterns of BCC. Adenoid-type changes are occasionally found within other types of BCC as they were in our case. [6]
Figure 1: (a) A red pedunculated nodule measuring 14 mm × 12 mm in diameter arising at the center of an existing scaly hyperpigmented nodule. The yellow lines indicate the tissue sections shown in Figure 1c and 2a. (b) Dermoscopic examination showing telangiectasia on the surface and a few blue-gray globules at the base. (c-e) Solid tumor nests (c: Original magnification, ×10) composed of basaloid cells palisading at the periphery (d: Original magnification, ×400) and various-sized cysts in the red nodule area (e: Original magnification, ×100) (H and E staining)

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Because of the interlacing thin strands of basaloid cells with basal pigmentation enclosing multiple pseudohorn cysts on the side edge of the BCC [Figure 2]a], the hyperkeratotic dark-brown nodule was diagnosed as a reticulated type of SK. Within the boundary between the BCC and the SK, an exophytic proliferation of basaloid cells palisading at the periphery around a pseudohorn cyst was observed [Figure 2]b. Because no pseudohorn cysts were found within the red nodule consisting entirely of BCC, the pseudohorn cyst [Figure 2]b was surely a part of an SK. In the immunohistochemical evaluation, positive staining with CK19, which has been reported as a useful marker in differentiating BCC from nonneoplastic hair buds, [7],[8] was determined in the proliferating basaloid cell area but not in the few cell layers around the pseudohorn cyst as well as in the BCC area [Figure 2]c and d. These features led us to think that the BCC had arisen directly from the pseudohorn cyst of the SK.
Figure 2: (a) Interlacing thin strands of basaloid cells with basal pigmentation enclosing multiple pseudohorn cysts on the right-side edge of the basal cell carcinoma. The dashed line represents the boundary between the seborrheic keratoses and basal cell carcinoma. (H and E, original magnification ×2). (b-d) Exophytic proliferation of basaloid cells (c: H and E, original magnification × 400), which were positive for CK19 (d: DAB, original magnification ×400), palisading at the periphery of a pseudohorn cyst at the boundary between seborrheic keratoses and basal cell carcinoma (b: H and E, original magnification ×200)

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   Discussion Top


Three possible reasons for BCC associated with SKs are generally suggested as follows: (1) Malignant transformation of the SKs owing to carcinogenic factors such as prolonged sunlight and low-dose chronic ionized radiation exposure, (2) BCC arising from the same follicular origin as the SKs, [9] and (3) BCC incidentally coexisting with the SKs. [10] In our case, the BCC did not coexist with the SK incidentally but arose directly from the SK because the histologic features showed the BCC as being continuous with the SK, unlike the case reported previously. [7] In the 2 cases with BCC from the series of 639 cases with SKs, it is unclear whether the BCC just coexisted with the SK or arose from the SK. [1] In addition, nodular and/or cystic BCC rarely arose within SKs while the most common histologic type of BCC within SK is the superficial type. [1],[7]

In aggregate, the patient presented here represents a rare case of nodulocystic BCC arising directly from an SK. Careful observation of the clinical and histologic features should be important even though SK is rarely a background condition for malignant transformation.

Acknowledgments

We would like to thank F. Miyamasu (Medical English Communications Center, University of Tsukuba) for grammatical review and advice.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Lim C. Seborrhoeic keratoses with associated lesions: A retrospective analysis of 85 lesions. Australas J Dermatol 2006;47:109-13.  Back to cited text no. 1
    
2.
Delacrétaz J. Keratotic basal-cell carcinoma arising from an epidermoid cyst. J Dermatol Surg Oncol 1977;3:310-1.  Back to cited text no. 2
    
3.
Tsujita-Kyutoku M, Danbara N, Yuri T, Nikaido Y, Hatano T, Tsubura A. Basal cell carcinoma arising from a keratinous cyst of the skin: A case report and review of the literature. Med Mol Morphol 2005;38:130-3.  Back to cited text no. 3
    
4.
Gupta SK, Gupta V. Basal cell carcinoma and syringocystadenoma papilliferum arising in nevus sebaceous on face-A rare entity. Indian J Dermatol 2015;60:637.  Back to cited text no. 4
  Medknow Journal  
5.
Dini M, Innocenti A, Romano GF. Basal cell carcinoma arising from epidermoid cyst: A case report. Dermatol Surg 2001;27:585-6.  Back to cited text no. 5
    
6.
Lever WF, Schaumburg-Lever G. Basal cell carcinoma. In: Elder D, editor. Histopathology of the Skin. 8 th ed. Philadelphia, PA: Lippincott Raven; 1997. p. 719-31, 792, 795.  Back to cited text no. 6
    
7.
Ishida M, Ohsato N, Okabe H. Basal cell carcinoma arising within a seborrheic keratosis with respect to immunohistochemical characteristics. Oncol Lett 2011;2:625-7.  Back to cited text no. 7
    
8.
Bedir R, Yurdakul C, Güçer H, Sehitoglu I. Basal cell carcinoma arising within seborrheic keratosis. J Clin Diagn Res 2014;8:YD06-7.  Back to cited text no. 8
    
9.
Cascajo CD, Reichel M, Sánchez JL. Malignant neoplasms associated with seborrheic keratoses. An analysis of 54 cases. Am J Dermatopathol 1996;18:278-82.  Back to cited text no. 9
    
10.
Popadic M. A hyperkeratotic, clonal seborrheic keratosis accompanied by nodulocystic basal cell carcinoma. J Am Acad Dermatol 2015;72:e113-5.  Back to cited text no. 10
    

What is new?

  • Basal cell carcinoma (BCC) rarely arises directly from seborrheic keratoses (SKs)
  • In addition, the nodulocystic type of BCC rarely arises within SKs
  • Careful observations of the histologic and immunohistologic (CK19) features are important for SKs with recently arising tumors.


    Figures

  [Figure 1], [Figure 2]



 

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