Case for Diagnosis
A Slow-Growing Pedunculated Lesion
Lesión pediculada de crecimiento lento
M.T. López-Villaescusa
, F. de Manueles Marcos, L.J. Pérez García
Corresponding author
Servicio de Dermatología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
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López-Villaescusa, F. de Manueles Marcos, L.J. Pérez García" "autores" => array:3 [ 0 => array:4 [ "nombre" => "M.T." "apellidos" => "López-Villaescusa" "email" => array:1 [ 0 => "lopezvillaescusa@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "F." "apellidos" => "de Manueles Marcos" ] 2 => array:2 [ "nombre" => "L.J." "apellidos" => "Pérez García" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesión pediculada de crecimiento lento" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 634 "Ancho" => 950 "Tamanyo" => 103972 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 57-year-old male farmer with no relevant personal or family medical history and no known diseases presented with a lesion on the inner aspect of the left leg that had appeared about 10 years previously. The lesion was asymptomatic, had never bled, and had slowly and progressively grown over the years.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed an exophytic, polypoid tumor with a broad base and no adhesion to the deeper layers. The tumor was soft with a friable, erythematous, fleshy surface and measured 3<span class="elsevierStyleHsp" style=""></span>cm in diameter (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Dermoscopy revealed that the tumor surface consisted of multiple raised structures interconnected in a honeycomb pattern and displayed some whitish radial streaks and fine arborizing telangiectasias (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Locoregional lymph nodes were not palpable and no other significant abnormalities were observed in the physical examination.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0025" class="elsevierStylePara elsevierViewall">Histopathology with hematoxylin-eosin (original magnification ×<span class="elsevierStyleHsp" style=""></span>20) revealed a tumor composed of thin, elongated, anastamosing strands of basaloid cells that were connected to the epidermis and extended down towards the dermis forming a lattice-like pattern within a dense fibrotic stroma (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis?</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0035" class="elsevierStylePara elsevierViewall">Fibroepithelioma of Pinkus.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinial Course and Treatment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Under local anesthesia, the patient underwent surgical excision with margins and direct closure, without complications. After 6 months of follow-up the patient has a nonpathological scar with no signs of local recurrence or new lesions.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comment</span><p id="par0045" class="elsevierStylePara elsevierViewall">Fibroepithelioma of Pinkus, initially described in 1953 as a premalignant fibroepithelial tumor of the skin,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> is a benign neoplasm with differentiation toward follicular germinative cells. This tumor has been traditionally considered a rare variant of basal cell carcinoma (BCC), based on its characteristic histopathological features. Histologically, the tumor consists of strands of interconnected basaloid epithelia coated with preexisting follicular infundibula that connect to the epidermis to form a fenestrated pattern, with occasional solid islands of basaloid cells, a dense fibrotic stroma, and a rich capillary network.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In some cases the cytology, stroma, and architectural features suggest that this tumor type would be more correctly classified as a retiform variant of trichoblastoma rather than a BCC.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However, it does not display as advanced a degree of follicular differentiation as seen in trichoblastoma.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Fibroepithelioma of Pinkus affects men and women similarly, and appears in individuals between 40 and 60 years of age. The most common location is the trunk. It has a predilection for unexposed areas (unlike BCC), especially the lumbosacral area, although it can develop in any anatomic site except areas of skin that lack hair follicles. While the tumor manifests clinically as an initially flat lesion, it grows progressively and causes few symptoms, and can thus reach a large size, as seen in our patient. It is scarcely aggressive and has a good prognosis; no distant metastases have been described.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The dermoscopic pattern of this tumor has been described; the key features are arborized telangiectasias that are longer and finer than those seen in BCC and whitish streaks caused by abundant fibrovascular stroma. These correspond respectively to the brownish maple leaf and spoke-wheel structures seen in classic BCC.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The differential diagnosis of Fibroepithelioma of Pinkus includes squamous cell carcinoma, amelanotic melanoma, skin metastasis, Merkel cell carcinoma, and primary cutaneous diffuse large B-cell lymphoma, leg type. However, those tumors are malignant skin neoplasms characterized by rapid growth and a poor prognosis, features that are not concordant with the clinical course of our patient's tumor. Therefore, the differential diagnosis must also include other less common benign neoplasms with follicular differentiation in which the definitive diagnosis is established by histopathology; these include large solitary trichodiscoma, trichoadenoma, fibroadenoma, and eccrine syringofibroadenoma, as well as other tumors such as lymphoepithelial tumor of the skin.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinial Course and Treatment" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: López-Villaescusa MT, de Manueles Marcos F, Pérez García LJ. Lesión pediculada de crecimiento lento. Actas Dermosifiliogr. 2014;105:789–790.</p>" ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 634 "Ancho" => 950 "Tamanyo" => 103972 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 481 "Ancho" => 951 "Tamanyo" => 72639 ] ] ] 2 => array:6 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 584 "Ancho" => 952 "Tamanyo" => 216556 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fibroepithelioma of Pinkus induced by radiotherapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.J. Holcomb" 1 => "K. Motaparthi" 2 => "S.J. Grekin" 3 => "T. Rosen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dermatol Online J" "fecha" => "2012" "volumen" => "18" "paginaInicial" => "5" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23286795" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tratamiento quirúrgico de tumor de Pinkus en el pie" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F.J. García" 1 => "N. 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Descripción dermatoscópica de 3 casos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Zamberk-Majlis" 1 => "D. Velázquez-Tarjuelo" 2 => "J.A. Avilés-Izquierdo" 3 => "P. Lázaro-Ochaita" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2009" "volumen" => "100" "paginaInicial" => "899" "paginaFinal" => "902" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20038369" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010500000008/v1_201409260034/S157821901400208X/v1_201409260034/en/main.assets" "Apartado" => array:4 [ "identificador" => "6154" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010500000008/v1_201409260034/S157821901400208X/v1_201409260034/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901400208X?idApp=UINPBA000044" ]
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| 2022 June | 29 | 27 | 56 |
| 2022 May | 47 | 33 | 80 |
| 2022 April | 31 | 30 | 61 |
| 2022 March | 36 | 39 | 75 |
| 2022 February | 29 | 19 | 48 |
| 2022 January | 31 | 40 | 71 |
| 2021 December | 24 | 39 | 63 |
| 2021 November | 32 | 43 | 75 |
| 2021 October | 51 | 60 | 111 |
| 2021 September | 34 | 38 | 72 |
| 2021 August | 29 | 30 | 59 |
| 2021 July | 36 | 32 | 68 |
| 2021 June | 26 | 20 | 46 |
| 2021 May | 22 | 28 | 50 |
| 2021 April | 53 | 59 | 112 |
| 2021 March | 48 | 9 | 57 |
| 2021 February | 44 | 32 | 76 |
| 2021 January | 22 | 12 | 34 |
| 2020 December | 39 | 12 | 51 |
| 2020 November | 25 | 14 | 39 |
| 2020 October | 16 | 7 | 23 |
| 2020 September | 32 | 17 | 49 |
| 2020 August | 15 | 11 | 26 |
| 2020 July | 25 | 14 | 39 |
| 2020 June | 29 | 17 | 46 |
| 2020 May | 19 | 10 | 29 |
| 2020 April | 21 | 13 | 34 |
| 2020 March | 30 | 15 | 45 |
| 2020 February | 8 | 0 | 8 |
| 2020 January | 2 | 2 | 4 |
| 2019 December | 10 | 5 | 15 |
| 2019 November | 2 | 0 | 2 |
| 2019 October | 0 | 2 | 2 |
| 2019 September | 4 | 1 | 5 |
| 2019 August | 4 | 10 | 14 |
| 2019 July | 8 | 5 | 13 |
| 2019 June | 4 | 18 | 22 |
| 2019 May | 6 | 24 | 30 |
| 2019 April | 2 | 16 | 18 |
| 2019 March | 0 | 7 | 7 |
| 2019 February | 4 | 3 | 7 |
| 2018 December | 2 | 0 | 2 |
| 2018 November | 4 | 0 | 4 |
| 2018 October | 4 | 0 | 4 |
| 2018 September | 2 | 0 | 2 |
| 2018 August | 0 | 1 | 1 |
| 2018 July | 0 | 3 | 3 |
| 2018 May | 0 | 1 | 1 |
| 2018 April | 0 | 11 | 11 |
| 2018 March | 1 | 1 | 2 |
| 2018 February | 38 | 5 | 43 |
| 2018 January | 40 | 7 | 47 |
| 2017 December | 43 | 5 | 48 |
| 2017 November | 31 | 9 | 40 |
| 2017 October | 43 | 12 | 55 |
| 2017 September | 40 | 29 | 69 |
| 2017 August | 28 | 8 | 36 |
| 2017 July | 20 | 17 | 37 |
| 2017 June | 37 | 25 | 62 |
| 2017 May | 43 | 21 | 64 |
| 2017 April | 38 | 9 | 47 |
| 2017 March | 19 | 34 | 53 |
| 2017 February | 50 | 12 | 62 |
| 2017 January | 17 | 14 | 31 |
| 2016 December | 31 | 14 | 45 |
| 2016 November | 30 | 17 | 47 |
| 2016 October | 27 | 15 | 42 |
| 2016 September | 1 | 9 | 10 |
| 2016 August | 0 | 4 | 4 |
| 2016 July | 11 | 1 | 12 |
| 2016 June | 22 | 11 | 33 |
| 2016 May | 7 | 22 | 29 |
| 2016 April | 4 | 18 | 22 |
| 2016 March | 6 | 1 | 7 |
| 2016 February | 18 | 17 | 35 |
| 2016 January | 5 | 15 | 20 |
| 2015 December | 12 | 11 | 23 |
| 2015 November | 19 | 11 | 30 |
| 2015 October | 14 | 10 | 24 |
| 2015 September | 19 | 11 | 30 |
| 2015 August | 15 | 1 | 16 |
| 2015 July | 32 | 3 | 35 |
| 2015 June | 30 | 5 | 35 |
| 2015 May | 25 | 2 | 27 |
| 2015 April | 16 | 5 | 21 |
| 2015 March | 6 | 3 | 9 |
| 2015 February | 8 | 1 | 9 |
| 2015 January | 4 | 1 | 5 |
| 2014 December | 5 | 2 | 7 |
| 2014 November | 10 | 3 | 13 |
| 2014 October | 11 | 1 | 12 |
Show all
