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
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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. Fernández" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Piel" "fecha" => "2008" "volumen" => "23" "paginaInicial" => "205" "paginaFinal" => "207" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Carcinoma basocelular con diferenciación folicular" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.C. Fariña" 1 => "C. Requena" 2 => "L. Requena" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Neoplasias anexiales cutáneas" "paginaInicial" => "341" "paginaFinal" => "350" "serieFecha" => "2004" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fibroepitelioma de Pinkus. 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 Noviembre | 83 | 35 | 118 |
| 2022 Octubre | 74 | 25 | 99 |
| 2022 Septiembre | 125 | 36 | 161 |
| 2022 Agosto | 98 | 42 | 140 |
| 2022 Julio | 84 | 32 | 116 |
| 2022 Junio | 29 | 27 | 56 |
| 2022 Mayo | 47 | 33 | 80 |
| 2022 Abril | 31 | 30 | 61 |
| 2022 Marzo | 36 | 39 | 75 |
| 2022 Febrero | 29 | 19 | 48 |
| 2022 Enero | 31 | 40 | 71 |
| 2021 Diciembre | 24 | 39 | 63 |
| 2021 Noviembre | 32 | 43 | 75 |
| 2021 Octubre | 51 | 60 | 111 |
| 2021 Septiembre | 34 | 38 | 72 |
| 2021 Agosto | 29 | 30 | 59 |
| 2021 Julio | 36 | 32 | 68 |
| 2021 Junio | 26 | 20 | 46 |
| 2021 Mayo | 22 | 28 | 50 |
| 2021 Abril | 53 | 59 | 112 |
| 2021 Marzo | 48 | 9 | 57 |
| 2021 Febrero | 44 | 32 | 76 |
| 2021 Enero | 22 | 12 | 34 |
| 2020 Diciembre | 39 | 12 | 51 |
| 2020 Noviembre | 25 | 14 | 39 |
| 2020 Octubre | 16 | 7 | 23 |
| 2020 Septiembre | 32 | 17 | 49 |
| 2020 Agosto | 15 | 11 | 26 |
| 2020 Julio | 25 | 14 | 39 |
| 2020 Junio | 29 | 17 | 46 |
| 2020 Mayo | 19 | 10 | 29 |
| 2020 Abril | 21 | 13 | 34 |
| 2020 Marzo | 30 | 15 | 45 |
| 2020 Febrero | 8 | 0 | 8 |
| 2020 Enero | 2 | 2 | 4 |
| 2019 Diciembre | 10 | 5 | 15 |
| 2019 Noviembre | 2 | 0 | 2 |
| 2019 Octubre | 0 | 2 | 2 |
| 2019 Septiembre | 4 | 1 | 5 |
| 2019 Agosto | 4 | 10 | 14 |
| 2019 Julio | 8 | 5 | 13 |
| 2019 Junio | 4 | 18 | 22 |
| 2019 Mayo | 6 | 24 | 30 |
| 2019 Abril | 2 | 16 | 18 |
| 2019 Marzo | 0 | 7 | 7 |
| 2019 Febrero | 4 | 3 | 7 |
| 2018 Diciembre | 2 | 0 | 2 |
| 2018 Noviembre | 4 | 0 | 4 |
| 2018 Octubre | 4 | 0 | 4 |
| 2018 Septiembre | 2 | 0 | 2 |
| 2018 Agosto | 0 | 1 | 1 |
| 2018 Julio | 0 | 3 | 3 |
| 2018 Mayo | 0 | 1 | 1 |
| 2018 Abril | 0 | 11 | 11 |
| 2018 Marzo | 1 | 1 | 2 |
| 2018 Febrero | 38 | 5 | 43 |
| 2018 Enero | 40 | 7 | 47 |
| 2017 Diciembre | 43 | 5 | 48 |
| 2017 Noviembre | 31 | 9 | 40 |
| 2017 Octubre | 43 | 12 | 55 |
| 2017 Septiembre | 40 | 29 | 69 |
| 2017 Agosto | 28 | 8 | 36 |
| 2017 Julio | 20 | 17 | 37 |
| 2017 Junio | 37 | 25 | 62 |
| 2017 Mayo | 43 | 21 | 64 |
| 2017 Abril | 38 | 9 | 47 |
| 2017 Marzo | 19 | 34 | 53 |
| 2017 Febrero | 50 | 12 | 62 |
| 2017 Enero | 17 | 14 | 31 |
| 2016 Diciembre | 31 | 14 | 45 |
| 2016 Noviembre | 30 | 17 | 47 |
| 2016 Octubre | 27 | 15 | 42 |
| 2016 Septiembre | 1 | 9 | 10 |
| 2016 Agosto | 0 | 4 | 4 |
| 2016 Julio | 11 | 1 | 12 |
| 2016 Junio | 22 | 11 | 33 |
| 2016 Mayo | 7 | 22 | 29 |
| 2016 Abril | 4 | 18 | 22 |
| 2016 Marzo | 6 | 1 | 7 |
| 2016 Febrero | 18 | 17 | 35 |
| 2016 Enero | 5 | 15 | 20 |
| 2015 Diciembre | 12 | 11 | 23 |
| 2015 Noviembre | 19 | 11 | 30 |
| 2015 Octubre | 14 | 10 | 24 |
| 2015 Septiembre | 19 | 11 | 30 |
| 2015 Agosto | 15 | 1 | 16 |
| 2015 Julio | 32 | 3 | 35 |
| 2015 Junio | 30 | 5 | 35 |
| 2015 Mayo | 25 | 2 | 27 |
| 2015 Abril | 16 | 5 | 21 |
| 2015 Marzo | 6 | 3 | 9 |
| 2015 Febrero | 8 | 1 | 9 |
| 2015 Enero | 4 | 1 | 5 |
| 2014 Diciembre | 5 | 2 | 7 |
| 2014 Noviembre | 10 | 3 | 13 |
| 2014 Octubre | 11 | 1 | 12 |
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