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Desmoplastic Trichoepithelioma

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The image shows histologic hallmarks of desmoplastic trichoepithelioma: thin epithelial strands and keratinous cysts in a background of desmoplastic stroma.

Differential diagnosis of desmoplastic trichoepithelioma: The main differential is from morpheaform basal cell carcinoma.

Features favoring trichoepithelioma are: symmetry of the lesion; absence of features such as ulceration, necrosis, peripheral palisading, retraction artifact, increased mitotic activity; presence of CK20+ve Merkel cells; presence of horn cysts; and lack of androgen receptors.

Other entities that may mimic desmoplastic trichoepithelioma, especially in small biopsies, include: syringoma, microcystic adnexal carcinoma, and eccrine epithelioma.

Image courtesy of: Univ. of Michigan Dept. of Pathology; used with permission

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