The Journal of Dermatology Vol. 19: 61R-h21, 1992
BCC-Associated Amyloidosis with a Peculiar Pattern of Deposition Keiko Nojiri, Tomomichi Ono, Masayoshi johno, Ken-ichi Kayashima, Reiko Nogami* and Ichiro Kikuchi* Abstract
An 83-year-old Japanese woman with lepromatous leprosy had been treated in a leprosarium. More than 10 years ago, she developed a dome-like brown tumor on the dorsum of the nose which showed the histology of basal cell carcinoma. The lesion was a well bordered, rounded tumor with tumor cell nests on its periphery extending toward the center as cords of tumor nest and with amyloid depositions between the cords. The tumor nests and amyloid lessened toward the center of the tumor, being replaced by collagen fibers. Amyloidosis showing this peculiar pattern of transition was reported with a review of published cases.
Key words: BCC; amyloidosis
Introduction Secondary localized amyloidosis occurs following various dermatoses and frequently following skin tumors. Among these skin tumors, basal cell carcinoma is the most frequent. Amyloidosis seen in basal cell carcinoma has been given keen attention since the 1960s (1). In considering the genesis of amyloid in this condition, Hashimoto and his co-workers (2) assumed that fibroblasts produce amyloid under the effects of skin tumors, while Kobayashi and Hashimoto (3) suggested amyloid is produced through the filamentous degeneration of skin tumors, apoptosis into the dermis, and phagocytosis by the macrophages. Eto and his co-workers (4) found that amyloid thus produced is labeled with monoclonal antibodies to epidermal keratin. Therefore, the amyloid seen in basal cell carcinoma may reflect a degeneration of tumor cells. In this paper, we describe a case of basal cell Received June 15, 1992; accepted for publication August 26, 1992. Department of Dermatology, Kumamoto University School of Medicine, and *the National Leprosarium Kikuchi Keifu-en, Kumamoto,Japan. Reprint requests to: Tomomichi Ono, M.D., Department of Dermatology, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto 860,Japan.
carcinoma whose center showed fibrous proliferation and whose tumor cells were arranged as iflining its periphery; among them a marked degree of amyloid was deposited.
Case Report An 83-year-old Japanese female who had been treated for lepromatous leprosy in the National Leprosarium Kikuchi Keifu-en had noted the development of a pigmented mole on the dorsum of her nose for approximately the previous 10 years. She had developed lepromatous leprosy at age 41 and had remained bacillus-free for the previous 25 years. Seven years ago, she rejected our proposal to remove the mole. There was no serious injury to this area, but she once tried in vain to remove it with a needle. The mole was dome-like, 13 mm by 12 mm by 8 mm high, erythemato-brownish to black in color, with normal skin color at its base and several lines of telangiectasia (Fig. 1). There was a slight scaling; but no ulcer. Skin appendage tumor or nevocellular nevus was suspected, and it was excised. Pathological findings: There was an oval area composed of tumor cells from the superficial dermis to the fatty tissue (Fig. 2). The epidermis was flat from pressure and connected with the tumor nests at a point. The tumor cell area was well bordered with one fibrous capsule and a marked dilatation of superficial blood vessels at the periphery of the
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2 Fig. 1. An 83-year-old japanese woman, long treated for lepromatous leprosy, with an erythemato-brownish to black colored domeshaped tumor on the dorsum of her nose.
Fig. 2. Scanning view of the tumor (H & E). An almost round tumor is present from the dermis down to the subcutaneous tissue, the center ofwhich gives the impression of being amorphous.
Fig. 3. The epidermis is atrophic and is continuous with the tumor lesion, which is composed of basaloid cells in a palisading arrangement The tumor cells become cord-like toward the center of the lesion, and amorphous materials are seen between tumor cell nests. tumor. Cellular infiltration was minimal. The tumor cell area was composed of nests of typical basal cell carcinoma seen in the so-called palisading arrangement The distribution of tumor cells was very complicated, becoming smaller and cord-like toward the center of the tumor while connective tissue hyperplasia increased (Fig. 3). Round, eosinophilic
bodies were observed in the complicated tumor lesion as if they filled the gaps. These bodies were also distributed in the core of the tumor and stained positively with Dylon stain and Congo red stain, proving them to be amyloid (Fig. 4-a). Closer examination revealed that these bodies were also present, although in small amounts, in the paren-
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Nojiri et al
Fig. 5. Immunohistochemical staining with antikeratin antibody. Dylon-positive materials stain positively with an antikeratin antibody stain.
~ Fig.
4-a. Dylon stammg. Positively stammg materials are seen between tumor cell cords (nests) and also outside the tumor cell nests. Dylon-positive materials decrease toward the center of the lesion.
BCC-Associated Amyloidosis with a Peculiar Pattern of Deposition Keiko Nojiri, Tomomichi Ono, Masayoshi johno, Ken-ichi Kayashima, Reiko Nogami* and Ichiro Kikuchi* Abstract
An 83-year-old Japanese woman with lepromatous leprosy had been treated in a leprosarium. More than 10 years ago, she developed a dome-like brown tumor on the dorsum of the nose which showed the histology of basal cell carcinoma. The lesion was a well bordered, rounded tumor with tumor cell nests on its periphery extending toward the center as cords of tumor nest and with amyloid depositions between the cords. The tumor nests and amyloid lessened toward the center of the tumor, being replaced by collagen fibers. Amyloidosis showing this peculiar pattern of transition was reported with a review of published cases.
Key words: BCC; amyloidosis
Introduction Secondary localized amyloidosis occurs following various dermatoses and frequently following skin tumors. Among these skin tumors, basal cell carcinoma is the most frequent. Amyloidosis seen in basal cell carcinoma has been given keen attention since the 1960s (1). In considering the genesis of amyloid in this condition, Hashimoto and his co-workers (2) assumed that fibroblasts produce amyloid under the effects of skin tumors, while Kobayashi and Hashimoto (3) suggested amyloid is produced through the filamentous degeneration of skin tumors, apoptosis into the dermis, and phagocytosis by the macrophages. Eto and his co-workers (4) found that amyloid thus produced is labeled with monoclonal antibodies to epidermal keratin. Therefore, the amyloid seen in basal cell carcinoma may reflect a degeneration of tumor cells. In this paper, we describe a case of basal cell Received June 15, 1992; accepted for publication August 26, 1992. Department of Dermatology, Kumamoto University School of Medicine, and *the National Leprosarium Kikuchi Keifu-en, Kumamoto,Japan. Reprint requests to: Tomomichi Ono, M.D., Department of Dermatology, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto 860,Japan.
carcinoma whose center showed fibrous proliferation and whose tumor cells were arranged as iflining its periphery; among them a marked degree of amyloid was deposited.
Case Report An 83-year-old Japanese female who had been treated for lepromatous leprosy in the National Leprosarium Kikuchi Keifu-en had noted the development of a pigmented mole on the dorsum of her nose for approximately the previous 10 years. She had developed lepromatous leprosy at age 41 and had remained bacillus-free for the previous 25 years. Seven years ago, she rejected our proposal to remove the mole. There was no serious injury to this area, but she once tried in vain to remove it with a needle. The mole was dome-like, 13 mm by 12 mm by 8 mm high, erythemato-brownish to black in color, with normal skin color at its base and several lines of telangiectasia (Fig. 1). There was a slight scaling; but no ulcer. Skin appendage tumor or nevocellular nevus was suspected, and it was excised. Pathological findings: There was an oval area composed of tumor cells from the superficial dermis to the fatty tissue (Fig. 2). The epidermis was flat from pressure and connected with the tumor nests at a point. The tumor cell area was well bordered with one fibrous capsule and a marked dilatation of superficial blood vessels at the periphery of the
BCC-Associated Amyloidosis
619
2 Fig. 1. An 83-year-old japanese woman, long treated for lepromatous leprosy, with an erythemato-brownish to black colored domeshaped tumor on the dorsum of her nose.
Fig. 2. Scanning view of the tumor (H & E). An almost round tumor is present from the dermis down to the subcutaneous tissue, the center ofwhich gives the impression of being amorphous.
Fig. 3. The epidermis is atrophic and is continuous with the tumor lesion, which is composed of basaloid cells in a palisading arrangement The tumor cells become cord-like toward the center of the lesion, and amorphous materials are seen between tumor cell nests. tumor. Cellular infiltration was minimal. The tumor cell area was composed of nests of typical basal cell carcinoma seen in the so-called palisading arrangement The distribution of tumor cells was very complicated, becoming smaller and cord-like toward the center of the tumor while connective tissue hyperplasia increased (Fig. 3). Round, eosinophilic
bodies were observed in the complicated tumor lesion as if they filled the gaps. These bodies were also distributed in the core of the tumor and stained positively with Dylon stain and Congo red stain, proving them to be amyloid (Fig. 4-a). Closer examination revealed that these bodies were also present, although in small amounts, in the paren-
620
Nojiri et al
Fig. 5. Immunohistochemical staining with antikeratin antibody. Dylon-positive materials stain positively with an antikeratin antibody stain.
~ Fig.
4-a. Dylon stammg. Positively stammg materials are seen between tumor cell cords (nests) and also outside the tumor cell nests. Dylon-positive materials decrease toward the center of the lesion.
