title: Basaloid/follicular hyperplasia overlying connective tissue/mesenchymal hamartomas simulating basal cell carcinomas.
abstract: BACKGROUND
  Basaloid hyperplasia has been described overlying dermatofibromas as well as in the epidermis overlying nevus sebaceus. Although the morphology of these areas may resemble that of basal cell carcinoma (BCC), in the majority of cases aggressive behavior of the proliferation is not seen. In fact, the basaloid proliferation often shows follicular differentiation and may be stimulated and maintained by its relationship with the underlying stromal cells.
  
  
  OBJECTIVE
  We wanted to determine whether immunohistochemical staining for antibodies, which may suggest differences in pathogenesis, were different in basaloid hyperplasia overlying connective tissue/mesenchymal hamartomas and BCC.
  
  
  METHODS
  We report 3 cases of connective tissue/mesenchymal hamartomas with overlying basaloid hyperplasia, in which the areas of the basaloid proliferation showed follicular differentiation. Immunohistochemical stains included Ber-EP4, PCNA, Ki-67, Bcl-2, p53, SM-Actin, CD31, factor XIIIa, KP-1, and CD34.
  
  
  RESULTS
  There was a diffuse positive reaction for Ber-EP4 in all specimens and there was increased nuclear staining for PCNA and Ki-67. There was focal cytoplasmic staining for Bcl-2 in the areas of basaloid hyperplasia. Immunohistochemical staining for p53 showed only scattered positive cells except in a small focus in the areas of basaloid hyperplasia. The connective tissue component of all lesions showed diffuse staining for CD34 surrounding areas of basaloid hyperplasia in the mesenchymal component as well as in abundant S-100(+) nerves.
  
  
  CONCLUSIONS
  The areas of basaloid hyperplasia in these hamartomas exhibited an immature phenotype similar to that seen in both BCCs and follicular tumors; however, the patterns of proliferation markers, p53, Bcl-2, and the surrounding stromal cell markers were similar to those of benign follicular tumors. Thus the staining pattern for this group of antibodies suggests that areas of basaloid hyperplasia are not BCC.
authors.affiliation: Department of Dermatology, National Naval Medical Center, Bethesda, Maryland, USA.
authors.forename: M E
authors.initials: ME
authors.lastname: Stashower
authors.forename: K
authors.initials: K
authors.lastname: Smith
authors.forename: D
authors.initials: D
authors.lastname: Corbett
authors.forename: H G
authors.initials: HG
authors.lastname: Skelton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000473:pathology*; D003238:Connective Tissue / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D019254:Genes, bcl-2 / Q000276:immunology; D006222:Hamartoma / Q000276:immunology / Q000473:pathology*; D006801:Humans; D006965:Hyperplasia; D007150:Immunohistochemistry; D012871:Skin Diseases / Q000276:immunology / Q000473:pathology*; D012878:Skin Neoplasms / Q000473:pathology*; D016159:Tumor Suppressor Protein p53 / Q000276:immunology
chemical_list: D016159:Tumor Suppressor Protein p53