title: Does the panel of cytokeratin 20 and androgen receptor antibodies differentiate desmoplastic trichoepithelioma from morpheaform/infiltrative basal cell carcinoma?
abstract: BACKGROUND
  Evaluation of androgen receptor (AR) and cytokeratin 20 (CK20) expression can aid in distinguishing between conventional basal cell carcinoma (characteristically AR+, CK20-) and trichoepithelioma (frequently AR-, CK20+). Within these two groups of tumors, morpheaform/infiltrative basal cell carcinoma (mBCC) and desmoplastic trichoepithelioma (DTE) are particularly challenging to differentiate both clinically and histologically. We investigated whether AR and CK20 immunostains may distinguish between mBCC and DTE.
  
  
  METHODS
  Immunohistochemistry for AR and CK20 was performed on 15 DTEs and 31 mBCCs. Any immunoreactivity within the tumor for AR or CK20 was considered positive.
  
  
  RESULTS
  AR expression was seen in 13% (2/15) of DTE and 65% (20/31) of mBCC cases (chi-square p = 0.0011). CK20-positive Mërkel cells were identified in 100% (15/15) of DTE and 3% (1/31) of mBCC (chi-square p < 0.0001). The expected pattern of AR-, CK20+ immunophenotype was present in 87% (13/15) of DTE cases. In mBCC, 61% (19/31) was AR+, CK20-. No DTE was AR+, CK20- and no mBCC was AR-, CK20+.
  
  
  CONCLUSIONS
  Immunohistochemical stains for AR and CK20 are useful to differentiate DTE from mBCC. The AR-, CK20+ immunophenotype is sensitive (87%) and specific for DTE (100%). The AR+, CK20- immunophenotype is specific (100%) and moderately sensitive (61%) for mBCC.
authors.affiliation: Department of Pathology, Indiana University School of Medicine, Indianapolis, IN 46259, USA. tmkatona@iupui.edu
authors.forename: Terrence M
authors.initials: TM
authors.lastname: Katona
authors.forename: Susan M
authors.initials: SM
authors.lastname: Perkins
authors.forename: Steven D
authors.initials: SD
authors.lastname: Billings
mesh_terms: D002280:Basal Cell Carcinoma / Q000378:metabolism* / Q000473:pathology; D003937:Diagnosis, Differential; D006801:Humans; D007150:Immunohistochemistry; D053554:Keratin-20 / Q000096:biosynthesis*; D018295:Neoplasms, Basal Cell / Q000378:metabolism*; D011944:Receptors, Androgen / Q000096:biosynthesis*; D012878:Skin Neoplasms / Q000378:metabolism* / Q000473:pathology
chemical_list: D053554:Keratin-20; D011944:Receptors, Androgen