Premalignant Fibroepithelial Tumor (Pinkus Tumor) Workup

  • Author: Darius Mehregan, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 24, 2012
 

Procedures

The diagnosis can be easily confirmed by performing a skin biopsy.

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Histologic Findings

The classic fibroepithelioma of Pinkus typically shows long, thin, branching and anastomosing strands of basal cell carcinoma embedded in a loose fibrovascular stroma. Many strands show a connection with the epidermis. The basaloid strands show 2 distinct-appearing cells. A lighter staining cell comprises the bulk of the strand. Scattered, small groups of darker cells are seen tapering off the main trunk in a palisading arrangement like buds on a branch.

Nuclear pleomorphism may be present, and staining with proliferation markers such as Ki-67 shows an increased proliferative index.[14] Coexpression of androgen receptor and cytokeratin 20, a marker for the presence of Merkel cells within islands of basaloid cells, may aid in the diagnosis of fibroepithelioma of Pinkus.[15] The tumor is superficial and well demarcated at its lower border. It bears strong histologic resemblance to reticulated seborrheic keratosis but lacks a typical horn and pseudohorn pearls. Hyperkeratosis is rarely present.

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Contributor Information and Disclosures
Author

Darius Mehregan, MD  Associate Professor, Hermann Pinkus Chairman of Dermatology, Department of Dermatology, Wayne State University; Clinical Associate Professor of Pathology, University of Toledo; Dermatopathologist, Pinkus Laboratory; Consulting Staff, Department of Dermatology, J Dingell Veterans Affairs Medical Center

Darius Mehregan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society of Dermatopathology, International Society of Dermatology, International Society of Dermatopathology, Phi Beta Kappa, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Jennifer Michelle Heyl, MD  Resident Physician, Department of Dermatology, Wayne State University School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Maureen B Poh-Fitzpatrick, MD  Professor Emerita of Dermatology and Special Lecturer, Columbia University College of Physicians and Surgeons; Professor of Medicine (Dermatology), University of Tennessee Health Science Center College of Medicine

Maureen B Poh-Fitzpatrick, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and New York Academy of Medicine

Disclosure: Lundbeck, Inc. Honoraria Review panel membership; Clinuvel Pharmaceuticals, Ltd. Honoraria Consulting

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD  Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology

Disclosure: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, David Pegouske MD, to the development and writing of this article.

References

  1. Pinkus H. Premalignant fibroepithelial tumors of skin. AMA Arch Derm Syphilol. Jun 1953;67(6):598-615. [Medline].

  2. Matsumura Y, Nishigori C, Yagi T, Imamura S, Takebe H. Characterization of p53 gene mutations in basal-cell carcinomas: comparison between sun-exposed and less-exposed skin areas. Int J Cancer. Mar 15 1996;65(6):778-80. [Medline].

  3. Aszterbaum M, Rothman A, Johnson RL, Fisher M, Xie J, Bonifas JM, et al. Identification of mutations in the human PATCHED gene in sporadic basal cell carcinomas and in patients with the basal cell nevus syndrome. J Invest Dermatol. Jun 1998;110(6):885-8. [Medline].

  4. Sellheyer K, Nelson P, Kutzner H. Fibroepithelioma of Pinkus is a true basal cell carcinoma developing in association with a newly identified tumour-specific type of epidermal hyperplasia. Br J Dermatol. Jan 2012;166(1):88-97. [Medline].

  5. Tarallo M, Cigna E, Fino P, Lo Torto F, Corrias F, Scuderi N. Fibroepithelioma of Pinkus: variant of basal cell carcinoma or trichoblastoma? Case report. G Chir. Jun-Jul 2011;32(6-7):326-8. [Medline].

  6. Ioannidis O, Papaemmanuil S, Kakoutis E, Papadopoulos G, Chatzopoulos S, Kotronis A, et al. Fibroepithelioma of pinkus in continuity with nodular basal cell carcinoma: supporting evidence of the malignant nature of the disease. Pathol Oncol Res. Mar 2011;17(1):155-7. [Medline].

  7. Stern JB, Haupt HM, Smith RR. Fibroepithelioma of Pinkus. Eccrine duct spread of basal cell carcinoma. Am J Dermatopathol. Dec 1994;16(6):585-7. [Medline].

  8. Pan Z, Huynh N, Sarma DP. Fibroepithelioma of pinkus in a 9-year-old boy: a case report. Cases J. 2008;1(1):21. [Medline].

  9. Hartschuh W, Schulz T. Merkel cell hyperplasia in chronic radiation-damaged skin: its possible relationship to fibroepithelioma of Pinkus. J Cutan Pathol. Sep 1997;24(8):477-83. [Medline].

  10. Bryant J. Fibroepithelioma of Pinkus overlying breast cancer. Arch Dermatol. Mar 1985;121(3):310. [Medline].

  11. Warner TF, Burgess H, Mohs FE. Extramammary Paget's disease in fibroepithelioma of Pinkus. J Cutan Pathol. Oct 1982;9(5):340-4. [Medline].

  12. Heymann WR, Soifer I, Burk PG. Penile premalignant fibroepithelioma of Pinkus. Cutis. May 1983;31(5):519-21. [Medline].

  13. Zalaudek I, Leinweber B, Ferrara G, Soyer HP, Ruocco E, Argenziano G. Dermoscopy of fibroepithelioma of pinkus. J Am Acad Dermatol. Jan 2005;52(1):168-9. [Medline].

  14. Naeyaert JM, Pauwels C, Geerts ML, Verplancke P. CD-34 and Ki-67 staining patterns of basaloid follicular hamartoma are different from those in fibroepithelioma of Pinkus and other variants of basal cell carcinoma. J Cutan Pathol. Nov 2001;28(10):538-41. [Medline].

  15. Katona TM, Ravis SM, Perkins SM, Moores WB, Billings SD. Expression of androgen receptor by fibroepithelioma of Pinkus: evidence supporting classification as a basal cell carcinoma variant?. Am J Dermatopathol. Feb 2007;29(1):7-12. [Medline].

  16. Barr RJ, Herten RJ, Stone OJ. Multiple premalignant fibroepitheliomas of Pinkus: a case report and review of the literature. Cutis. Mar 1978;21(3):335-7. [Medline].

  17. Jaffe ES. Premalignant fibroepithelioma of Pinkus. Arch Dermatol. 1964;89:768.

  18. Lever WF, Schaumberg-Lever G. Fibroepithelioma. In: Histopathology of the Skin. Philadelphia, Pa: Lippincott; 1983:570.

  19. Mehregan AH. Proliferation of sweat ducts in certain diseases of the skin. Am J Dermatopathol. 1981;3(1):27-31. [Medline].

  20. Val-Bernal JF, Gómez-Ortega JM, Fernández-Llaca H, Gómez-Román JJ. Fibroepithelioma of pinkus with tumor giant cells. Am J Dermatopathol. Aug 2002;24(4):336-9. [Medline].

 
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