Advanced differentiation in trichoepithelioma and basal cell carcinoma investigated by immunohistochemistry against neurofilaments

Basal cell carcinoma (BCC) and trichoepithelioma (TE) are sometimes diagnostic challenges for the pathologist in terms of their differential diagnosis. Although literature is quite rich in information about histologic and immunohistochemical clues to distinguish the differences between both, no single finding must be completely reliable. Moreover, some consider that TE is a better differentiated follicular tumour, while BCC represents a less developed stage in differentiation. For instance, the latter opinion is supported by the evidence of follicular papillae in TE. The formation of a perifollicular nerve plexus happens later than the formation of the follicular papillae in the development of a normal follicle. The study of the presence of the perifollicular nerve plexus in both tumours which could then provide us with evidence on the stage of differentiation of both tumours. 5 cases of TE and 10 cases of BCC were randomly selected from our archives and an immunohistochemical study for neurofilaments was performed in all the cases. We found a peritumoural nerve plexus in all the cases (TEs and BCCs). Since this plexus is a late sign of differentiation and since both types of neoplasias share it, we conclude that TE and BCC are both terminally differentiated neoplasms. The ability of BCC to infiltrate would have more to do with the acquisition by the tumour of such a property, rather than with a stage of indifferentiation.