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    AAD BF Paisley Tie Diagnosis

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    AAD BF Paisley Tie Diagnosis

    Uploaded by

    kahkashanahmed065
    96 views2 pages

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    96 views2 pages

    AAD BF Paisley Tie Diagnosis

    Uploaded by

    kahkashanahmed065

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    DermWorld

    directions in residency A Publication of the American Academy of Dermatology | Association

    boards fodder
    Paisley tie differential diagnoses
    By Sujitha Yadlapati, MD, and Thomas Davis, MD, FAAD
    Diagnosis Histopathologic Clinical features and Histology image
    features associations
    Desmoplastic • Central dell • Also known as a scle-
    trichoepithelioma • Tadpole-shaped rosing epithelial ham-
    cords and strands artoma, sometimes
    • Pink collagenous associated with a
    stroma melanocytic nevus
    • Respects the der- • Solitary, firm, flesh-
    mal subcutaneous colored papule with
    junction; often has central dell. The clas-
    a horizontal growth sic presentation is on
    pattern. the cheek of a young
    • Horn cysts with cal- woman.
    cification common
    • Clefts between
    collagen fibers
    within stroma ver-
    sus epithelium and
    stroma as seen in
    morpheaform BCC

    Microcystic adnexal • Deeply infiltrative • Indurated plaque on


    carcinoma (MAC) tumor the upper lip, cheek,
    • Bland basaloid or chin
    strands in the der- • More common in mid-
    mis dle-aged and older
    • Bi lineage differen- adults
    Sujitha tiation (horn cysts – • High recurrence rate
    Yadlapati, follicular differentia-
    tion; tadpole ducts
    MD, is a PGY-2 – sweat duct differ-
    dermatology resident entiation)
    at HCA Healthcare • Frequently exhibits
    Corpus Christi perineural invasion
    Medical Center-Bay • Lymphoid aggre-
    Area Program. gates

    Morpheaform Basal • Thin cords of basa- • Indurated firm plaque


    cell carcinoma loid cells invading resembling a scar in
    the dermis an older individual.
    • Sclerotic stroma
    • Clefting between
    epithelium and
    stroma (if present)
    • Mitoses and apop-
    totic cells often
    present
    • May demonstrate
    perineural invasion

    Thomas Davis, Syringoma • Islands or clusters • Cheek, under the eyes


    of tadpole-shaped in young women
    MD, FAAD, is a sweat ducts in • Clear cell variant can
    dermatopathologist
    dense sclerotic be noted in diabetes
    with Sagis Diagnostics background stroma. • Common in Asian
    in Dallas and serves • Lacks follicular women, and children
    as vice-president of differentiation with Down syndrome
    education for the • Eruptive syringomas
    organization. can be noted on the
    chest, back, or penis.

    p. 1 • Winter 2021 www.aad.org/DIR


    boards fodder
    Paisley tie differential diagnoses
    By Sujitha Yadlapati, MD, and Thomas Davis, MD, FAAD

    Characteristics of Paisley tie pattern tumors


    Characteristic MAC Desmoplastic Syringoma Morpheaform BCC
    trichoepithelioma
    Paisley tie pattern Yes, throughout Yes Yes Sometimes super-
    the tumor ficially
    Stroma Red, sclerotic Red, sclerotic Red, sclerotic Red, sclerotic; may
    have mucin
    Horn cysts Common Common Occasional (lacks fol- Occasional
    licular differentiation)
    Calcification Rare Common Rare Rare
    Deeply invasive Yes (a hallmark of No No Can be
    MAC)
    Perineural invasion Yes No No Yes
    Central dell No Yes No No
    Clinical presentation Firm plaque on the Firm papule on the Small papules on lower Indurated scar-like
    upper lip, medial cheek of a young lids, common with plaque in an older
    cheek, or chin female Down syndrome, and in individual
    Asian females
    References:
    1. Elston, D. “Sweat gland neoplasms.” Dermatopathology, by Dirk M. Elston et al., 3rd ed., Elsevier, 2019, pp. 88-9.
    2. Elston, D. “Pilar and sebaceous neoplasms.” Dermatopathology, by Dirk M. Elston et al., 3rd ed., Elsevier, 2019, pp. 72.
    3. Rapini, R. “Sweat Gland neoplasms.” Practical Dermatopathology, by Ronald P. Rapini, 3rd ed., Elsevier Health Sciences,
    2012, pp. 286-8.

    p. 2 • Winter 2021 www.aad.org/DIR

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