Basalioma (basal cell carcinoma)
A Basale-cellular cancer (basalioma, basale-cellular epithelioma, ulcus rodens, epithelioma basocellulare) is a tumor of the skin with the expressed destructive growing, and the propensity to the relapse, as a rule, it does not metastasizein. The term “basalioma " is more widely accepted in our literature.
Reasons of basalioma
A question about a histogenesis is not solved, most researchers believe in dysontogenetic theory of origin, in obedience to that basalioma develops from totipotential cells. They can be differentiated in different directions. In the development of basale-cellular chasse, the doctor draws his attention to the genetic factors, immune violations, unfavorable external influences (intensive insolation, contact with carcinogenic substances). It can develop on the clinically unchanged skin, and on a background, various skin pathologies (senile keratosis, radio dermatitis, tubercular lupus, nevus, psoriasis of and other).
Basalioma is a slowly metastasizing basale-cellular cancer, rising up in an epidermis or hair follicles the cells of which are similar to the cells of epidermis. Basalioma is not examined as a cancer or of a high quality new formation, but as a special family tumor with a deconstructive growing. Sometimes under the influence of strong carcinogens, foremost X-rays, basalioma passes into basale-cellular carcinoma. A question about the histogenesis of basaliomais remained unknown. Some scientists consider that basaliomas develop from a primary ephithelial rudiment, other - from all epithelial structures of the skin, including the embryonic rudiments and teratosiss.
Precipitating factors are insolation, ultraviolet emission, x-rays, burns, medication taking of arsenic. Therefore basalioma often attacks the people with the I and II type of skin and albinos that are exposed to intensive insolation. It is set that excessive insolation in childhood may overgrow into tumour.
The symptoms of a skin basalioma
Basalioma of skin is the single elaboration that has a semispherical form, often with the rounded outlines, insignificantly overpeering above the level of skin; it has pink or greyish-red color with a pearl tonality, but does not differ from a normal skin. The surface of tumour is smooth, in the center of it there is usually small impaction covered by a thin, loosely adherent ichor scaly-bark, the anabrosis is diagnosed in most of the cases, after removing this bark. The edge of the ulcerated element is iliac rolled and consists of the shallow knots of whitish color, designated usually as "pearls" and having a diagnostic value. In such state, a tumour can exist for years, slowly increasing.
Basalioma can be multifocal. Initially- multifocal form of basalioma, according to K.V Daniel -Bek and A.A Kolobyakova (1979), happens in 10% of cases, the amount of tumour hearths can gain several dozens and more, that can be the the symptom of cellular growth of Gorlin-Goltz symptomndrom.
All symptoms of basalioma of skin (basale-cellular cancer), including the Gorlin-Goltz syndrome allow the doctor to distinguish the next forms of basaliomas: knotted-ulcerous (ulcus rodens), superficial, morphea-like (type of morphea) pigmental and fibroplastic. In the presence of the numerous affected areas, the indicated clinical forms can be observed in different combinations.
A superficial form begins with the appearance of a limited peeling spot of the pink coloring. Then a spot acquires clear contours of oval, rounded or wrong form. Dense shallow gleaming knots that interlock and make raised above the level of skin iliac roll on the periphery of the affected area. The center of the affected area falls back insignificantly. The color of it becomes darkly pink, brown. The affected area can be isolated or multifocal. Among the superficial forms, we distinguish self-scaring or pagetoid basalioma with the zone of atrophy (or scarring) in a center or dense, opalescent tumular elements on periphery. The affected area becomes large. Usually it has a plural character and long-lasting flow. It develops slowly and according to the clinical signs can remind illness of Bowen.
In the presence of the pigmental form of basalioma, the affected area has the bluish, violet or umber colouring. This form is very alike to the step melanoma, especially on key, but has more dense consistency. In such case, dermatoscopy can make a difference.
The tumour form of is basalioma characterized with the origin of knot that gradually increases in sizes, and becomes one, 5-3 cm and more in a diameter, it acquires the rounded form and has stagnant-pink colour. The surface of tumour is smooth with expressed telangiectasis, sometimes covered by greyish scales. Sometimes the central part ulcerates and is covered by dense crusts. Rarely a tumour comes forward above the level of skin and has a fibro epithelial type. Small and large nodular lesion is distinguished depending on a size.
The ulcerous form of basalioma arises up as a primary variant or because of ulcerating of superficial or tumour form of new formation. The characteristic sign of ulcerous form is the funnel-shaped ulcerating that has massive, soldered with subject to fabrics infiltration (tumour infiltration) with unclear borders. Sizes of infiltration are a considerably larger than the ulcer (ulcus rodens). Deep ulcerating and destruction of subject to fabrics is marked. Sometimes papillomatous, warty excrescences accompany an ulcerous form.
Morphea-like, or cicatrical-atrophic, a form is a small, clearly delimited affected area with a compression in founding, almost not overpeering above the level of skin that has a yellow-whitish color. Atrophic changes, dyschromia, can become known in a center. Periodically on periphery of the element can be present erosions of different size, covered by the easily separated crust, that very substantially for realization of cytologic diagnostics.
Fibroepithelial tumour of Pincus is attributed to the variety of basalioma, although this kind of tumor passes more favorable. Clinically it shows up as a knot or nameplate of color of the skin, has a close-elastic consistency and practically is not exposed to erosion.
Histopathology of basalioma of skin
Epidermis is slightly atrophied sometimes ulcerated; excrescence of tumor basophilic cells similar with the cages of basale layer is marked. Anaplasia is less evident, there are small mitosises. Basalioma metastasizes rarely, as the tumor cells, getting in the current of blood are incapable of proliferation because of the lack of the factor of the height produced by the stroma of tumor.
Pathomorphology of basalioma of skin
Histological Basel-cell cancer is divided in two types - undifferentiated and differentiated. To the undifferentiated group belong solid, pigmental, morphealike and superficial basalioma, to differentiated - keratoticum (with a piloid embryonization) cystophorous and adenoids (with a ferrous embryonization) and basalioma with a greasy embryonization.
In international classification of WHO (1996) the following morphological variants of basale-cellular chasse are distinguished: superficial multicentric cancer, codular (solid, adenocystic), infiltrative, non-sclerogenic, sclerogenic (desmoplastic, morphea-like), fibroepithelial; basale-cellular cancer with a processing embryonization - a follicle, eccrin, keratomyc.
However, the morphological border of all varieties is unclear. For example, in a heterotype tumor can be structures of adenoids and, on the opposite, under the organoid structure are observed the focus of immature cells. In addition, there is no complete accordance between the clinical and histological pictures. Usually there is accordance only in such forms, as superficial, fibro- epithelium, morphea-like and pigmental.
In the presence of basalioma, the main histological criterion is a presence of typical complexes from ephithelial cells with the darkly painted oval kernels in the central part and located on the periphery of the complexes.
These cells remind the basale cells of epidermis, but differ from the last with the absence of intercellular bridges. Their kernels as a rule are monomorph and anaplasias are not liable. Connective stroma proliferates together with the cellular component of tumor; it is situated as bunches among cellular fiber bands, dividing them into lobules.
Storm is dense in glycosaminoglycans, painted chromic toluidine blue. It also contains many tissue basophiles between a parenchyma and stroma there are retraction cracks that are considered as an artifact of fixing, however, the probability of influence of surplus secretion of the hyaluronidase is not denied.
Among undifferentiated forms, a solid basale-cellular cancer is met most often. Histologically it consists of different tenias with forms and sizes and nucleus of compactly located basaloid cells with unclear borders, reminding syncytium the similar complexes of basaloid cells on periphery are surrounded by prolate elements formative the characteristic "paling". Cells in the center of these complexes can be exposed to the dystrophic changes with forming of cystophorous cavities. Thus, along with solid structures can exist cystophorous, forming a solidly-cystophorous variant. Sometimes the destructive masses as cellular detritus are encrusted by salts of calcium.
Pigment basale-cellular cancer is a histologically characterized diffuse pigmentation and connections with a presence in cells of melanin. There is a plenty of Melanophage with high maintenance of granules of melanin in the stroma of tumor. Usually, the enhanceable amount of pigment is exposed in the presence of a cystophorous variant, rarer at solid and superficial multicentric one. Basaliomas with the expressed pigmentation contain much melanin in the cells of epidermis above a tumor, in all its layer up to a horny one.
A superficial basal-like cancer is often multifocal. Histologically, it consists of the shallow, plural solid complexes related to the epidermis, as "suspended" to it, it occupies only overhead part of derma to the reticular layer. In the stroma lymphohysteocytic infiltrates are discovered often. Multiplicity of the affected areas is a reflection of the fact of the Multicentric genesis of the tumor. Superficial basalioma often recurrents after the treatment on the periphery of the scar.
Morphea-like a basale-cellular cancer, or type of "morphea', differs in the abundant development of connecting tissue of the morphea-like kind, in the presence of which the taenia of basaloid cells spreading deeply in a derma up to a hypoderm, is "walled". Polysadic of structure can be seen only in large fiber bands and cells. Reactive infiltration round the tumor complexes is located among the massive connective stroma, as a rule, is scanty and more shown in the zone of active height on the periphery. Further progress and destructive change happen in the formation of fewer and larger cystophorous cavities. Sometimes the destructive masses as cellular detritus are encrusted by salts of calcium.
A Basale-cellular cancer with a ferrous embryonization, or type of adenoids of basalioma, is characterized by the presence of not only the solid areas, but narrow ephithelial fiber bands consisting of a few, and sometimes 1-2 rows of cells, forming tubular or alveolar structures.
The peripheral cells of the last one have a cube form, palisade shaped character is absent.
The internal cells are larger, sometimes with the expressed cuticle, the cavities of tubes or alveolar structures are filled with an epithelial mucin. A reaction with a carcinoembryonic antigen gives the positive painting of extracellulary mucin on the surface of the cells, covering ductlike structures.
A Basale-cellular cancer with a cycloidal embryonization is characterized by the presence of the affected area in the complexes of basaloid cells, surrounded by the cells similar with acanthceous.
A cornification in these cases takes place after the keratohyalin stage, that reminds the keratogen zone of isthmus of normal hair follicles and can have a the trich-like embryonization.
Sometimes there are immature doubled follicles with the initial signs of forming of hair bars. The structures, reminding embryonic hair rudiments, and also the cells, containing a glycogen, to the cells of periblast of bulb of hair, are formed in some variants.
Sometimes there can be difficulties in differentiation of the follicle and basaloid hamartoma.
A Basale-cellular cancer with greasy differentiation is met rarely, and is defined by the appearance of the affected areas or the separate cells typical for oil-glands among the basaloid cells.
Some of them are large, castration cells, with a light cytoplasm and eccentrically located kernels. The fat appears under a color with Sudan III. Fat-containing cells are less differentiated, than in a normal oil-gland, between them and surrounding basaloid cells the transitional forms are observed.
It goes to show that this type of basalioma is histogenetically related to the oil-glands.
Fibroepithelial type of basale-cellular chasse is a rare variety of basalioma appearing in the lumbosacral area, can combine with a seborrheal keratosis and superficial basalioma. Clinically it looks as fibropapilloma. The cases of a multifocal defeat are described.
Histologically, in derma narrow and long fiber band of basaloid cells are found, walking away from an epidermis, surrounded by hyperplastic, often oedematous mucoid –degenerationing stroma with plenty of desmocytes. Stroma is rich in capillaries and tissue basophilies. Ephithelial fiber band anastomose against each other and, consist of shallow dark cells with the small amount of cytoplasm and kernels rounded or oval, intensively painted.
Sometimes there are the shallow cysts in similar fiber bands filled with homogeneous eosinophilic content or the horny masses.
Nevobasalioma (syn. The syndrome of Gordin - Goltz) is a polyorganotropic, autosomal dominant syndrome related to phacomatosis.
A complex of hyper - or neoplasty changes on soil of violations of embryonic development is the main reason of it.. A cardinal symptom is the multifocal basalioma with the cysts of jaws and anomaly of ribs on the early periods of life. Cataract and serious changes in the central nervous system are also possible.
It is also characterized by the frequent changes of hands and soles as "depression" in which we may also find basaloid structures.
Over the tears after an early nevoid-basaliomatic phase, usually in an adolescent period, on these areas appear ulcerous and locally malignant forms that talk about the beginning of the oncologic phase.
Histological changes in the presence of this syndrome are similar to the varieties of the basaliomas listed above. In the area of palm-sole “depressions”, there are defects of horny layer of epidermis with thinning of other its layers and appearance of the additional epithelial sprouts from shallow typical basaloid cells serious basaliomas in these areas develop rarely.
The separate basale-cellular hearths of linear character are plugged in itself by all variants of organoid basaliomas.
Histogenesis of basalioma of skin
Basalioma can develop both from the cells of epidermis and from the epithelium of pilosebaceous unit. The serial cuts of М. Hundeiker and Н. a Berger (1968) show that in 90 % cases a tumor develops from an epidermis. Histochemistry research of different varieties of basalioma shows that most of the cells contain glycogen, glycosaminoglycans in the stroma of the tumor, especially in case of adamantinoma and cylindromatous spiradenoma. Glycoprotein constantly becomes known in basal membranes.
The electronic microscopy shows that the cells of the tumor complexes contain the standard set of organoids: shallow mitochondria with a dark matrice and free polysomes. In the areas of contact intercellular bridges are absent, but finger-shaped projections and small amount of demo capable;e contacts are being observed. In the places of keratinizing the layers of cells contain safe intercellular bridges and plenty of tonofilament in a cytoplasm. Occasionally the doctors find out the zones of cells containing cellular membrane complexes that can be interpreted as a display of ferrous embryonization. A presence of melanosome in some of cells is the sign of pigmental embryonization. In basaloid cell the organoids, that are characteristic for mature epithelial colony-formings are absent, that suggesting that the cells are immature.
At the present time, the doctors consider that this tumor develops from pluripotent germinative cells of epithelium under act of different sort of external irritants. Histologicaly and histochemicaly is well proven the connection of basale-cellular chasse with the anagenesis stage hair growth and likeness with the proliferating embryonic rudiments of hair. R. Нolunar (1975) and М. Kumakiri (1978) consider that this tumor develops in the germinative layer of ectoblast, where immature basaloid cells appear with potency to the embryonization.
Differential diagnostics of basalioma of skin
basalioma must be distinguished from self-healing epithelioma, chancriform pyoderma, illness of Bauen, seborrheic eczema, Lichen Sclerosis, malignant melanoma, lymphocytoma of skin.
Treatment of basalioma of skin
Treatment of basalioma of skin (basale-cellular chasse) is this surgical oncotomy within the limits of healthy skin. In practice often, apply a cryolysis. Radial therapy is used in those cases, when an operation results in a cosmetic defect.
You are to use colchaminum and prospidinum ointments.