Abstract
The “rippled pattern” is a histomorphologic pattern of alternating chords of cells and stroma forming a pattern that resembles the ripples seen in a body of water or dessert sand. Tumors that are more commonly known to display this pattern include sebaceomas and trichoblastomas. Few rippled basal cell carcinomas (BCC) have been documented in the literature. One study evaluated 650 BCC specimens and only found only one example of a rippled BCC.(1) Mayo Clinic received a pathology consult for a biopsy specimen taken from a 41-year-old male. The specimen demonstrated a dense infiltrate of basaloid cells with intervening strands of pale stroma and scattered collections of mucin. The ripple-pattern tumor cells were arranged into larger lobules with collagenous septae and relative sparing of the superficial dermis. Immunostains for BerEP4, BCL2, KRT5 were strongly positive while KRT20, CEA, EMA and AR stains were negative. Staining for mismatch repair proteins and p40 was intact. This case is presented out of interest given its rarity and striking histopathology. References: 1 MISAGO, N., TSURUTA, N. and NARISAWA, Y. (2012), Rippled-pattern basal cell carcinoma. The Journal of Dermatology, 39: 632-635.
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