Paisley Tie (Tadpole) Differential Diagnosis

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Paisley Tie (Tadpole) Differential Diagnosis

Paisley Tie Tadpole Differential Diagnosis of Adnexal and Basaloid Tumors

Desmoplastic trichoepithelioma is a benign adnexal tumor that presents as a small firm annular papule or plaque most often on the face of young women and is characterized histologically by a well circumscribed dermal proliferation of bland basaloid epithelial strands within a fibroblast rich collagenous stroma. Central dell formation and numerous horn cysts with frequent calcification are classic features. Microcystic adnexal carcinoma is a malignant adnexal neoplasm that shows deeply infiltrative growth extending into subcutis and skeletal muscle with frequent perineural invasion and bi lineage differentiation toward follicular and eccrine structures. It contains superficial horn cysts and small syringoma like ducts and scattered lymphoid aggregates. Syringoma is a benign eccrine duct tumor composed of a circumscribed proliferation of small comma shaped or tadpole shaped ducts lined by a thin layer of cuboidal cells with an eosinophilic cuticle and amorphous luminal contents within a sclerotic stroma limited to the upper dermis and lacking follicular differentiation. Morpheaform basal cell carcinoma is an aggressive variant of basal cell carcinoma characterized by infiltrative sharply angulated strands of atypical basaloid cells within a dense morphea like stroma with numerous mitoses and apoptotic cells and without ductal differentiation lymphoid nodules or prominent horn cyst formation.

Paisley Tie (Tadpole) Differential

  • Tadpoles wearing paisley tie = Paisley tie tadpole differential diagnosis

Desmoplastic Trichoepithelioma

  • Disco tricycle = Desmoplastic trichoepithelioma
    • Doughnut shaped disco ball = Central dell
    • Purple stripes on tricycle = Bland basaloid epithelial strands
    • Magenta and purple swirls = Numerous horn cysts often calcified
    • Pink ropey fibers = Fibroblast rich pink collagenous stroma

Microcystic Adnexal Carcinoma

  • MAC truck with paisley tie design = Microcystic adnexal carcinoma
    • Deep underwater = Deeply infiltrative tumor
    • Fat yellow globs plus pink muscle = Extension into subcutis and skeletal muscle almost always
    • 2 way street = B lineage differentiation
      • Floating pink swirls on follicular pot = Superficial follicular horn cysts
      • Floating coiled snake holding syringe = Small syringoma like sweat ducts in superficial dermis
    • Purple cluster of limes = Scattered lymphoid nodules
    • Bowl of yellow noodles = Perineural invasion

Syringoma

  • Pink coiled snake holding a syringe = Syringoma
    • Tad pole = Circumscribed proliferation of small tadpole or comma shaped sweat ducts lined by a thin layer of cuboidal cells
    • Pink outline = Eosinophilic cuticle within sweat ducts
    • Light pink eyes = Amorphous sweat within the lumen
    • Pink sclerotic dragon only upper body is scaly = Sclerotic stroma confined to upper half of dermis
    • Broken follicular plant = Lacks follicular differentiation

Morpheaform Basal Cell Carcinoma

  • Purple snake morphing into a pink pearl = Morpheaform basal cell carcinoma
    • Bent in sharp angles = Sharply angulated strands of atypical basaloid cells
    • Morphing snake = Morphea like stroma
    • Dark purple dots = Numerous mitoses
    • Popping balloons = Apoptotic cells
    • No limes or coiled snakes = Lacks ductal differentiation and lymphoid nodules
    • One small pink swirl = Fewer horn cysts and calcifications than desmoplastic trichoepithelioma