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an <span class="elsevierStyleItalic">in vivo</span> non-invasive imaging examination at the cellular level&#44; which showed a fenestrated pattern&#44; with the presence of refractive tumor cords&#44; forming anastomoses and islets of basaloid cells&#44; surrounded by fibrous&#44; hyporefractive stroma&#46; Basaloid cells in palisade arrangement were also observed at the periphery of the cords &#40;<a class="elsevierStyleCrossRefs" href="#fig0015">Figs&#46; 3 and 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Histopathological analysis was performed and confirmed the diagnosis of fibroepithelioma of Pinkus &#40;FeP&#41;&#44; characterized by interconnected cords of tumor cells&#44; with peripheral palisade&#44; surrounded by fibrous stroma &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>A&#41;&#46; Immunohistochemical analysis showed the expression of the Ber-EP4 in the cords of tumor cells &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>B&#41;&#46; At the lower limit&#44; structures called germ-papillae&#44; characteristic of FeP&#44; were observed&#46; The histological arrangement corresponds to the fenestrated pattern on confocal microscopy&#44; allowing the safe diagnosis of FeP by this technique&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">FeP is a peculiar and uncommon subtype of basal cell carcinoma&#44; which can be clinically similar to benign tumor lesions&#44; such as intradermal nevus&#44; fibroepithelial polyp&#44; and seborrheic keratosis&#44; among others&#44; which are not routinely excised&#46; Classically&#44; FeP presents as a solitary&#44; cupuliform&#44; normochromic&#44; or brownish papule&#46; Dermoscopy may show polymorphous vessels &#40;thin&#44; focused&#44; short arboriform&#44; dotted&#41;&#44; short white lines&#44; milia-like cysts&#44; brownish-gray areas&#44; and bluish-gray dots&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Histopathology is considered essential for diagnosis&#46; It was described by Pinkus as peculiar and unmistakable&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> it features filaments or anastomosing cords of basaloid cells projecting downwards from the epidermis in a fenestrated pattern&#44; surrounded by abundant fibrous stroma&#46; The periphery of the cords is formed by columnar cells&#44; in palisade arrangement&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> Immunohistochemistry using the Ber-EP4 marker is a useful tool to diagnose neoplasms with follicular germinative differentiation and can be used to corroborate the histopathological diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">In vivo</span> confocal microscopy also shows the characteristic fenestrated pattern&#46; At the level of the dermal-epidermal junction&#44; hyporefrective spaces can be observed&#44; which correspond to the fibrous stroma&#44; surrounded by cords of tumor cells&#44; with greater refraction&#46; Cords and islets of tumor cells show a palisade arrangement at the periphery and canalicular vessels may also be observed&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">FeP often goes underdiagnosed on clinical examination&#46; The clinical characteristics are often nonspecific and dermoscopy may not be sufficient to confirm or rule out other hypotheses&#46; However&#44; the specific pattern revealed by confocal microscopy corresponds to the peculiar histopathological characteristics of FeP&#44; making its diagnosis possible with a higher level of safety and specificity&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;8</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#39; contributions</span><p id="par0050" class="elsevierStylePara elsevierViewall">Gabriella Campos do Carmo das Chagas&#58; Design and planning of the study&#59; data collection&#44; or analysis and interpretation of the data&#59; drafting and editing of the manuscript or critical review of important intellectual content&#59; collection&#44; analysis and interpretation of data&#59; effective participation in research orientation&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; approval of the final version of the manuscript&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">J&#250;lia Bozetti L&#243;ss&#58; Data collection&#44; or analysis and interpretation of data&#59; drafting and editing of the manuscript or critical review of important intellectual content&#59; collection&#44; analysis and interpretation of data&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; approval of the final version of the manuscript&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Gustavo Costa Verardino&#58; Data collection&#44; or data analysis and interpretation&#59; drafting and editing of the manuscript or critical review of important intellectual content&#59; collection&#44; analysis and interpretation of data&#59; approval of the final version of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Letter - Clinical
Fibroepithelioma of Pinkus – confocal microscopy as a diagnostic tool
Gabriella Campos-do-Carmoa,
Corresponding author
dragabriellacampos@gmail.com

Corresponding author.
, Júlia Bozetti Lóssa, Gustavo Costa Verardinob
a Department of Dermatology, Gávea Medical Center, Rio de Janeiro, RJ, Brazil
b Department of Pathology, Microimagem, Rio de Janeiro, RJ, Brazil
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 36-year-old female patient presented with an asymptomatic pigmented lesion on her abdomen during total body mapping examination&#46; The patient had no personal history of skin cancer&#44; although she had already had atypical nevi removed&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Clinically&#44; the lesion appeared as a brownish&#44; sessile papule&#44; measuring approximately 0&#46;8<span class="elsevierStyleHsp" style=""></span>cm &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; On dermoscopy&#44; the presence of multiple bluish-gray dots were seen in the middle of the brownish amorphous area&#44; as well as discrete thin vessels &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Confocal reflectance microscopy was performed&#44; an <span class="elsevierStyleItalic">in vivo</span> non-invasive imaging examination at the cellular level&#44; which showed a fenestrated pattern&#44; with the presence of refractive tumor cords&#44; forming anastomoses and islets of basaloid cells&#44; surrounded by fibrous&#44; hyporefractive stroma&#46; Basaloid cells in palisade arrangement were also observed at the periphery of the cords &#40;<a class="elsevierStyleCrossRefs" href="#fig0015">Figs&#46; 3 and 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Histopathological analysis was performed and confirmed the diagnosis of fibroepithelioma of Pinkus &#40;FeP&#41;&#44; characterized by interconnected cords of tumor cells&#44; with peripheral palisade&#44; surrounded by fibrous stroma &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>A&#41;&#46; Immunohistochemical analysis showed the expression of the Ber-EP4 in the cords of tumor cells &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>B&#41;&#46; At the lower limit&#44; structures called germ-papillae&#44; characteristic of FeP&#44; were observed&#46; The histological arrangement corresponds to the fenestrated pattern on confocal microscopy&#44; allowing the safe diagnosis of FeP by this technique&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">FeP is a peculiar and uncommon subtype of basal cell carcinoma&#44; which can be clinically similar to benign tumor lesions&#44; such as intradermal nevus&#44; fibroepithelial polyp&#44; and seborrheic keratosis&#44; among others&#44; which are not routinely excised&#46; Classically&#44; FeP presents as a solitary&#44; cupuliform&#44; normochromic&#44; or brownish papule&#46; Dermoscopy may show polymorphous vessels &#40;thin&#44; focused&#44; short arboriform&#44; dotted&#41;&#44; short white lines&#44; milia-like cysts&#44; brownish-gray areas&#44; and bluish-gray dots&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Histopathology is considered essential for diagnosis&#46; It was described by Pinkus as peculiar and unmistakable&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> it features filaments or anastomosing cords of basaloid cells projecting downwards from the epidermis in a fenestrated pattern&#44; surrounded by abundant fibrous stroma&#46; The periphery of the cords is formed by columnar cells&#44; in palisade arrangement&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> Immunohistochemistry using the Ber-EP4 marker is a useful tool to diagnose neoplasms with follicular germinative differentiation and can be used to corroborate the histopathological diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">In vivo</span> confocal microscopy also shows the characteristic fenestrated pattern&#46; At the level of the dermal-epidermal junction&#44; hyporefrective spaces can be observed&#44; which correspond to the fibrous stroma&#44; surrounded by cords of tumor cells&#44; with greater refraction&#46; Cords and islets of tumor cells show a palisade arrangement at the periphery and canalicular vessels may also be observed&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">FeP often goes underdiagnosed on clinical examination&#46; The clinical characteristics are often nonspecific and dermoscopy may not be sufficient to confirm or rule out other hypotheses&#46; However&#44; the specific pattern revealed by confocal microscopy corresponds to the peculiar histopathological characteristics of FeP&#44; making its diagnosis possible with a higher level of safety and specificity&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;8</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#39; contributions</span><p id="par0050" class="elsevierStylePara elsevierViewall">Gabriella Campos do Carmo das Chagas&#58; Design and planning of the study&#59; data collection&#44; or analysis and interpretation of the data&#59; drafting and editing of the manuscript or critical review of important intellectual content&#59; collection&#44; analysis and interpretation of data&#59; effective participation in research orientation&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; approval of the final version of the manuscript&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">J&#250;lia Bozetti L&#243;ss&#58; Data collection&#44; or analysis and interpretation of data&#59; drafting and editing of the manuscript or critical review of important intellectual content&#59; collection&#44; analysis and interpretation of data&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; approval of the final version of the manuscript&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Gustavo Costa Verardino&#58; Data collection&#44; or data analysis and interpretation&#59; drafting and editing of the manuscript or critical review of important intellectual content&#59; collection&#44; analysis and interpretation of data&#59; approval of the final version of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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ISSN: 03650596
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