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Expression of Connexin 43 (Cx43) in Benign Cutaneous Tumors With Follicular Differentiation

Fernandez-Flores, Angel MD, PhD*,†; Varela-Vazquez, Adrian; Mayan, Maria D. PhD; Fonseca, Eduardo MD, PhD†,‡

The American Journal of Dermatopathology: November 2019 - Volume 41 - Issue 11 - p 810–818
doi: 10.1097/DAD.0000000000001395
Original Study

Introduction: Benign cutaneous tumors with follicular differentiation are alleged to differentiate toward parts of the hair follicle. Connexin 43 (Cx43) is a gap junction protein, the tumoral role of which has been investigated in several types of tumors.

Objective: To study the pattern of expression of Cx43 in benign cutaneous tumors with follicular differentiation and to compare it with that shown by their alleged anatomical counterparts of the hair follicle.

Materials and Methods: Five cases each of trichofolliculoma, trichilemmoma, fibrofolliculoma/trichodiscoma, trichoblastoma, trichoepithelioma, pilomatrixoma, and proliferating trichilemmal tumor, 3 cases of pilar sheath acanthoma, and 1 case of tumor of the follicular infundibulum were examined. Anti-Cx43 antibody was used.

Results: Cx43 was expressed by all follicular tumors studied. Comparisons between trichoblastoma and trichoepithelioma and their respective normal counterparts could not be made. In 3 tumors (trichofolliculoma, pilomatrixoma, and the spectrum fibrofolliculoma/trichodiscoma), there was a parallelism between their Cx43 expression pattern and that of their alleged anatomical counterparts. In pilar sheath acanthoma, trichilemmoma, and the tumor of the follicular infundibulum, we only found partial similarities in Cx43 expression. Only the proliferating trichilemmal tumor showed a discordant pattern of expression.

Conclusions: Cx43 expression is preserved in benign cutaneous tumors with follicular differentiation and the patterns of Cx43 expression in benign cutaneous tumors with follicular differentiation parallel those of their alleged anatomical counterparts in 5 types (either totally or partially). This preservation might be related to the good behavior of the entities studied.

*Department of Cellular Pathology, Hospital El Bierzo, Ponferrada, Spain;

CellCOM-SB Research Group Department, Institute for Biomedical Research of A Coruña (INIBIC), University of A Coruña (UDC), A Coruña, Spain; and

Department of Dermatology, Universitary Hospital of A Coruña, A Coruña, Spain.

Correspondence: Angel Fernandez-Flores, MD, PhD, Servicio de Anatomía Patologica, Hospital El Bierzo, Medicos sin Fronteras 7, 24411, Ponferrada, Spain (e-mail:

The authors declare no conflicts of interest.

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