Trichoblastoma: management of a rare skin lesion

Trichoblastoma and breast carcinoma as metachronous primary tumors: Case report

INTRODUCTION AND IMPORTANCE

The occurrence of more than one tumor originating from the same or different organs is the definition of multiple primary tumors. According to the time of diagnosis, these tumors are classified into two types: metachronous and synchronous tumors. Trichoblastoma is a rare benign skin tumor that is rarely involved in multiple primary tumors, especially in patients with breast cancer.

CASE PRESENTATION

A 60-year-old male with left breast and lateral chest wall masses. Lastly, he has been diagnosed with invasive ductal carcinoma of the left breast and chest wall trichoblastoma as metachronous primary tumors with no significant genetic background.

CLINICAL DISCUSSION

With the development in the medical field, such tumors are being encountered more. Some authors suggest a relationship between these tumors and genetic mutations. Although rare trichoblastomas can be transformed into malignant tumors and get metastasized.

CONCLUSION

The diagnosis and management of primary tumors can be challenging in some cases. Researchers should focus on further exploration of the genetic bases and risk factors of such tumors.

A case of racemiform trichoblastoma in a dog

Trichoblastoma, which is common in dogs, is now occurring with other cellular changes outside the recognized forms to warrant their continuous evaluation for proper elucidation even as their causes largely remain unknown. A case at hand involved a 9-year-old Caucasian dog, which weighed 35 kg with chief complaint of a progressive bleeding mass on the scalp. The dog had an up-to-date vaccination record and all vital parameters were within optimum ranges. The surgical excision of the firm, solitary, and alopecic mass with traumatized upper surface revealed the presence of a well-demarcated and unencapsulated mass composed of grapes-like nests of basaloid epithelial cells within follicular stroma devoid of stromal necrosis, inflammatory cellular infiltration, and neoplastic epidermal connection. However, there was tissue necrosis, hemorrhages, and inflammatory cellular infiltrates on the exposed upper part of the traumatized growth. Immunohistochemical analysis showed positive reactivity to AE1/AE3, CK5/6, and p63 but negative immunoreactivity to CK7, CK20, CEA, and TTF-1. The histomorphological and immunohistochemical evaluation of the mass on the scalp of the dog suggested a solitary racemiform trichoblastoma with a traumatized exposed upper part despite basal cell carcinoma mimicry where histological diagnosis currently hold sway over immunohistochemical evaluation.

Trichoblastoma mimicking basal cell carcinoma and the approach to its management: Case report

INTRODUCTION AND IMPORTANCE

Trichoblastoma is a benign and rare cutaneous lesion with striking resemblance to basal cell carcinoma. However, the course of the illness varies significantly from basal cell carcinoma. It usually takes a less malicious route and causes minimal harm to the patient,unlike basal cell carcinoma where it can be aggressive and requires additional radiotherapy. Therefore, being able to differentiate them from one another is crucial to properly set a management plan.

CASE PRESENTATION

A 44-year-old Saudi male, diagnosed with basal cell carcinoma of the scalp in Dammam Medical Centre (DMC) and was referred to our hospital for re-excision of positive margins. Slide review of the histopathology samples in our hospital showed features consistent with trichoblastoma. This was further confirmed by a dermahistopathologist.

CLINICAL DISCUSSION

This rare benign tumour has posed multiple challenges in the clinical setting as not enough studies were conducted in order to dictate a proper management course. However, current management approach to the majority of skin lesions rely on the histopathological subtype and surgical excision. Many benign and malignant dermatological entities may mimic basal cell carcinoma, and therefore misdiagnosis can lead to either unnecessary excision or delayed treatment of metastatic disease. It is important to request the proper investigations to ease the process of diagnosis and more importantly, the process of differentiation.

CONCLUSION

Differentiating the two tumours from one another allows for the initiation of proper treatment early resulting in an improved prognosis for both lesions. The gold standard investigation to diagnose and differentiate between them is a surgical biopsy. Trichoblastoma typically has a favourable prognosis with a low incidence of recurrence or progression.

Extensive Facial Trichoblastoma - A Rare and Disfiguring Condition

Patient: Female, 62-year-old

Final Diagnosis: Trichoblastoma

Symptoms: Nodular skin lesion • papular skin lesion

Medication: —

Clinical Procedure: —

Specialty: Dermatology • Family Medicine • Plastic Surgery

Trichoblastomas Mimicking Basal Cell Carcinoma: The Importance of Identification and Differentiation

Trichoblastoma is a rare, slow-growing, benign cutaneous tumor derived from follicular germinative cells. Trichoblastoma commonly appears as an asymptomatic, symmetrical, well-circumscribed, skin-colored to brown or blue-black papule or nodule. It may appear clinically and histologically similar to basal cell carcinoma, making its diagnosis challenging. Even on dermoscopy, it is challenging to differentiate trichoblastoma from basal cell carcinoma. In practice, it is important to differentiate the two, because the choice of treatment and resulting prognosis differ between the lesions. Surgical biopsy to analyze histopathological and immunohistochemical differences is the gold standard for diagnosing and differentiating trichoblastoma from basal cell carcinoma. Trichoblastoma typically has a favorable prognosis, with a low incidence of recurrence, progression or association with malignancy. This paper provides a review of the epidemiology, clinical presentation, dermoscopy, histology, immunochemistry, treatment, and prognosis of trichoblastoma.