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Jiménez Antón A, Jiménez Gallo D, Millán Cayetano JF, Gallo Pineda G, Linares Barrios M. Fibroblast Growth Factor Receptor 2 Overexpression in Multiple Familial Trichoepithelioma. Am J Dermatopathol 2024; 46:69. [PMID: 38078627 DOI: 10.1097/dad.0000000000002569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Alicia Jiménez Antón
- Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Puerta del Mar, Cádiz, España
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Does Immunohistochemistry Add to Morphology in Differentiating Trichoepithelioma, Desmoplastic Trichoepithelioma, Morpheaform Basal Cell Carcinoma, and Microcystic Adnexal Carcinoma? Appl Immunohistochem Mol Morphol 2022; 30:273-277. [DOI: 10.1097/pai.0000000000001002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/01/2021] [Indexed: 11/26/2022]
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3
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Lobo Y, Blake T, Wheller L. Management of multiple trichoepithelioma: A review of pharmacological therapies. Australas J Dermatol 2021; 62:e192-e200. [PMID: 33403677 DOI: 10.1111/ajd.13537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/17/2020] [Indexed: 12/01/2022]
Abstract
Trichoepithelioma is a rare benign adnexal neoplasm that can occur in various forms including solitary, multiple, familial or nonfamilial. Multiple facial trichoepithelioma can be associated with significant psychosocial burden. Conventional treatment modalities such as surgical excision and ablative laser have variable results and can be associated with unacceptable complications and tumour regrowth. Pharmacological interventions such as topical and systemic agents are potentially effective but clinical data are limited and treatments are poorly standardised. We review the available evidence to determine the role of pharmacological therapies in the management of multiple trichoepithelioma. Demographic and clinical data were retrospectively collected from the available English literature. Majority of cases treated with pharmacological therapies (93.75%) had a positive treatment outcome, achieving partial lesion response. Adverse effects associated with pharmacological therapies were generally well tolerated and did not interrupt treatment. There are limitations as to how our results can be interpreted owing to the paucity of good quality evidence, spectrum of disease severity, and diversity of study designs utilised in the included articles. Nonetheless, the results of our study indicate that while most pharmacological interventions for multiple trichoepithelioma produce a partial response, they can be employed as effective suppressive therapies, either alone or in conjunction with conventional treatments. The current evidence for pharmacological therapies remains largely anecdotal justifying the need for further clinical studies in this area.
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Affiliation(s)
- Yolanka Lobo
- Department of Dermatology, Mater Misericordiae Health Services, Brisbane, Queensland, Australia
| | - Tristan Blake
- Department of Dermatology, Mater Misericordiae Health Services, Brisbane, Queensland, Australia
| | - Laura Wheller
- Department of Dermatology, Mater Misericordiae Health Services, Brisbane, Queensland, Australia.,Department of Dermatology, Queensland Children's Hospital, Brisbane, Queensland, Australia
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Clinical, Histopathological, and Management Challenges of Multiple Familial Trichoepithelioma: A Case Report of a Patient Presenting with Multiple Facial Papules. Case Rep Dent 2020; 2020:5648647. [PMID: 32963838 PMCID: PMC7499335 DOI: 10.1155/2020/5648647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 08/22/2020] [Accepted: 08/28/2020] [Indexed: 12/14/2022] Open
Abstract
Trichoepitheliomas (TE) are benign skin tumours of the pilosebaceous apocrine unit with follicular differentiation. Multiple familial trichoepithelioma (MFT) is a considerably rare condition inherited in an autosomal dominant pattern. We present a case of a 15-year-old male who presented with multiple papulo-nodular lesions in the central face and a family history of a similar type of lesions from his mother. Significance of consideration of various clinical differential diagnoses with serious pathological outcomes, strategies followed in the diagnosis including histopathological evaluation aided by immunohistochemical investigations, and subsequent challenges that may be faced in the management of MFT in light of the presentation with multiple facial papules are documented in this case report.
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Aslan Kayiran M, Karadağ AS, Küçük Y, Çobanoğlu Şimşek B, Erdemir VA, Akdeniz N. Are clinicians successful in diagnosing cutaneous adnexal tumors? a retrospective, clinicopathological study. Turk J Med Sci 2020; 50:832-843. [PMID: 32283901 PMCID: PMC7379409 DOI: 10.3906/sag-2002-126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 04/11/2020] [Indexed: 01/10/2023] Open
Abstract
Background/aim Cutaneous adnexal tumors (CAT) are rare tumors originating from the adnexal epithelial parts of the skin. Due to its clinical and histopathological characteristics comparable with other diseases, clinicians and pathologists experience difficulties in its diagnosis.We aimed to reveal the clinical and histopathological characteristics of the retrospectively screened cases and to compare the prediagnoses and histopathological diagnoses of clinicians. Materials and methods The data of the last 5 years were scanned and patients with histopathological diagnosis of CAT were included in the study. Results A total of 65 patients, including 39 female and 26 male patients aged between 8 and 88, were included in the study. The female to male ratio was 1.5, and the mean age of the patients was 46.15 ± 21.8 years. The benign tumor rate was 95.4%, whereas the malignant tumor rate was 4.6%. 38.5% of the tumors were presenting sebaceous, 35.4% of them were presenting follicular, and 18.5% of them were presenting eccrine differentiation. It was most commonly seen in the head-neck region with a rate of 66.1%. When clinical and histopathological prediagnoses were compared, prediagnoses and histopathological diagnoses were compatible in 45% of the cases. Most frequently, it was the basal cell carcinoma, epidermal cyst, and sebaceous hyperplasia identified in preliminary diagnoses. Conclusion Cutaneous adnexal tumors are very important, as they can accompany different syndromes and may be malignant. Due to difficulties in its clinical diagnosis, histopathological examination must be performed from suspicious lesions for definitive diagnosis.
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Affiliation(s)
- Melek Aslan Kayiran
- Department of Dermatology, Göztepe Training and Research Hospital, İstanbul Medeniyet University, İstanbul, Turkey
| | - Ayşe Serap Karadağ
- Department of Dermatology, Göztepe Training and Research Hospital, İstanbul Medeniyet University, İstanbul, Turkey
| | - Yasin Küçük
- Department of Dermatology, Göztepe Training and Research Hospital, İstanbul Medeniyet University, İstanbul, Turkey
| | - Bengü Çobanoğlu Şimşek
- Department of Pathology, Göztepe Training and Research Hospital, İstanbul Medeniyet University, İstanbul, Turkey
| | - Vefa Asli Erdemir
- Department of Dermatology, Göztepe Training and Research Hospital, İstanbul Medeniyet University, İstanbul, Turkey
| | - Necmettin Akdeniz
- Department of Dermatology, Göztepe Training and Research Hospital, İstanbul Medeniyet University, İstanbul, Turkey
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Cengiz FP, Kelahmetoglu O, Yildiz P, Yenigun A, Emiroglu N, Akarslan TC, Shbair A, Seker M, Tekce E, Onsun N. A case of multiple familial trichoepitelioma with malignant transformation successfully treated with Vismodegib. Dermatol Ther 2020; 33:e13569. [PMID: 32401420 DOI: 10.1111/dth.13569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/16/2020] [Accepted: 05/10/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Fatma P Cengiz
- Department of Dermatoveneorology, Bezmialem Vakif University, Istanbul, Turkey
| | - Osman Kelahmetoglu
- Department of Plastic and Esthetic Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Pelin Yildiz
- Department of Pathology, Bezmialem Vakif University, Istanbul, Turkey
| | - Alper Yenigun
- Department of Ear Nose and Throat, Bezmialem Vakif University, Istanbul, Turkey
| | - Nazan Emiroglu
- Department of Dermatoveneorology, Bezmialem Vakif University, Istanbul, Turkey
| | - Tahsin C Akarslan
- Department of Dermatoveneorology, Bezmialem Vakif University, Istanbul, Turkey
| | - Abdallah Shbair
- Department of Medical Oncology, Bezmialem Vakif University, Istanbul, Turkey
| | - Mesut Seker
- Department of Medical Oncology, Bezmialem Vakif University, Istanbul, Turkey
| | - Ertugrul Tekce
- Department of Radiation Oncology, Bezmialem Vakif University, Istanbul, Turkey
| | - Nahide Onsun
- Department of Dermatoveneorology, Bezmialem Vakif University, Istanbul, Turkey
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Frequent and differential mutations of the CYLD gene in basal cell salivary neoplasms: linkage to tumor development and progression. Mod Pathol 2018; 31:1064-1072. [PMID: 29463883 DOI: 10.1038/s41379-018-0018-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/11/2017] [Accepted: 12/17/2017] [Indexed: 12/28/2022]
Abstract
Basal cell salivary neoplasms display similar cyto-morphologic features and are classified into adenoma and adenocarcinoma based on the presence or absence of tumor invasion at diagnosis. These neoplasms also share considerable phenotypic resemblance and co-exist with certain dermal adnexal tumors harboring the CYLD gene mutations inferring common genetic association. We sequenced the CYLD gene in both basal cell adenomas and adenocarcinomas and correlated the findings with CYLD, NF-κB, and β-catenin expression levels and clinicopathologic factors. Twenty mutations were identified and comprised of 3 synonymous and 17 non-synonymous (missense) types involving the coding exons of the CYLD gene. Mutations in exons 9-11 were identified in both adenomas and adenocarcinomas, while mutations in exons 12-20, encoding the USP domain, were exclusively found in carcinomas. Although no significant correlation between CYLD mutations and expression levels of CYLD, NF-κB, and β-catenin or clinicopathologic parameters was found, basal cell adenocarcinomas with multiple mutations showed reduction in CYLD protein expression and pursued aggressive clinical behavior. Our study revealed high incidence and sequential CYLD mutations in both basal cell adenoma and adenocarcinoma supporting a single neoplastic continuum for their evolution and provides evidence for potential diagnostic and therapeutic utility.
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Baur V, Papadopoulos T, Kazakov DV, Agaimy A, Hartmann A, Isbary G, Wirtz RM, Schultz ES. A case of multiple familial trichoepitheliomas responding to treatment with the Hedgehog signaling pathway inhibitor vismodegib. Virchows Arch 2018; 473:241-246. [DOI: 10.1007/s00428-018-2397-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 06/13/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022]
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9
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Sinha K, Mallipeddi R, Sheth N, Al-Niaimi F. Carbon dioxide laser ablation for trichoepitheliomas: The largest reported series. J COSMET LASER THER 2017; 20:9-11. [DOI: 10.1080/14764172.2017.1288257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Khushboo Sinha
- Department of Dermatologic Surgery and Laser Unit, St. John’s Institute of Dermatology, St Thomas’s Hospital, London, London, UK
| | - Raj Mallipeddi
- Department of Dermatologic Surgery and Laser Unit, St. John’s Institute of Dermatology, St Thomas’s Hospital, London, London, UK
| | - Nisith Sheth
- Department of Dermatologic Surgery and Laser Unit, Guy’s and St. Thomas’ Hospitals, London, UK
| | - Firas Al-Niaimi
- St. John’s Institute of Dermatology, St. Thomas’ Hospital, London, UK
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Mahajan VK, Sharma AL, Chauhan PS, Mehta KS, Sharma S. SkIndia Quiz 27: Rhinophyma and numerous facial papule and nodules in a 39-year-old woman. Indian Dermatol Online J 2016; 7:350-2. [PMID: 27559531 PMCID: PMC4976436 DOI: 10.4103/2229-5178.182404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Vikram K Mahajan
- Department of Dermatology, Venereology, Leprosy, Dr. R.P. Government Medical College, Kangra, Tanda, Himachal Pradesh, India
| | - Anju Lath Sharma
- Department of Dermatology, Venereology, Leprosy, Dr. R.P. Government Medical College, Kangra, Tanda, Himachal Pradesh, India
| | - Pushpinder S Chauhan
- Department of Dermatology, Venereology, Leprosy, Dr. R.P. Government Medical College, Kangra, Tanda, Himachal Pradesh, India
| | - Karaninder S Mehta
- Department of Dermatology, Venereology, Leprosy, Dr. R.P. Government Medical College, Kangra, Tanda, Himachal Pradesh, India
| | - Saurabh Sharma
- Department of Pathology, Dr. R.P. Government Medical College, Kangra, Tanda, Himachal Pradesh, India
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Navarrete-Dechent C, Bajaj S, Marghoob AA, González S, Muñoz D. Multiple familial trichoepithelioma: confirmation via dermoscopy. Dermatol Pract Concept 2016; 6:51-4. [PMID: 27648384 PMCID: PMC5006553 DOI: 10.5826/dpc.0603a10] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 05/01/2016] [Indexed: 12/03/2022] Open
Abstract
Trichoepitheliomas are uncommon benign adnexal neoplasms that originate from the hair follicles. Multiple familial trichoepithelioma constitute an autosomal dominant disease characterized by the appearance of multiple flesh-colored, symmetrical papules, tumors and/or nodules in the central face and occasionally on the scalp. Although clinical diagnosis is usually straightforward in light of the family history and naked-eye examination, dermoscopy may aid in its confirmation. Dermoscopy of each papule revealed in-focus arborizing vessels, multiple milia-like cysts and rosettes amidst a whitish background. In a patient with multiple facial papules revealing a dermoscopic appearance described above, the diagnosis of sporadic or familial multiple trichoepithelioma should be considered.
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Affiliation(s)
- Cristián Navarrete-Dechent
- Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Melanoma and Skin Cancer Unit, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Shirin Bajaj
- Dermatology Service, Memorial Sloan Kettering Cancer Center, Hauppauge, NY, USA
| | - Ashfaq A Marghoob
- Dermatology Service, Memorial Sloan Kettering Cancer Center, Hauppauge, NY, USA
| | - Sergio González
- Melanoma and Skin Cancer Unit, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pathology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Daniel Muñoz
- Department of Dermatology, Complejo Asistencial Hospital Sótero del Río, Santiago, Chile
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12
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Sehrawat M, Jairath V, Jain VK. Nonfamilial Multiple Trichoepithelioma: Few and Far Between. Indian J Dermatol 2016; 61:78-80. [PMID: 26955100 PMCID: PMC4763700 DOI: 10.4103/0019-5154.174030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Trichoepithelioma is a rare benign adnexal tumor which may be of solitary nonfamilial type or multiple familial trichoepitheliomas. Here, we describe a rare presentation of nonfamilial case of trichoepithelioma in a 50-year-old female with multiple skin colored facial papules and nodules over the face, upper back, and extremities.
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Affiliation(s)
- Manu Sehrawat
- Department of Dermatology, Venereology, Leprosy, Pt. B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Vijayeeta Jairath
- Department of Dermatology, Venereology, Leprosy, Pt. B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - V K Jain
- Department of Dermatology, Venereology, Leprosy, Pt. B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
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13
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Inherited cylindromas: lessons from a rare tumour. Lancet Oncol 2015; 16:e460-e469. [DOI: 10.1016/s1470-2045(15)00245-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 04/09/2015] [Accepted: 04/10/2015] [Indexed: 11/23/2022]
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14
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du Toit JP, Schneider JW, Visser WI, Jordaan HF. The clinicopathological spectrum of trichoepitheliomas: a retrospective descriptive study. Int J Dermatol 2015. [DOI: 10.1111/ijd.12855] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jacques P. du Toit
- Division of Dermatology; Department of Medicine; University of Stellenbosch and Tygerberg Academic Hospital; Cape Town South Africa
| | - Johann W. Schneider
- Division of Anatomical Pathology; Department of Pathology; University of Stellenbosch and National Health Laboratory Service; Cape Town South Africa
| | - Willem I. Visser
- Division of Dermatology; Department of Medicine; University of Stellenbosch and Tygerberg Academic Hospital; Cape Town South Africa
| | - Henry F. Jordaan
- Division of Dermatology; Department of Medicine; University of Stellenbosch and Tygerberg Academic Hospital; Cape Town South Africa
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Kataria U, Agarwal D, Chhillar D. Familial Facial disfigurement in Multiple Familial Trichoepithelioma. J Clin Diagn Res 2014; 7:3008-9. [PMID: 24551711 DOI: 10.7860/jcdr/2013/6218.3830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 11/12/2013] [Indexed: 11/24/2022]
Abstract
Trichoepithelioma is an uncommon, benign hamartomatous tumor of the pilosebaceous follicle. Presenting as multiple papules and nodules on face and neck, they pose a significant cosmetic problem in affected individuals. Familial involvement of this dermatosis occurs in an autosomal dominant pattern, the locus being located on chromosome 9p21, which causes multiple facial lesions in family members and their kins. Here, we report a case of multiple familial trichoepithelioma causing considerable disfigurement of the face.
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Affiliation(s)
- Usha Kataria
- Assistant Professor, Department of Dermatology & Veneral Disease, BPS Govt. Medical College for Women , Khanpur Kalan, Sonepat, Haryana, India
| | - Deepti Agarwal
- Associate Professor, Department of Pathology, BPS Govt. Medical College for Women , Khanpur Kalan, Sonepat, Haryana, India
| | - Dinesh Chhillar
- Demonstrator, Department of Microbiology, BPS Govt. Medical College for Women , Khanpur Kalan, Sonepat, Haryana, India
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Samaka RM, Bakry OA, Seleit I, Abdelwahed MM, Hassan RA. Multiple familial trichoepithelioma with malignant transformation. Indian J Dermatol 2013; 58:409. [PMID: 24082215 PMCID: PMC3778810 DOI: 10.4103/0019-5154.117348] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Trichoepithelioma (TE) is a benign tumor of follicular origin that presents as small, skin-colored papules predominantly on the face. When more than one family member is affected, the disease is known as multiple familial trichoepithelioma (MFT). It is a rare autosomal dominant (AD) skin disease. Malignant transformation is very rare. We present a case of MFT in a female patient and her father with malignant transformation to basal cell carcinoma (BCC) in the father. We summarized the main histological differential parameters between TE and BCC and applied immunophenotyping for both by administration of Bcl2, CD34, CD10 and androgen receptor (AR) antibodies.
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Affiliation(s)
- Rehab M Samaka
- Department of Pathology, Andrology and S.T.Ds, Faculty of Medicine, Menoufiya University, Shebin Elkom, Egypt
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Novel and recurrent germline and somatic mutations in a cohort of 67 patients from 48 families with Brooke-Spiegler syndrome including the phenotypic variant of multiple familial trichoepitheliomas and correlation with the histopathologic findings in 379 biopsy specimens. Am J Dermatopathol 2013; 35:34-44. [PMID: 23249834 DOI: 10.1097/dad.0b013e31824e7658] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Brooke-Spiegler syndrome (BSS) is a rare, inherited, autosomal dominant disorder characterized by development of multiple adnexal cutaneous neoplasms including spiradenoma, cylindroma, spiradenocylindroma, and trichoepithelioma. The syndrome of multiple familial trichoepitheliomas (MFT) is considered a phenotypic variant of BSS in which patients present with trichoepitheliomas only. We studied germline and somatic mutations of the CYLD gene by direct sequencing in patients with BSS (n = 49) and MFT (n = 18) using peripheral blood and 90 samples of frozen or formalin-fixed paraffin-embedded tumor tissue selected from 379 available histology specimens. Germline CYLD mutations were found in 51 patients (76%) from 36 families (75%). Germline CYLD mutations were found in 43 of the 49 patients with BSS (88%) but in only 8 of 18 MFT cohort (44%). Twenty-one frameshift, 15 nonsense, 3 missense, and 4 splice site mutations were found in patients with BSS, whereas 1 frameshift, 5 nonsense, and 2 splice site mutations were identified in the MFT cohort. Five novel mutations were identified including 4 frameshift mutations (c.1027dupA/p.T343NfsX7, c.2155dupA/p.M719NfsX5, c.2288_2289delTT/p.F763X, and c.2641delG/p.D881TfsX32) and 1 nonsense mutation (c.2713C>T/p. Q905X). Of the 76 tumors from 32 patients with a germline CYLD mutation, 12 were spiradenomas, 15 spiradenocylindromas, 26 cylindromas, 15 trichoepitheliomas, and 7 were other tumor types. Somatic mutations were detected in 67 specimens of these 76 tumors (88%). Of the 67 somatic mutations, 21 (31%) represented a sequence alteration and 46 (69%) showed loss of heterozygosity. In the remaining 9 cases (12%), the somatic changes remained unknown. A germline CYLD mutation was not detected in 14 tumor samples from 8 patients. In these 14 tumors, somatic mutations were identified in 6 samples (43%), all consisting of sequence alterations (1 sample showed 2 different sequence alterations). In the remaining 8 samples (53%), neither germline nor somatic mutations were found in the lesional tissue. Our study increases the catalog of known CYLD mutations in patients with BSS/MFT to 86 and documents the variability of somatic mutations that may occur in them. We confirm the absence of firm genotype-phenotype correlations and the existence of a subset of patients with BSS/MFT who lack a demonstrable germline CYLD mutation. Further studies are needed to explain the reasons for this phenomenon.
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Zhao XY, Huang YJ, Liang YH, Huang L, Zhao Y, Zeng K. Multiple familial trichoepithelioma: report of a Chinese family not associated with a mutation in the CYLD gene and CYLD protein expression in the trichoepithelioma tumor tissue. Int J Dermatol 2013; 53:e279-81. [PMID: 23879700 DOI: 10.1111/ijd.12153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Xiao-yan Zhao
- Department of Dermatology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, 361003, China
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Multiple Trichoepitheliomas Associated With a Novel Heterozygous Mutation in the CYLD Gene as an Adjunct to the Histopathological Diagnosis. Am J Dermatopathol 2013; 35:445-7. [DOI: 10.1097/dad.0b013e31827132af] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ponti G, Nasti S, Losi L, Pastorino L, Pollio A, Benassi L, Giudice S, Bertazzoni G, Veratti E, Azzoni P, Bianchi Scarrà G, Seidenari S. Brooke-Spiegler syndrome: report of two cases not associated with a mutation in the CYLD and PTCH tumor-suppressor genes. J Cutan Pathol 2011; 39:366-71. [DOI: 10.1111/j.1600-0560.2011.01813.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Multiple (familial) trichoepitheliomas: a clinicopathological and molecular biological study, including CYLD and PTCH gene analysis, of a series of 16 patients. Am J Dermatopathol 2011; 33:251-65. [PMID: 21389835 DOI: 10.1097/dad.0b013e3181f7d373] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Multiple familial trichoepitheliomas (MFT) constitute an autosomally inherited syndrome possibly related to Brooke-Spiegler syndrome (BSS). Although some early studies suggested a role for the PTCH gene on chromosome 9q22.3 in the etiopathogenesis of MFT, recent studies of occasional patients with the MFT clinical phenotype identified mutations in the CYLD gene on chromosome 16q12-q13, a gene responsible for BSS. A systematic investigation of PTCH and CYLD mutations in patients with MFT has never been performed. Our main objective was to collect a reasonably large series of patients with MFT to (1) study the clinicopathological spectrum of the disease, (2) determine whether the PTCH gene is implicated in the pathogenesis of MFT, and if so (3) determine the relative frequency of CYLD and PTCH mutations, (4) establish if there may be any possible genotype-phenotype correlations, and (5) study the spectrum of somatic mutations. Clinical analysis including family histories, histopathological investigations, and molecular genetic studies were performed. There were 9 female and 7 male patients ranging in age from 11 to 63 years. They presented with multiple, small, discrete and sometimes confluent, skin-colored to pink, asymptomatic nodules preferentially located on the face, being especially prominent and confluent in the nasolabial folds and inner aspects of the eyebrows. A total of 66 conventional trichoepitheliomas (TEs) were studied microscopically. Aside from typical features of TE, some also exhibited variant morphological patterns including areas reminiscent of other benign adnexal neoplasms and melanocytic hyperplasia. In none of the 9 patients tested was a germline mutation of the PTCH gene identified. Germline CYLD mutations were detected in 6 of 13 patients tested (identical in 2 unrelated patients) including 2 novel mutations, whereas the remaining 7 individuals showed wild-type alleles. Two patients with germline wild-type CYLD showed, however, a somatic mutation in the gene (1 duplication, 1 substitution mutation). Neither CYLD nor PTCH germline mutations were found in the 5 patients in whom both genes were analyzed. MFT seems to be a phenotypic variant of BSS. The PTCH gene is rarely, if ever, involved in the pathogenesis of MFT. Absence of a germline mutation of the CYLD gene in cases harboring a somatic mutation may be explained by large deletions in the gene or by mutation in intronic sequences or in the promoter region. Considering our 5 patients with no mutation in either gene, the final possibility is that another, as yet undescribed gene (neither CYLD nor PTCH) is implicated in the pathogenesis of some patients with MFT.
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Benign Lid Tumors. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00038-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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23
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Kuo DS, Nyong'o OL. Congenital solitary eyelid trichoepithelioma. J AAPOS 2010; 14:277-9. [PMID: 20603064 DOI: 10.1016/j.jaapos.2010.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 04/20/2010] [Accepted: 04/21/2010] [Indexed: 11/24/2022]
Abstract
Trichoepitheliomas are unusual, benign tumors of hair follicle origin. They may present in children and adults as acquired lesions on the body and face, but they rarely involve the eyelids. Solitary trichoepitheliomas have not previously been reported in infants. We present a first report of congenital solitary eyelid trichoepithelioma in an infant and review the classification of trichoepitheliomas.
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Affiliation(s)
- Debbie S Kuo
- Department of Ophthalmology, University of California, San Francisco, California, USA
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Mamelak AJ, Goldberg LH, Katz TM, Graves JJ, Arnon O, Kimyai-Asadi A. Desmoplastic trichoepithelioma. J Am Acad Dermatol 2010; 62:102-106. [PMID: 20082889 DOI: 10.1016/j.jaad.2009.06.066] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2008] [Revised: 05/27/2009] [Accepted: 06/12/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Desmoplastic trichoepithelioma (DTE) is an uncommon adnexal tumor usually found on the face of young women. OBJECTIVE We sought to describe the clinical and histologic characteristics of DTE and discuss management strategies for these tumors. METHODS We conducted a retrospective case series and review of the literature. RESULTS A series of 17 cases of DTE is reported. Of our patients, 82% were female and half of all these cases occurred on the cheek. Unlike previous reports, the patients in our study were slightly older, with 53% older than 51 years and 71% between the ages of 31 and 60 years at the time of surgery (mean age 49 years, median age 52 years, range 14-81 years). Approximately 38% of the tumors had been present for 1 to 2 years before presentation. The average size of the tumors at the time of surgery was 0.8 x 0.6 cm. All cases were treated with Mohs micrographic surgery. To date, none of the tumors have recurred. LIMITATIONS This is a small case series. The referral patterns of our predominantly Mohs micrographic surgery clinic might further bias this study. CONCLUSION DTE is a benign tumor that has a predilection for the face. With its rapid growth, aggressive histologic features that may be confused with basal cell carcinoma, and tendency to arise in cosmetically and functionally sensitive areas, these tumors should be removed in a manner that assures clear surgical margins, such as Mohs micrographic surgery.
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Affiliation(s)
- Adam J Mamelak
- Department of Dermatology, the Methodist Hospital, Houston, Texas; DermSurgery Associates, Houston, Texas
| | - Leonard H Goldberg
- Department of Dermatology, the Methodist Hospital, Houston, Texas; DermSurgery Associates, Houston, Texas.
| | | | - Jeffery J Graves
- Department of Dermatology, the Methodist Hospital, Houston, Texas
| | - Ofer Arnon
- Department of Plastic and Reconstructive Surgery, Soroka University Medical Center, Beer-Sheva, Israel
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Spectrum of tumors with follicular differentiation in a patient with the clinical phenotype of multiple familial trichoepitheliomas: a clinicopathological and molecular biological study, including analysis of the CYLD and PTCH genes. Am J Dermatopathol 2010; 31:819-27. [PMID: 19730223 DOI: 10.1097/dad.0b013e3181a70eef] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report a patient with multiple trichoepitheliomas whose biopsy material also demonstrated a range of other neoplasms with follicular differentiation, including small nodular trichoblastoma, small nodular basal cell carcinoma (BCC), and areas resembling infundibulocystic BCC/basaloid follicular hamartoma. These were all intimately associated with otherwise typical trichoepitheliomas that dominated the microscopic appearances. Peripheral blood and tumor tissues of the patient and his 2 daughters, who apparently had a milder phenotype, were studied for alterations in the CYLD and PTCH genes, but mutations or loss of heterozygosity was not found in either gene. The occurrence of multiple follicular neoplasms within a single lesion adds evidence that, although in most cases BCC and trichoblastoma are distinct lesions, the 2 neoplasms do encompass a morphological spectrum of follicular differentiation, which is probably more overtly expressed in syndromic patients.
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26
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Amaro C, Freitas I, Lamarão P, Afonso A, Skrzypczak M, Heinritz W. Multiple trichoepitheliomas - a novel mutation in the CYLD gene. J Eur Acad Dermatol Venereol 2009; 24:844-6. [DOI: 10.1111/j.1468-3083.2009.03497.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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27
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Blake PW, Toro JR. Update of cylindromatosis gene (CYLD) mutations in Brooke-Spiegler syndrome: novel insights into the role of deubiquitination in cell signaling. Hum Mutat 2009; 30:1025-36. [PMID: 19462465 DOI: 10.1002/humu.21024] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Germline mutations in the cylindromatosis (CYLD) gene have been described in families with cylindromas, trichoepitheliomas, and/or spiradenomas. Brooke-Spiegler syndrome (BSS) is the autosomal dominant predisposition to skin appendageal neoplasms including cylindromas, trichoepitheliomas, and/or spiradenomas. We review the clinical features, molecular genetics, and the animal models of BSS. To date, a total of 51 germline CYLD mutations have been reported, occurring in exons 9-20, in 73 families with diverse ethnic and racial backgrounds. Of 51 mutations, 86% are expected to lead to truncated proteins. The seven missense mutations reported to date occur only within the ubiquitin (Ub)-specific protease (USP) domain of the CYLD protein and most are associated exclusively with multiple familial trichoepithelioma (MFT). CYLD functions as a tumor suppressor gene. CYLD encodes a deubiquitinating (DUB) enzyme that negatively regulates the nuclear factor (NF)-kappaB and c-Jun N-terminal kinase (JNK) pathways. CYLD DUB activity is highly specific for lysine 63 (K63)-linked Ub chains but has been shown to act on K48-linked Ub chains as well. In 2008, the CYLD USP domain was crystallized, revealing that the truncated Fingers subdomain confers CYLD's unique specificity for K63-linked Ub chains. Recent work using animal models revealed new roles for CYLD in immunity, lipid metabolism, spermatogenesis, osteoclastogenesis, antimicrobial defense, and inflammation.
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Affiliation(s)
- Patrick W Blake
- Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health (NIH), Rockville, Maryland 20892-4562, USA
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28
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Affiliation(s)
- Catherine A Harwood
- Center for Cutaneous Research, Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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29
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Pincus LB, McCalmont TH, Neuhaus IM, Kasper R, Oh DH. Basal cell carcinomas arising within multiple trichoepitheliomas. J Cutan Pathol 2008; 35 Suppl 1:59-64. [PMID: 18544067 DOI: 10.1111/j.1600-0560.2008.01002.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Although trichoepitheliomas (TEs) are commonly regarded as benign tumors of follicular origin, the natural history of multiple familial trichoepitheliomas (MFT) and their risk for malignancy has been unclear. We describe a 57-year-old male with numerous skin-colored firm papules and plaques present on the central face since 6 years of age. Recently, some lesions had enlarged and ulcerated. Other family members were similarly affected. Biopsies from multiple lesions showed TEs both alone and associated with basal cell carcinoma (BCC) in the same section, suggesting the secondary development of BCCs within TEs. Many prior reports of BCCs arising within TEs in patients with presumed MFT were likely misdiagnosed cases of nevoid BCC. This report is a compelling example of MFT in which BCCs evolved secondarily. Awareness of the potential for the evolution of carcinoma in patients with MFT is important in the management of these patients.
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Affiliation(s)
- Laura B Pincus
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA.
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30
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Oranje AP, Halley D, den Hollander JC, Teepe RGC, van de Graaf R, van den Ouweland A, Wagner A. Multiple familial trichoepithelioma and familial cylindroma: one cause! J Eur Acad Dermatol Venereol 2008; 22:1395-6. [PMID: 18355210 DOI: 10.1111/j.1468-3083.2008.02648.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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31
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Almeida S, Maillard C, Itin P, Hohl D, Huber M. Five new CYLD mutations in skin appendage tumors and evidence that aspartic acid 681 in CYLD is essential for deubiquitinase activity. J Invest Dermatol 2007; 128:587-93. [PMID: 17851586 DOI: 10.1038/sj.jid.5701045] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Brooke-Spiegler syndrome, familial cylindromatosis, and familial trichoepithelioma are autosomal-dominant genetic predispositions for benign tumors of skin appendages caused by mutations in the CYLD gene localized on chromosome 16q12-q13. The encoded protein functions as ubiquitin-specific protease (UBP), which negatively regulates NF-kappaB and c-Jun N-terminal kinase (JNK) signaling. We investigated five families affected with these skin neoplasms and identified four premature stop codons and the novel missense mutation D681G in a family in which 11 of 12 investigated tumors were trichoepitheliomas. CYLD protein harboring this missense mutation had a significant reduced ability to inhibit TNF receptor-associated factor (TRAF)2- and TRAF6-mediated NF-kappaB activation, tumor necrosis factor-alpha (TNFalpha)-induced JNK signaling, and to deubiquitinate TRAF2. CYLD-D681G was coimmunoprecipitated by TRAF2, but was unable to cleave K63-linked polyubiquitin chains. Aspartic acid 681 is highly conserved in CYLD homologues and other members of the UBP family, but does not belong to the Cys and His boxes providing the CYLD catalytic triad (Cys601, His871, and Asp889). As reported previously, the homologous residue D295 of HAUSP/USP-7 forms a hydrogen bond with the C-terminal end of ubiquitin and is important for the enzymatic activity. These results underline that D681 in CYLD is required for cleavage of K63-linked polyubiquitin chains.
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Affiliation(s)
- Stéphanie Almeida
- Service of Dermatology, University Hospital Center and University of Lausanne, Lausanne, Switzerland
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33
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Suedmeyer WK, Williams F. Multiple trichoepitheliomas in an alpaca (Lama pacos). J Zoo Wildl Med 2007; 36:706-8. [PMID: 17312731 DOI: 10.1638/04115.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A 13-yr-old male Alpaca (Lama pacos) presented with multiple ovoid, well-circumscribed, nonulcerated intradermal masses. Individual masses measured 1-4 cm in diameter, and the overlying skin was alopecic. Several of the masses were surgically removed and evaluated microscopically. Histopathologic evaluation demonstrated multiple dermal cysts lined by neoplastic follicular epithelium. The cysts were filled with multiple layers of lamellar keratin and lined by abortive inner and outer root sheaths exhibiting cellular atypia, supporting the diagnosis of trichoepitheliomas. No additional treatment was initiated, and the alpaca continues to do well.
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Affiliation(s)
- W Kirk Suedmeyer
- Kansas City Zoo, 6700 Zoo Drive, Kansas City, Missouri 64132, USA
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34
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Alsaad KO, Obaidat NA, Ghazarian D. Skin adnexal neoplasms--part 1: an approach to tumours of the pilosebaceous unit. J Clin Pathol 2007; 60:129-44. [PMID: 16882696 PMCID: PMC1860623 DOI: 10.1136/jcp.2006.040337] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2006] [Indexed: 12/16/2022]
Abstract
Skin adnexal neoplasms comprise a wide spectrum of benign and malignant tumours that exhibit morphological differentiation towards one or more types of adnexal structures found in normal skin. Most adnexal neoplasms are relatively uncommonly encountered in routine practice, and pathologists can recognise a limited number of frequently encountered tumours. In this review, the first of two, the normal histology of the skin adnexal structures is reviewed, and the histological features of selected but important benign and malignant tumours and tumour-like lesions of pilosebaceous origin discussed, with emphasis on the diagnostic approach and pitfalls in histological diagnosis.
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Affiliation(s)
- K O Alsaad
- Department of Laboratory Medicine and Pathobiology, University of Toronto and University Health Network, Toronto, Ontario, Canada
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35
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Strauss RM, Merchant WJ, Stainforth JM, Clark SM. Unilateral naevoid trichoepitheliomas on the face of a child. Clin Exp Dermatol 2006; 31:778-80. [PMID: 17040262 DOI: 10.1111/j.1365-2230.2006.02216.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Trichoepitheliomas are benign epidermal appendage tumours that present most commonly as solitary lesions, and less often as multiple, symmetrically distributed lesions on the face, scalp, neck and trunk. Only a few patients have been reported in whom trichoepitheliomas were found as unusually configured linear or plaque-like confluent lesions, all of which occurred in patients with skin types V or VI. We describe a white girl with a hemifacial plaque of confluent naevoid trichoepitheliomas, the first report of such lesions in a white patient.
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Affiliation(s)
- R M Strauss
- Department of Dermatology, Leeds General Infirmary, Leeds, UK.
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36
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Affiliation(s)
- David A Fairhurst
- Leeds General Infirmary, Department of Dermatology, Leeds, West Yorkshire, UK.
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37
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Abstract
We report a unique occurrence of linear multiple trichoepitheliomas that follow Blaschko lines on the face of an otherwise healthy 8-year-old African American girl. Per the mother, the lesions had been present since birth. The diagnosis was made based on the histologic presence of palisading basaloid cells surrounding central areas of follicular differentiation and papillary mesenchymal bodies. To the authors' best knowledge, this is the first report of linear multiple trichoepitheliomas following the lines of embryologic cutaneous cell development, and possibly, the first of congenital multiple trichoepitheliomas.
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Affiliation(s)
- Yuchi Connie Chang
- Department of Internal Medicine at the University of Texas Health Sciences Center, Galveston, 77555, USA
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38
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Gómez-Avivar I, Ramos F, Tercedor J, Ramírez A, Massare E, García-Mellado V. [Erythematous scaly facial plaques]. ACTAS DERMO-SIFILIOGRAFICAS 2006; 96:191-3. [PMID: 16476366 DOI: 10.1016/s0001-7310(05)73067-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Ilar Gómez-Avivar
- Sección de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, Spain.
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Watts GDJ, Mehta SG, Zhao C, Ramdeen S, Hamilton SJ, Novack DV, Mumm S, Whyte MP, Mc Gillivray B, Kimonis VE. Mapping autosomal dominant progressive limb-girdle myopathy with bone fragility to chromosome 9p21-p22: a novel locus for a musculoskeletal syndrome. Hum Genet 2005; 118:508-14. [PMID: 16244874 DOI: 10.1007/s00439-005-0075-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2005] [Accepted: 09/05/2005] [Indexed: 10/25/2022]
Abstract
Progressive myopathy of a limb-girdle distribution and bone fragility is a rare autosomal dominant disorder of unknown etiology. Affected individuals, within this family, present with various combinations of progressive muscle weakness, easy fracturing, and poor healing of long bones. Additional features include premature graying with thin hair, thin skin, hernias, and clotting disorders. Electromyograms show myopathic changes and biopsies reveal non-specific myopathic changes. Skeletal radiographs demonstrate coarse trabeculation, patchy sclerosis, cortical thickening, and narrowing of medullary cavities. We report genetic mapping of this disorder to chromosome 9p21-p22 in a multigenerational family. A genome-wide scan for the disease locus obtained a maximal LOD score of 3.74 for marker GATA87E02 N (D9S1121). Haplotype analysis localized the disease gene within a 15 Mb interval flanked by markers AGAT142P and GATA5E06P. This region also localizes diaphyseal medullary stenosis with malignant fibrous histiocytoma (DMS-MFH). Identification of the disease gene will be necessary to understand the pathogenesis of this complex disorder.
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Affiliation(s)
- Giles D J Watts
- Division of Genetics and Metabolism, Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Fegan 10, Boston, MA, 02115, USA
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Yung A, Newton-Bishop JA. A case of Bazex-Dupré-Christol syndrome associated with multiple genital trichoepitheliomas. Br J Dermatol 2005; 153:682-4. [PMID: 16120174 DOI: 10.1111/j.1365-2133.2005.06819.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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41
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Hatta N, Hirano T, Kimura T, Hashimoto K, Mehregan DR, Ansai S, Takehara K, Takata M. Molecular diagnosis of basal cell carcinoma and other basaloid cell neoplasms of the skin by the quantification of Gli1 transcript levels. J Cutan Pathol 2005; 32:131-6. [PMID: 15606671 DOI: 10.1111/j.0303-6987.2005.00264.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Distinguishing basal cell carcinoma (BCC) from other benign and malignant skin tumors is sometimes a difficult task for the pathologists. Because the activation of hedgehog signals and the up-regulation of its critical transcriptional factor Gli1 are well documented in BCC, a molecular technique measuring Gli1 transcripts may aide the diagnosis. METHODS Gli1 transcript levels were measured by real-time quantitative reverse transcriptase polymerase chain reaction (RT-PCR) using RNA extracted from formalin-fixed, paraffin-embedded tissues of 68 cases of various skin tumors. Hematoxylin and eosin-stained pathology slides were independently reviewed by three expert dermatopathologists. RESULTS The histological diagnoses were unambiguous in 53 tumors. The tumors included BCC (21), squamous cell carcinoma (13), seborrheic keratoses (8), trichoepithelioma (5), eccrine poroma/porocarcinoma (4), and sebaceous epithelioma/carcinoma (2). In these unambiguous cases, all BCC and trichoepithelioma tumors showed high expression of Gli1mRNA, while the expression was virtually absent in other tumors. The diagnosis was discordant among three pathologists in the remaining 15 tumors. Histological diagnoses included BCC, BCC with sebaceous differentiation, sebaceoma/sebaceous epithelioma, trichoblastoma, trichoepithelioma, basaloid follicular harmartoma, basosquamous carcinoma, etc. Six of them showed high Gli1 transcript levels. CONCLUSIONS Quantification of Gli1 transcripts by RT-PCR is helpful in discriminating BCC and trichoepithelioma from other skin tumors.
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Affiliation(s)
- Naohito Hatta
- Department of Dermatology, Postgraduate School of Medicine, Kanazawa University, Kanazawa, Japan
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42
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Kazakov DV, Soukup R, Mukensnabl P, Boudova L, Michal M. Brooke-Spiegler syndrome: report of a case with combined lesions containing cylindromatous, spiradenomatous, trichoblastomatous, and sebaceous differentiation. Am J Dermatopathol 2005; 27:27-33. [PMID: 15677973 DOI: 10.1097/01.dad.0000138049.86662.3e] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Brooke-Spiegler syndrome is an autosomal dominantly inherited disease with predisposition to cutaneous adnexal neoplasms, most commonly cylindromas and trichoepitheliomas. We report a patient in whom 11 lesions were removed from the scalp and face for various reasons over a period of 3 years. The histopathological survey revealed a plethora of benign adnexal neoplasms showing apocrine, follicular, and sebaceous differentiation occurring independently and conjointly. The histopathological spectrum in our patient included cylindromas, spiradenomas, trichoepitheliomas, small nodular trichoblastomas, and lymphadenomas. Many lesions had hybrid features of two or more neoplasms. By far the most common composite tumor was spiradenocylindroma. Some spiradenocylindromas demonstrated prominent sebaceous or trichoblastomatous differentiation or both. We suggest the terms "sebaceous spiradenocylindroma" and "trichospiradenocylindroma" for these lesions. The occurrence of sebaceous and trichoblastic differentiation in spiradenocylindromas is a further proof that spiradenoma and cylindroma are not eccrine tumors but neoplasms of the folliculosebaceousapocrine unit.
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MESH Headings
- Adenoma, Sweat Gland/metabolism
- Adenoma, Sweat Gland/pathology
- Adenoma, Sweat Gland/surgery
- Aged
- Biomarkers, Tumor/metabolism
- Carcinoma, Adenoid Cystic/metabolism
- Carcinoma, Adenoid Cystic/pathology
- Carcinoma, Adenoid Cystic/surgery
- Carcinoma, Skin Appendage/metabolism
- Carcinoma, Skin Appendage/pathology
- Carcinoma, Skin Appendage/surgery
- Hair Diseases/metabolism
- Hair Diseases/pathology
- Hair Diseases/surgery
- Hair Follicle/metabolism
- Hair Follicle/pathology
- Humans
- Immunoenzyme Techniques
- Male
- Neoplasms, Multiple Primary/pathology
- Neoplastic Syndromes, Hereditary/pathology
- Sebaceous Glands/metabolism
- Sebaceous Glands/pathology
- Skin Neoplasms/metabolism
- Skin Neoplasms/pathology
- Skin Neoplasms/surgery
- Syndrome
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Affiliation(s)
- Dmitry V Kazakov
- Sikl's Department of Pathology, Charles University, Medical Faculty Hospital, Pilsen, Czech Republic
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43
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Salhi A, Bornholdt D, Oeffner F, Malik S, Heid E, Happle R, Grzeschik KH. Multiple familial trichoepithelioma caused by mutations in the cylindromatosis tumor suppressor gene. Cancer Res 2004; 64:5113-7. [PMID: 15289313 DOI: 10.1158/0008-5472.can-04-0307] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The recessive oncogene cylindromatosis (CYLD) mapping on 16q12-q13 is generally implicated in familial cylindromatosis, whereas a gene region for multiple familial trichoepithelioma has been assigned to 9p21. Markers from both chromosome intervals were subjected to linkage analysis in a large family with multiple hereditary trichoepithelioma (TE) from Algeria. Linkage to 9p21 was excluded, whereas CYLD remained as a candidate. Mutation analysis identified a single bp germ-line deletion expected to result in truncation or absence of the encoded protein, which segregated with the multiple TE phenotype. In individual tumors, loss of heterozygosity at 16q or a somatic point mutation in the CYLD gene was detected. Hence, mutations of the tumor suppressor gene CYLD at 16q12-q13 may give rise to familial TE indistinguishable from the phenotype assigned to 9p21.
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Affiliation(s)
- Aicha Salhi
- Department of Dermatology, University of Algiers, Algiers, Algeria
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Zhang XJ, Liang YH, He PP, Yang S, Wang HY, Chen JJ, Yuan WT, Xu SJ, Cui Y, Huang W. Identification of the cylindromatosis tumor-suppressor gene responsible for multiple familial trichoepithelioma. J Invest Dermatol 2004; 122:658-64. [PMID: 15086550 DOI: 10.1111/j.0022-202x.2004.22321.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Multiple familial trichoepithelioma (MFT) is an autosomal dominant skin disease characterized by the presence of many small benign tumors with pilar differentiation predominantly on the face. The first locus has been previously mapped to chromosome 9p21, but no gene for MFT has been identified to date. To identify the disease gene in a large Chinese family, we initially performed linkage analysis with microsatellite markers from 9p21, but failed to confirm the linkage to this region. Previous publications showed MFT and familial cylindromatosis (FC) can occur within one family and in a single person. Therefore, we speculated that the cylindromatosis gene (CYLDI gene) responsible for FC may be related to the pathogenesis of MFT. In view of that, we genotyped all available individuals using 11 microsatellite markers spanning the CYLDI gene region at 16q12-q13. We identified the linkage of MFT to this region. Mutation analysis in the CYLDI gene detected a frameshift mutation, designated as c.2355-2358delCAGA. The study firstly identified the cylindromatosis gene responsible for MFT and showed that different mutations of the CYLDI gene can give rise to distinct clinical and histological expression such as FC and MFT.
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Affiliation(s)
- Xue-Jun Zhang
- Institute of Dermatology, Anhui Medical University, Hefei, China.
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Abstract
A 38-year-old mother and her 8-year-old daughter presented with multiple facial papules. In both cases, the papules had started to develop at about the age of 4-5 years. Biopsy of one of the mother's papules revealed a trichoepithelioma. With time the lesions had become less obvious in the mother, so she and her daughter elected to have no treatment. Both mother and daughter were otherwise well. However, there have been rare reports of multiple trichoepitheliomas being associated with systemic conditions. Multiple trichoepitheliomas are inherited in an autosomal dominant manner and have been mapped to chromosome 9p21.
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Affiliation(s)
- Kerry Crotty
- The Childrens Hospital at Westmead, Westmead, New South Wales, Australia
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Hu G, Onder M, Gill M, Aksakal B, Oztas M, Gürer MA, Celebi JT. A novel missense mutation in CYLD in a family with Brooke-Spiegler syndrome. J Invest Dermatol 2003; 121:732-4. [PMID: 14632188 DOI: 10.1046/j.1523-1747.2003.12514.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Brooke-Spiegler syndrome (BSS, familial cylindromatosis or turban tumor syndrome) is an inherited disease characterized by neoplasms of the skin appendages such as cylindroma, trichoepithelioma, and spiradenoma. The disease has been mapped to 16q12-13, and mutations in the CYLD gene have been identified in families with this disorder. Of interest, multiple familial trichoepithelioma (MFT) has been described as a distinct disorder characterized by the familial occurrence of trichoepitheliomas. MFT has been mapped to 9p21; however, to date a candidate gene has not been identified. In this report, we describe a four-generation family with BSS presenting predominantly with trichoepitheliomas (resembling MFT phenotype). We identified a novel missense mutation in the CYLD gene, designated E474G, in the affected individuals of this family. Our findings exemplify clinical heterogeneity within BSS and extend the body of evidence that mutations in CYLD are implicated in this disease. Although not conclusive, these findings suggest that BSS and MFT may represent a single entity.
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Affiliation(s)
- Guofang Hu
- Department of Dermatology, Columbia University, New York, New York 10032, USA
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Saunders H, Tucker P, Saurine T, Watkins F. Pedigree of multiple benign adnexal tumours of Brooke-Spiegler type. Australas J Dermatol 2003; 44:144-8. [PMID: 12752191 DOI: 10.1046/j.1440-0960.2003.00663.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A pedigree of autosomal dominant expression of multiple benign adnexal tumours is presented. Seven cases spanning three generations are discussed. The clinical manifestations of these tumours are quite variable, including multiple papules concentrated on the face, scalp nodules and a large turban tumour. One member of the family had a linear papular eruption involving one half of his body. Histopathology of all lesions demonstrated benign adnexal characteristics, including well-characterized eccrine spiradenomas, trichoepitheliomas and an eccrine cylindroma. The cutaneous tumours occurring in these patients have continued to develop during their lifetimes. The authors propose that this pedigree has phenotypic characteristics consistent with Brooke-Spiegler syndrome.
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Affiliation(s)
- Helen Saunders
- Department of Medicine (Dermatology), Royal Hobart Hospital, Tasmania, Australia
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Harwood CA, McGregor JM, Swale VJ, Proby CM, Leigh IM, Newton R, Khorshid SM, Cerio R. High frequency and diversity of cutaneous appendageal tumors in organ transplant recipients. J Am Acad Dermatol 2003; 48:401-8. [PMID: 12637920 DOI: 10.1067/mjd.2003.97] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Recipients of organ transplant who are immunosuppressed are at greatly increased risk of nonmelanoma skin cancers compared with the general population, but their risk of appendageal tumors is unknown. OBJECTIVE Our aim was to conduct a systematic examination of cutaneous appendageal tumors arising in recipients of organ transplants compared with individuals who were immunocompetent (ICP). METHODS We conducted a retrospective, clinicopathologic analysis of consecutive appendageal tumors arising in 650 recipients of organ transplants and in the general population of approximately 605,000 people served by our institution. RESULTS Between 1993 and 1998, 231 appendageal tumors were identified in 211 individuals; 23 tumors were found in 21 of 650 patients undergoing transplant (3%), 10 in individuals with other immunosuppressive conditions, 3 in 2 patients with Muir-Torre syndrome, and 195 in 178 apparently ICP. In addition to the increased frequency of appendageal tumors among recipients of transplants, malignant tumors were overrepresented (43% of transplant tumors vs 4% in ICP; P <.0001) as were tumors of sebaceous origin (30% vs 6%; P <.0001). CONCLUSIONS Recipients of organ transplant who are immunosuppressed have a greatly increased risk of cutaneous appendageal tumors compared with apparently ICP. In addition, their tumors are more likely to be malignant and of sebaceous origin.
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Clarke J, Ioffreda M, Helm KF. Multiple familial trichoepitheliomas: a folliculosebaceous-apocrine genodermatosis. Am J Dermatopathol 2002; 24:402-5. [PMID: 12357201 DOI: 10.1097/00000372-200210000-00005] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We reviewed the pathologic findings on a family with multiple hereditary trichoepitheliomas. Although the majority of the lesions were trichoepitheliomas, basal cell carcinomas, spiradenomas, and spiradenomas with cylindromatous foci (spiradenocylindroma) were present, representing a spectrum of lesions exhibiting folliculosebaceous (trichoepithelioma, basal cell carcinoma) and apocrine (spiradenoma, spiradenocylindroma) differentiation. Multiple familial trichoepitheliomas may be a syndrome whereby tumors develop from undifferentiated germinative cells of the folliculosebaceous-apocrine unit. Published findings regarding the genetics of this syndrome and solitary trichoepitheliomas are reviewed; although the molecular basis for the tumors has yet to be determined, current data suggest that a tumor suppressor gene may be involved.
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Affiliation(s)
- Jennie Clarke
- Department of Pathology, Hershey Medical Center of Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033, USA
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Poblete Gutiérrez P, Eggermann T, Höller D, Jugert FK, Beermann T, Grussendorf-Conen EI, Zerres K, Merk HF, Frank J. Phenotype diversity in familial cylindromatosis: a frameshift mutation in the tumor suppressor gene CYLD underlies different tumors of skin appendages. J Invest Dermatol 2002; 119:527-31. [PMID: 12190880 DOI: 10.1046/j.1523-1747.2002.01839.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Familial cylindromatosis (turban tumor syndrome; Brooke-Spiegler syndrome) (OMIM numbers 123850, 132700, 313100, and 605041) is a rare autosomal dominantly inherited tumor syndrome. The disorder can present with cutaneous adnexal tumors such as cylindromas, trichoepitheliomas, and spiradenomas, and tumors preferably develop in hairy areas of the body such as head and neck. In affected families, mutations have been demonstrated in the CYLD gene located on chromosome 16q12-13 and reveal the characteristic attributes of a tumor suppressor. Here, we studied familial cylindromatosis in a multigeneration family of German origin. Clinically, some individuals only revealed discrete small skin-colored tumors localized in the nasolabial region whereas one family member showed expansion of multiple big tumors on the trunk and in a turban-like fashion on the scalp. Histologically, cylindromas as well as epithelioma adenoides cysticum were found. We detected a frameshift mutation in the CYLD gene, designated 2253delG, underlying the disorder and were able to show that a single mutation can result in distinct clinical and histologic expression in familial cylindromatosis. The reasons for different expression patterns of the same genetic defect in this disease remain elusive, however. Identification of mutations in the CYLD gene enable us to rapidly confirm putative diagnoses on the genetic level and to provide affected families with genetic counseling.
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Affiliation(s)
- Pamela Poblete Gutiérrez
- Departments of Dermatology and Human Genetics and Interdisciplinary Center for Clinical Research (IZKF), University Clinic of the RWTH Aachen, Germany
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