Brooke-Spiegler syndrome complicated by unilateral hearing loss

Brooke-Spiegler syndrome: radiotherapy as the last resort?

PURPOSE

To describe the case of successful radiotherapeutic treatment of a woman suffering from Brooke-Spiegler syndrome who had multiple disfiguring cylindromas on the entire scalp and further tumors on the trunk.

METHODS

After decades of treatment with conventional therapies including surgery and topically applied salicylic acid, the 73-year-old woman agreed to undergo radiotherapeutic treatment. She received 60 Gy to the scalp and 36 Gy to painful nodules in the lumbar spine region.

RESULTS

Over a follow-up period of 14 and 11 years, respectively, the scalp nodules almost completely regressed, while the lumbar nodules became painless and considerably smaller. Apart from alopecia, no late adverse effects of treatment remain.

CONCLUSION

This case should remind us of the potential role that radiotherapy could play in treating Brooke-Spiegler syndrome. The required dose for treatment of such extensive disease is still a matter of debate due to the scarcity of radiotherapeutic experience. This case demonstrates that for scalp tumors, 30 × 2 Gy can result in long-term tumor control, while other dose prescriptions may be adequate for tumors in other locations.

Familial dermal eccrine cylindromatosis with emphasis on histology and genetic mapping

Familial cylindromatosis (FC) is an autosomal dominant disorder with apparently complete penetrance, but variable expression. There is an increasing evidence that FC is clinically, genetically, and histologically heterogeneous disorder as the simultaneous occurrence of cylindromas and other tumors of skin appendages within the affected individuals and families. The presence of multiple scalp cylindromas is often associated with autosomal dominant Brooke-Spielger syndrome, a condition in which there are co-existent facial trichoepitheliomas and spiradenomas. We present here a case of multiple cylindromatosis in a family affecting many members successively.

A novel therapeutic strategy for turban tumor: scalp excision and combined reconstruction with artificial dermis and split skin graft

BACKGROUND

Brooke-Spiegler syndrome is a hereditary tumor predisposition disorder characterized by the development of cylindromas, trichoepitheliomas, and spiradenomas. Predilection sites of the disease are hair follicles and sweat glands of the head and neck. In some patients, the tumors can coalesce to so-called turban tumors, which then usually cause cosmetic, psychological, and functional impairment. A curative therapy is not yet available, and thus total scalp excision followed by split skin graft is evolving as a frequently applied therapy. However, this treatment can lead to the formation of a thin and vulnerable skin, which hampers wearing a wig. Therefore, a more robust and functional solution is preferable. Here, we report on a woman with a turban tumor who suffered enormously from the disease and had secluded herself from social life.

METHODS

We treated her with a total scalp excision down to the periosteum, followed by sequential combined reconstruction with an artificial dermal template and split skin grafts.

RESULTS

The treatment resulted in formation of a robust and flexible skin.

CONCLUSION

Treatment of turban tumor is a challenge considering the localization and extensiveness of the tumor masses. This novel therapy for turban tumor leads to a very good cosmetic and functional outcome.

Dermal cylindroma of the scalp

Dermal cylindroma is a benign neoplasm of the eccrine sweat glands, which presents in the head and neck area in majority of cases. In its most florid presentation, the entire scalp can be involved, leading to the descriptive label turban tumor. They most commonly occur on the head and neck as solitary or multiple tumors. Solitary cylindromas occur sporadically and typically are not inherited. Multiple tumors are observed in an autosomal dominantly inherited manner. When nodules enlarge and coalesce on the scalp, they form the distinctive turban tumor feature. We present a case of multiple form of dermal cylindroma, occupying the anterior scalp in a 38-year-old male patient.

Malignant cylindroma of the scalp arising in a setting of multiple cylindromatosis: a case report

An unusual case of malignant cylindroma of the scalp arising in a 79-year-old white female with multiple cylindromatosis is presented. The tumor apparently arose from a cylindroma and had features of spiradenoma. Multiple cylindromatosis is an uncommon hereditary autosomal dominant disease, which is characterized by multiple skin adnexal tumors like cylindromas and trichoepitheliomas and occasional spiradenomas. Cylindroma is an uncommon benign tumor, which originates from skin appendages and is most commonly found on the scalp and face with a strong predilection for middle-aged and elderly females. Although cylindromas are usually benign neoplasms, carcinoma arising in such neoplasms is rare with only sporadic reports in literature. Her family history was negative for a similar disease. The patient's main concern was painful lesions over her right ear that interfered with wearing of her glasses. The clinical, histological immunohistochemical features, and treatment are presented along with a review of the literature.