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Drozdowski R, Grant-Kels JM, Falcone M, Stewart CL. Adnexal neoplasms of the eye. Clin Dermatol 2024; 42:321-342. [PMID: 38281687 DOI: 10.1016/j.clindermatol.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Adnexal neoplasms of the eyelid encompass a wide variety of benign and malignant tumors of sebaceous, follicular, and sweat gland origin. Due to the specialized structures of the eyelid, these neoplasms present differently when compared with those of other locations. Although most dermatologists and ophthalmologists are familiar with the commonly reported adnexal tumors of the eyelid, such as hidrocystoma, pilomatrixoma, and sebaceous carcinoma, many other adnexal neoplasms have been reported at this unique anatomic site. Accurate and timely identification of these neoplasms is essential, as alterations of eyelid anatomy and function can have a negative impact on eye health, vision, and quality of life. We review the clinical and histopathologic features of common and rare eyelid adnexal neoplasms and discuss proposed treatment options.
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Affiliation(s)
- Roman Drozdowski
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA; Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Madina Falcone
- Division of Ophthalmology, Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Campbell L Stewart
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA.
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2
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Liu L, Long T, Wei N, Zhang H, Tang C, Gao J. Successful treatment of trichilemmal carcinoma with distant metastasis using pembrolizumab: a case report and review. Immunotherapy 2024; 16:659-667. [PMID: 39259509 PMCID: PMC11404700 DOI: 10.1080/1750743x.2024.2353535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/30/2024] [Indexed: 09/13/2024] Open
Abstract
Trichilemmal carcinoma (TC) is a rare, malignant cutaneous adnexal tumor. TC often has nonspecific clinical manifestations and its aggressive nature is frequently overlooked. Metastasis of TC is rarely reported and there is no standard treatment for recurrent or metastatic TC. We report a complicated case of TC arising from the parotid gland with metastasis to cervical lymph nodes. The tumor progressed after multiple surgeries, radiation and chemotherapy. Finally, the patient achieved good response and disease control with pembrolizumab, an immune checkpoint inhibitor targeting programmed cell death protein-1. Currently, the patient has received 19 cycles of pembrolizumab and the disease remains well controlled. This represents the first reported use of immune checkpoint blockade to treat TC.
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Affiliation(s)
- Lei Liu
- Department of Radiotherapy and Oncology, Hefei Ion Medical Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230088, China
| | - Tengfei Long
- Department of Radiotherapy and Oncology, Hefei Ion Medical Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230088, China
| | - Nannan Wei
- Department of Radiotherapy and Oncology, Hefei Ion Medical Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230088, China
| | - Hongyan Zhang
- Department of Radiotherapy and Oncology, Hefei Ion Medical Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230088, China
- Department of Radiotherapy and Oncology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Chaoliang Tang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Jin Gao
- Department of Radiotherapy and Oncology, Hefei Ion Medical Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230088, China
- Department of Radiotherapy and Oncology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
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3
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Knani L, Oueslati M, Ben Khemis I, Ghachem M, Frini S, Moussa S, Mokni M, Ghorbel M. [Trichilemmal cyst of the eyelid: Clinical and histological features]. J Fr Ophtalmol 2024; 47:104003. [PMID: 37919152 DOI: 10.1016/j.jfo.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 09/24/2023] [Accepted: 09/28/2023] [Indexed: 11/04/2023]
Affiliation(s)
- L Knani
- Service d'ophtalmologie, CHU Farhat Hached de Sousse, rue Ibn El Jazzar, 4000 Sousse, Tunisie; Faculté de médecine de Sousse, Université de Sousse, 4000 Sousse, Tunisie
| | - M Oueslati
- Service d'ophtalmologie, CHU Farhat Hached de Sousse, rue Ibn El Jazzar, 4000 Sousse, Tunisie.
| | - I Ben Khemis
- Service d'ophtalmologie, CHU Farhat Hached de Sousse, rue Ibn El Jazzar, 4000 Sousse, Tunisie
| | - M Ghachem
- Service d'ophtalmologie, CHU Farhat Hached de Sousse, rue Ibn El Jazzar, 4000 Sousse, Tunisie
| | - S Frini
- Laboratoire d'anatomie et de cytologie pathologiques, CHU Farhat Hached de Sousse, rue Ibn El Jazzar, 4000 Sousse, Tunisie
| | - S Moussa
- Laboratoire d'anatomie et de cytologie pathologiques, CHU Farhat Hached de Sousse, rue Ibn El Jazzar, 4000 Sousse, Tunisie; Faculté de médecine de Sousse, Université de Sousse, 4000 Sousse, Tunisie
| | - M Mokni
- Laboratoire d'anatomie et de cytologie pathologiques, CHU Farhat Hached de Sousse, rue Ibn El Jazzar, 4000 Sousse, Tunisie; Faculté de médecine de Sousse, Université de Sousse, 4000 Sousse, Tunisie
| | - M Ghorbel
- Service d'ophtalmologie, CHU Farhat Hached de Sousse, rue Ibn El Jazzar, 4000 Sousse, Tunisie; Faculté de médecine de Sousse, Université de Sousse, 4000 Sousse, Tunisie
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Sun J, Zhang L, Xiao M, Li S, Chen R, Li Y, Yang Y. Systematic analysis and case series of the diagnosis and management of trichilemmal carcinoma. Front Oncol 2023; 12:1078272. [PMID: 36727056 PMCID: PMC9886092 DOI: 10.3389/fonc.2022.1078272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023] Open
Abstract
Background Trichilemmal carcinoma (TLC) is a rare malignant cutaneous adnexal neoplasm, with no relatively comprehensive research. Objective The aim of this study is to perform an updated statistical analysis so as to better understand TLC's epidemiology, clinical features, diagnosis, and treatment. Methods The diagnosis and treatment of three TLC cases in our department were summarized. Then, all TLC cases published in the literature were retrieved for a comprehensive analysis, followed by the analysis of global trends and regional distribution, demographic characteristics, clinical features, pathogenesis, histopathological features, and treatment and prognosis of TLC. Results Of the 231 cases, the incidence of TLC has shown an upward trend recently, especially in China, in Asia. The susceptible population is men aged 60-80 and women over 80, and the most prone location is head and neck. The phenotype of TLC is not always typical and may be misdiagnosed because of the coexistence of other diseases. There is a linear relationship between the diameter and its duration or thickness. UV, locally present skin lesions, trauma, scarring, organ transplantation, and genetic disorders may trigger the occurrence of TLC. Periodic acid-Schiff staining and CD34, but not Epithelial Membrane Antigen (EMA), were helpful in the diagnosis of TLC. Although effective, surgical excision and Mohs micrographic surgery need further improvement to reduce recurrence of TLC. Carcinoma history is an independent risk factor for TLC recurrence. Limitations The limitation of this study is the lack of randomized controlled trial on TLC treatment and recurrence. Conclusion TLC has the possibility of invasive growth and recurrence, especially in patients with longer duration and carcinoma history.
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Affiliation(s)
- Jiachen Sun
- Department of Dermatology, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lihua Zhang
- Department of Pathology, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Minglu Xiao
- Department of Dermatology, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shiyi Li
- Department of Burns and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Runkai Chen
- Department of General Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ying Li
- Department of Pathology, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yuguang Yang
- Department of Dermatology, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China,*Correspondence: Yuguang Yang,
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Zhang L, Lin Z, Wu H, Ou S. Corneal Perforation Caused by Eyelid Margin Trichilemmal Carcinoma: A Case Report and Review of Literature. Front Med (Lausanne) 2022; 9:896393. [PMID: 35646982 PMCID: PMC9136284 DOI: 10.3389/fmed.2022.896393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/19/2022] [Indexed: 11/22/2022] Open
Abstract
Background Trichilemmal carcinoma (TLC) is a rare malignant adnexal tumor most commonly found in the elderly, usually affecting the scalp, eyelids, neck and face. Here, we first reported a rare case of corneal perforation caused by eyelid margin TLC. Case Presentation A 68-year-old female presented with 2 months history of unprovoked redness, pain and blurred vision in the left eye. On slit-lamp examination, a 1 × 2 mm sized aseptic corneal perforation embedded by iris prolapsed was noted. Upon detailed case investigation, we speculated that the severe meibomian gland dysfunction (MGD) and subsequent Blepharokeratoconjunctivitis (BKC) could have led to corneal perforation. The patient underwent penetrating keratoplasty to prevent ulcer enlargement and infection. However, several tiny nodules gradually developed on the eyelid margin postoperatively, accompaniedby with bleeding, burst and madarosis postoperatiely. Subsequently, biopsy revealed the growth of TLC on the eyelid margin, and lesionectomy was immediately conducted During the 1-year follow-up period, no local recurrence or metastasis was observed. Conclusions To date, there has not been any report of corneal perforation caused by eyelid margin TLC. Consideration of the clinical presentation, feature and histopathologist will be benefit for the dignoses and treatment of TLC. Ensuring a smooth eyelid margin by total excision of TLC and consistent followup of patient will avoid recurrence.
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Affiliation(s)
- Liying Zhang
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Department of Ophthalmology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
- Fujian Key Laboratory of Ocular Surface and Corneal Diseases, Xiamen University, Xiamen, China
| | - Zhirong Lin
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Fujian Key Laboratory of Ocular Surface and Corneal Diseases, Xiamen University, Xiamen, China
| | - Huping Wu
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Fujian Key Laboratory of Ocular Surface and Corneal Diseases, Xiamen University, Xiamen, China
- Huping Wu
| | - Shangkun Ou
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Fujian Key Laboratory of Ocular Surface and Corneal Diseases, Xiamen University, Xiamen, China
- *Correspondence: Shangkun Ou
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Jia Q, Yuan Y, Mao D, Wen G, Chen X. Trichilemmal Carcinoma of the Scalp in a Young Female: A Case Report. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2022; 15:139-143. [PMID: 35115802 PMCID: PMC8805741 DOI: 10.2147/ccid.s349797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/11/2022] [Indexed: 11/30/2022]
Abstract
Trichilemmal carcinoma (TC) is a rare malignant cutaneous adnexal neoplasm originating from the outer root sheath of hair follicles, which occurs commonly in sun-exposed areas of the elderly. Here, we introduce a case of a 24-year-old woman with TC on her scalp.
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Affiliation(s)
- Qiuyu Jia
- Department of Dermatology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Yunyan Yuan
- Department of Dermatology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Dandan Mao
- Department of Dermatology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Guangdong Wen
- Department of Dermatology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Xue Chen
- Department of Dermatology, Peking University People's Hospital, Beijing, People's Republic of China
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Fronek L, Brahs A, Farsi M, Miller R. A Rare Case of Trichilemmal Carcinoma: Histology and Management. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2021; 14:25-30. [PMID: 34804352 PMCID: PMC8594537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Trichilemmal carcinoma (TC) is a rare cutaneous tumor thought to be derived from the follicular outer root sheath (ORS). It often manifests as a nondescript skin-colored or pink papule on the hair-bearing, sun-exposed anatomic sites of elderly patients. Trichilemmal carcinoma shows many histologic features reminiscent of follicular ORS-notably, its glycogen-rich clear cells, trichilemmal keratinization, and similar immunostaining profile. Historically, it has been described as following a relatively indolent clinical course, but cases of recurrence, local aggression, and distant metastases have recently been elucidated. Here, we report the case of a 66-year-old male patient who presented with an asymptomatic, erythematous plaque on his neck; biopsy confirmed a diagnosis of TC. The patient deferred Mohs micrographic surgery in favor of wide local excision and was treated successfully with 3-mm margins. Salient histopathologic features, treatment modalities, and management recommendations are discussed.
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Affiliation(s)
- Lisa Fronek
- Drs. Fronek, Brahs, and Miller are with HCA Healthcare USF Morsani College of Medicine Largo Medical Center Program in Largo, Florida
- Dr. Farsi is with the Department of Mohs Micrographic Surgery at the University of Florida in Gainesville, Florida
| | - Allyson Brahs
- Drs. Fronek, Brahs, and Miller are with HCA Healthcare USF Morsani College of Medicine Largo Medical Center Program in Largo, Florida
- Dr. Farsi is with the Department of Mohs Micrographic Surgery at the University of Florida in Gainesville, Florida
| | - Maheera Farsi
- Drs. Fronek, Brahs, and Miller are with HCA Healthcare USF Morsani College of Medicine Largo Medical Center Program in Largo, Florida
- Dr. Farsi is with the Department of Mohs Micrographic Surgery at the University of Florida in Gainesville, Florida
| | - Richard Miller
- Drs. Fronek, Brahs, and Miller are with HCA Healthcare USF Morsani College of Medicine Largo Medical Center Program in Largo, Florida
- Dr. Farsi is with the Department of Mohs Micrographic Surgery at the University of Florida in Gainesville, Florida
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8
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Usseglio J, Pagès E, Guyot A, Laloze J, Ferri J. Trichilemmal carcinoma of the scalp. Int J Oral Maxillofac Surg 2021; 50:1289-1292. [PMID: 33642152 DOI: 10.1016/j.ijom.2021.02.008] [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: 09/05/2020] [Revised: 12/17/2020] [Accepted: 02/04/2021] [Indexed: 11/25/2022]
Abstract
This report describes the case of an 86-year-old male who presented with a large scalp tumour. Imaging revealed a large vertex mass, without intracranial extension, and multiple nodular subcapsular hepatic lesions suspected to be secondary in nature. Surgical resection was performed. Pathological examination revealed an adnexal carcinoma of follicular origin, thus a trichilemmal carcinoma. Controlled wound healing (budding of the diploë) was completely successful within 12 months. The patient refused the assessment and treatment of his metastases.
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Affiliation(s)
- J Usseglio
- Department of Maxillofacial and Plastic Surgery, CHU Dupuytren, Limoges, France.
| | - E Pagès
- Department of Maxillofacial and Plastic Surgery, CHU Dupuytren, Limoges, France
| | - A Guyot
- Department of Anatomy and Pathology, CHU Dupuytren, Limoges, France
| | - J Laloze
- Department of Maxillofacial and Plastic Surgery, CHU Dupuytren, Limoges, France
| | - J Ferri
- Department of Stomatology and Maxillofacial Surgery, CHU Salengro, Lille, France
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CD34 and BerEP4 Are Helpful to Distinguish Basaloid Tricholemmoma From Basal Cell Carcinoma. Am J Dermatopathol 2018; 40:561-566. [PMID: 29570129 DOI: 10.1097/dad.0000000000001117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Tricholemmoma, a benign follicular neoplasm with outer root sheath differentiation, typically comprises clear or pale cells, and when multiple is pathognomic of Cowden's syndrome. The tumor is probably underrecognized and in basaloid examples can be difficult to distinguish from basal cell carcinoma (BCC). We studied 55 tricholemmomas (including 15 basaloid cases) and compared immunohistochemical profile with nodular BCC from our archives. Basaloid and non-basaloid tricholemmomas had similar staining characteristics. BerEP4 was focally positive (range 10%-20%) in only 3/39 (7.7%) tricholemmomas compared with widespread positivity in BCC (90.8%, 139 of 151 cases with ≥50% tumor area stained). CD34 was expressed, usually focally (median 20%, range 10%-90%), in 52/53 (98.1%) tricholemmomas and was negative in all 21 BCCs stained. EMA staining lacked sensitivity or specificity in differentiating tricholemmoma from BCC. Five or more Merkel cells were found in 7/17 (40.1%) tricholemmomas and 1/23 (4.3%) nodular BCCs studied. In summary, immunohistochemistry is helpful in distinction between tricholemmoma, including difficult basaloid examples (BerEP4 negative or focal, CD34 positive) compared with BCC (BerEP4 widespread in most cases, CD34 negative). The presence of 5 or more Merkel cells is a relatively specific but not a particularly sensitive discriminator.
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10
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Maya-Rico AM, Jaramillo-Pulgarín C, Londoño-García Á, Peña-Zúñiga B. Locally aggressive trichilemmal carcinoma. An Bras Dermatol 2018; 93:579-581. [PMID: 30066770 PMCID: PMC6063117 DOI: 10.1590/abd1806-4841.20187461] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/20/2017] [Indexed: 11/22/2022] Open
Abstract
Trichilemmal carcinoma is a rare adnexal neoplasia with histologic features reminiscent of the outer root sheath of hair follicles. The clinical presentation of trichilemmal carcinoma is variable, as it may mimic basal cell carcinomas and squamous cell carcinomas, thus requiring histologic diagnosis. We report the case of a patient with aggressive trichilemmal carcinoma in the auricle.
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Chai MK, Tenzel P, Iacob C, Jordan A, Reddy HS. Eyelid trichilemmal carcinoma. Saudi J Ophthalmol 2017; 31:183-185. [PMID: 28860920 PMCID: PMC5569329 DOI: 10.1016/j.sjopt.2017.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 05/08/2017] [Indexed: 11/19/2022] Open
Abstract
Trichilemmal carcinomas are rare malignant adnexal tumors which can involve the head and, rarely, the eyelid. Accurate diagnosis and differentiation from basal cell carcinoma or trichoepithelioma are dependent on histopathological and immunohistochemical analysis. We report a case of an eyelid mass, initially diagnosed by incisional biopsy as a trichoepithelioma, later found on excisional biopsy to be a trichilemmal carcinoma and present a review of the literature of the histopathology, differential diagnosis and management. Consideration of these entities will be useful to the histopathologist and clinician to better identify and treat these challenging lesions.
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Affiliation(s)
- Michael K. Chai
- Corresponding author at: 310 East 14th Street, New York, NY 10003, United States.310 East 14th StreetNew YorkNY10003United States
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12
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Romeu M, Foletti J, Chossegros C, Dales J, Berbis P, Cribier B, Guyot L. Les tumeurs cutanées malignes à différentiation pilaire de la face et du cuir chevelu : mise au point diagnostique et thérapeutique. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2017; 118:95-102. [DOI: 10.1016/j.jormas.2017.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 06/02/2016] [Accepted: 01/11/2017] [Indexed: 12/01/2022]
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Abstract
A 16-year-old African American male, the youngest patient to date, presented with a well-circumscribed upper eyelid lesion. On excision, the dermal nodule was contiguous with the epidermis, displayed trichohyalin-like bodies in an expanded outer root sheath, and was composed chiefly of small cellular clusters separated by a prominent network of periodic acid Schiff -positive hyaline bands of basement membrane material. The tumor cells were positive for high molecular weight cytokeratins (CK) 5/6, CK14, and CK34βE12 and were negative for CK7, carcinoembryonic antigen and epithelial membrane antigen. Negative S100, glial fibrillary acidic protein, and smooth muscle actin immunoreactions ruled out a myoepithelial lesion. The Ki-67 proliferation index was <10%. The diagnosis was a hyalinized trichilemmoma, contrasting with the more common lobular type. As an isolated lesion, trichilemmoma does not portend Cowden syndrome.
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14
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Sia PI, Figueira E, Allende A, Selva D. Malignant hair follicle tumors of the periorbital region: A review of literature and suggestion of a management guideline. Orbit 2016; 35:144-56. [PMID: 27171562 DOI: 10.1080/01676830.2016.1176048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Malignant hair follicle tumors are rare skin adnexal malignancies that have a predilection for the head and neck region. They can be categorized into a number of different subtypes. Histologically, they are distinct from their benign counterpart. To the best of our knowledge, there is no extensive review of these malignancies, especially in the periorbital region. We aim to provide a literature review and a guideline for management of these malignant tumors in the periorbital region. Database from Medline, PubMed, Embase, and Google Scholar were consulted. A total of 16 cases from the literature on hair follicle malignancies in the periorbital region were included in this review. The clinical presentations, diagnostic patterns, investigations used, and best management approach of these tumors are discussed. The American Joint Committee on Cancer (AJCC) 7(th) edition carcinoma of the eyelid staging system was used to describe their behaviors. We recommend wide excision surgery and a close follow-up for these tumors. Tumors presenting with a late stage require work-up for distant metastasis and consideration for exenteration procedures. The role of radiotherapy and chemotherapy in this context is still uncertain.
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Affiliation(s)
- Paul Ikgan Sia
- a South Australian Institute of Ophthalmology and Discipline of Ophthalmology & Visual Sciences , University of Adelaide , Adelaide , Australia
| | - Edwin Figueira
- a South Australian Institute of Ophthalmology and Discipline of Ophthalmology & Visual Sciences , University of Adelaide , Adelaide , Australia
| | - Alexandra Allende
- b Douglass Hanly Moir Pathology , Sydney , New South Wales , Australia
| | - Dinesh Selva
- a South Australian Institute of Ophthalmology and Discipline of Ophthalmology & Visual Sciences , University of Adelaide , Adelaide , Australia
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15
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Danialan R, Mutyambizi K, Aung PP, Prieto VG, Ivan D. Challenges in the diagnosis of cutaneous adnexal tumours. J Clin Pathol 2015; 68:992-1002. [DOI: 10.1136/jclinpath-2015-203228] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The diagnosis of cutaneous adnexal neoplasms, a heterogeneous group of entities, is often perceived by practising pathologists as challenging. A systematic approach to diagnosis is necessary for classification of these lesions, which establishes the tumour differentiation (follicular, sebaceous, sweat gland or apocrine) and evaluates histological features differentiating between benign and malignant entities. Consideration of clinical history is a necessary adjunct in evaluation of the adnexal neoplasm, as characteristic anatomical sites are described for many adnexal lesions. In some instances, immunohistochemical studies may also be employed to aid the diagnosis. The differential diagnosis between primary cutaneous adnexal neoplasms and cutaneous metastases from visceral tumours may also be difficult. Clinical, radiological, histological and immunohistochemical characteristics will be further discussed, considering that the correct diagnosis has a significant impact on the patient's management and prognosis.
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Shi S, Zhao Y. MR Imaging Findings of Giant Trichilemmal Carcinoma on the Scalp. A Case Report. Neuroradiol J 2011; 24:946-50. [PMID: 24059904 DOI: 10.1177/197140091102400622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2010] [Accepted: 09/17/2011] [Indexed: 11/17/2022] Open
Abstract
We describe the magnetic resonance imaging findings of a huge trichilemmal carcinoma (TLC) on the parietal and occipital region of the scalp in one patient. Our aim is to discuss the clinical, radiologic, and pathologic features of scalp TLC and to review relevant literature regarding this tumor. One patient with recent rapid tumor growth in the parietal and occipital region of the scalp underwent MR studies and subtotal resection. The tumor was seen as a poorly marginated and lobulated soft-tissue mass with isointense signal on T1-weighted images and hyperintense signal on T2-weighted images. Necrosis and ulceration were also found on the tumor surface. The TLC has been massively invading the nearby skull, meninges, brain tissue, and superior sagittal sinus. After exhibiting contrast, the tumor showed significant enhancement, with small portions remaining unenhanced. Subtotal excision of the mass and reconstruction of the scalp were performed. Microscopically, the mass was composed of trabecular growth of tumor cells with clear cytoplasm, prominent nucleoli, frequent mitoses, and foci of trichilemmal keratinization. Tumor on the scalp with heterogeneous, mixed signals on T2-weighted images, significant enhancement of solid portion, and local infiltration accompanied by surface deep ulceration may indicate a TLC. Wide surgical excision with tumor-free margins remains the best choice for treatment.
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Affiliation(s)
- S Shi
- Department of Radiology, First Affiliated Hospital of Bengbu Medical College; Bengbu, Anhui Province, China -
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