Malignant proliferating trichilemmal tumour presenting early in life: an uncommon feature

Malignant proliferating trichilemmal tumor of the scalp: report of 4 cases and a short review of the literature

Malignant proliferating pilar tumors are very rare adnexial lesions that can be confused with other skin neoplasms. The authors present four patients with malignant proliferating trichilemmal tumors located on the scalp. A review of the literature search for malignant proliferating pilar tumors and treatments was performed.

Treatment of Malignant Adnexal Tumors of the Skin: A 12-Year Perspective

Malignant adnexal cancers of the skin—extremely rare neoplasms—are mostly reported as non-symptomatic, slow-growing nodules. These carcinomas occur mainly in the middle-aged (50–60 years of age); they are mostly localized on the upper part of the body and are locally aggressive, infiltrate surrounding tissue, and metastasize to regional lymph nodes. The patients’ outcomes depend on multiple prognostic factors, including the size of the primary tumor and its mitotic count. Surgical resection of the primary tumor with or without regional lymph nodes is the treatment method of choice; however, due to aggressive tumor behavior, perioperative treatment may be considered. The role and efficacy of radiotherapy in the treatment of skin adnexal malignancies are not yet fully defined. Some authors suggest that adjuvant radiotherapy may be considered in locally advanced and regional disease. The aim of this study was to evaluate treatment outcomes and assess the efficacy of combined therapy in patients with adnexal malignancies. Our analysis covered all cases of cutaneous adnexal tumor patients diagnosed and provided with multidisciplinary treatment with surgery and radiotherapy since the beginning of 2009.

Malignant proliferating trichilemmal tumor in abdominal wall: Report of a rare case at an uncommon site with literature review

The proliferating trichilemmal tumor (PTT) is a very rare cutaneous neoplasm that rarely is malignant. PTTs mainly occur in the scalp of elderly women. Only 10% occur in places other than scalp. We present a 62-year-old male patient with malignant PTT in his abdominal wall.

Trichilemmal carcinoma of the axilla with regional lymph nodes metastasis: A case report

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Cutaneous adnexal neoplasms are calcified according to the skin appendage origin.

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Clinical diagnosis is impossible. Thus, surgical excision is always required.

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Pathological examination is generally adequate for their correct classification.

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Trichilemmal carcinoma is a malignant cutaneous adnexal neoplasm of hair follicles.

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Trichilemmal carcinoma is a rare tumour, mainly when located in the axilla.

Introduction and importance

Trichilemmal carcinoma is a rare malignant cutaneous adnexal neoplasm of hair follicles originating from the external root sheath epithelium. The diagnosis is rarely made clinically and is still challenging for an experienced pathologist.

Aim

To report a rare case of trichilemmal carcinoma presenting as a right axillary mass with regional lymph nodes metastasis and was treated with wide local excision in the General Surgery Department Jordanian Royal Medical Services (JRMS), Jordan.

Case presentation

A 45-year-old presented with a right axillary mass of six-month duration. Physical examination revealed a hyperemic, thickened skin of both armpits with a palpable 5-cm mass in the right axilla. He underwent an excisional biopsy of the right mass. Histopathologic examination revealed a malignant adnexal skin tumour with foci of trichilemmal-type keratinisation. It was excised with adequate margins.

Clinical discussion

Trichilemmal carcinoma usually occurs on the forehead, scalp, neck, back of hands and trunk. These neoplasms are rare lesions presenting as locally aggressive, low-grade carcinomas and have the potential for nodal involvement and distant metastasis. Therefore, the establishment of a correct diagnosis is vital to guide the treatment plan. Wide excision with adequate tumour-free margins is considered a curative treatment and offers a successful outcome.

Conclusion

Malignant cutaneous adnexal tumours are one of the most challenging subjects of dermatopathology. Surgical excision is always required to establish a definitive diagnosis and differentiation subtypes. Trichilemmal carcinoma is a relatively rare tumour, mainly when located in the axilla.

Clinicopathological correlation of malignant skin tumors: A retrospective study of 5 years

OBJECTIVE

Skin cancers are relatively uncommon malignancies worldwide, but there is a progressive increase in the incidence over the last few decades.

METHODS

We have studied the clinical and histopathological features of malignant skin tumors received in the department of pathology of our tertiary care institute over a period of 3 years and 8 months. A detailed analysis of clinical, gross, and microscopic findings was performed, followed by clinicopathological correlation.

RESULTS

One hundred and one specimens of skin tumors were received during this period, of which 37 (36.27%) were malignant tumors. Keratinocytic tumors were most common (81.08%) followed by appendageal tumors (10.81%). Squamous cell carcinoma (SCC) was the most frequent malignancy followed by basal cell carcinoma (BCC). Malignant melanoma, hidradenocarcinoma, malignant proliferating trichilemmal tumor (MPTT), sebaceous carcinoma, and fibrosarcomatous dermatofibrosarcoma were also observed. Variants such as hybrid verrucous SCC, basosquamous carcinoma, infiltrating BCC, and MPTT with spindle SCC were also found. Malignant skin tumors were most frequent in the seventh decade (40.54%). Males and females were almost equally affected. Overall, head and neck region was the most common site for malignant skin tumors.

CONCLUSION

The vast diversity of skin tumors produces difficulty in diagnosis. Any lesion, for which the diagnosis is uncertain, based on the history and clinical examination, should be biopsied for histopathological examination to rule out malignancy.

Malignant proliferating trichilemmal tumour

Proliferating trichilemmal tumours are benign but locally aggressive skin neoplasms arising from hair follicles. Rarely, they can become malignant and must be appropriately managed to prevent recurrence and metastasis. One must have a low threshold for diagnosing this rare neoplasm.

Atypical Proliferating Trichilemmal Cyst with Malignant Breast Skin Transformation: A Case Report and Review of the Literature

Proliferating trichilemmal tumors (PTTs) are benign adnexal skin neoplasms that arise from the outer root sheath of the hair follicle. These tumors are most commonly observed on the scalp and occur, most of the time, in elderly women. Malignant transformation of these neoplasms is a rare event; less than 50 cases have been reported in the English medical literature. We present the case of a 39-year-old Hispanic woman with a tumor located on the skin of one of her breasts that in her third surgical procedure the histologic examination revealed the presence of a malignant proliferating trichilemmal tumor (MPTT). Furthermore, a review of the medical literature and a discussion of the clinical and pathologic features of this rare entity are provided.

Malignant hair follicle tumors of the periorbital region: A review of literature and suggestion of a management guideline

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.

Anaesthesia for a "Scalped" Patient

Trichilemmal carcinoma of scalp is a rare malignant tumour of scalp. A 52-year-old female presented with an extensive ulcerative lesion of the scalp. As the location of the tumour was in the occipital region and there was loss of bony skull in the region, this case became challenging. This patient was managed in the left lateral which was a difficult situation for even the experienced Anaesthesiologist. Intravenous access was acquired, central venous catheter (CVC) was placed in the right internal jugular vein under ultrasonography (USG) guidance and intubation was carried out in the lateral position. After the procedure, patient was again returned to the left lateral position. The trachea was extubated in the lateral position once the patient was awake, after thorough reversal of neuromuscular blockade. Patient had an uneventful postoperative period. This case report highlights the management of an unusual case of Trichilemmal carcinoma of the scalp.

A large proliferating trichilemmal cyst masquerading as squamous cell carcinoma

Proliferating trichilemmal cyst (PTC), a rare benign tumor, is a fascinating follicular neoplasm. It occurs on head and neck region of elderly women and its histologic hallmark is trichilemmal keratinization. A 70-year-old female presented to skin outpatient department with complaints of a slowly growing mass on scalp for the past 2 years. On examination, the lesion was firm, mobile, painless, and measured 6 × 5 × 3 cm and was not fixed to the underlying bone. Laboratory investigations were unremarkable. Excisional biopsy was done. Histopathology revealed well-demarcated tumor with variably sized lobules of squamous epithelium undergoing an abrupt change into eosinophilic amorphous keratin without granular cell layer (trichilemmal keratinization). PTC should be differentiated from trichilemmal cyst as it has potential for malignant transformation. Thus, complete excision is recommended for all benign proliferating variants owing to their potential for locally aggressive behavior and malignant transformation.