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Solitary calcified trichilemmal cyst on forearm.

Srinivas SM, Vittal CR, Naik M, Nagaraj C - Int J Trichology (2013)

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Ananya Hospital, Karnataka, India.

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Sir, Solitary asymptomatic nodule poses a great diagnostic challenge to clinicians as there are numerous clinical and pathological differential diagnoses... There was no history of preceding trauma... Past history was unremarkable... Excision biopsy of the nodule revealed acanthotic epidermis and cystic lesion in deep dermis lined by stratified squamous epithelium and filled with homogenous eosinophilic material and few nucleated squamous cells... Trichilemmal cysts arise from the epithelium of follicular isthmus, where the outer root sheath undergoes a specific form of keratinisation (trichilemmal keratinisation) forming a cyst wall without a granular area... The cell of the lining epithelium gradually increases in size as they approach the cyst cavity, appearing swollen with pale cytoplasm, keratinizing abruptly... It is differentiated from epidermoid cyst by absence of punctum and location... Wide excision is the treatment of choice but recurrences are common... Knowledge about morphology of different cystic lesion and its behavior is essential to come to diagnosis... Many benign cystic lesions can have unusual presentation and can be clinically misdiagnosed.

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Related in: MedlinePlus

(a) Acanthotic epidermis with deep dermis showing small cystic mass (H and E, ×4) (b) Cystic mass lined by stratified squamous epithelium filled with homogeneous eosinophilic material (H and E, ×10)
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Figure 2: (a) Acanthotic epidermis with deep dermis showing small cystic mass (H and E, ×4) (b) Cystic mass lined by stratified squamous epithelium filled with homogeneous eosinophilic material (H and E, ×10)

Mentions: A 60-year-old female presented with asymptomatic swelling on forearm from past 10 years, gradually increasing in size from 2 months. There was slight pain and watery like, nonfoul smelling discharge from the swelling from 2 days. There was no history of preceding trauma. Past history was unremarkable. None of the family members had similar complaints. Cutaneous examination showed single well defined, erythematous, firm, freely mobile, tender nodule measuring 1.5 × 2 cm on the flexor aspect of forearm [Figure 1]. Differential diagnosis of inflamed epidermoid cyst, pyogenic granuloma, xanthoma, and foreign body cyst was considered. Excision biopsy of the nodule revealed acanthotic epidermis and cystic lesion in deep dermis lined by stratified squamous epithelium and filled with homogenous eosinophilic material and few nucleated squamous cells. Calcification was noted at the centre of the cyst [Figures 2 and 3]. Based on histological findings, a diagnosis of calcified trichilemmal cyst was considered.


Solitary calcified trichilemmal cyst on forearm.

Srinivas SM, Vittal CR, Naik M, Nagaraj C - Int J Trichology (2013)

(a) Acanthotic epidermis with deep dermis showing small cystic mass (H and E, ×4) (b) Cystic mass lined by stratified squamous epithelium filled with homogeneous eosinophilic material (H and E, ×10)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3927180&req=5

Figure 2: (a) Acanthotic epidermis with deep dermis showing small cystic mass (H and E, ×4) (b) Cystic mass lined by stratified squamous epithelium filled with homogeneous eosinophilic material (H and E, ×10)
Mentions: A 60-year-old female presented with asymptomatic swelling on forearm from past 10 years, gradually increasing in size from 2 months. There was slight pain and watery like, nonfoul smelling discharge from the swelling from 2 days. There was no history of preceding trauma. Past history was unremarkable. None of the family members had similar complaints. Cutaneous examination showed single well defined, erythematous, firm, freely mobile, tender nodule measuring 1.5 × 2 cm on the flexor aspect of forearm [Figure 1]. Differential diagnosis of inflamed epidermoid cyst, pyogenic granuloma, xanthoma, and foreign body cyst was considered. Excision biopsy of the nodule revealed acanthotic epidermis and cystic lesion in deep dermis lined by stratified squamous epithelium and filled with homogenous eosinophilic material and few nucleated squamous cells. Calcification was noted at the centre of the cyst [Figures 2 and 3]. Based on histological findings, a diagnosis of calcified trichilemmal cyst was considered.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Ananya Hospital, Karnataka, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Sir, Solitary asymptomatic nodule poses a great diagnostic challenge to clinicians as there are numerous clinical and pathological differential diagnoses... There was no history of preceding trauma... Past history was unremarkable... Excision biopsy of the nodule revealed acanthotic epidermis and cystic lesion in deep dermis lined by stratified squamous epithelium and filled with homogenous eosinophilic material and few nucleated squamous cells... Trichilemmal cysts arise from the epithelium of follicular isthmus, where the outer root sheath undergoes a specific form of keratinisation (trichilemmal keratinisation) forming a cyst wall without a granular area... The cell of the lining epithelium gradually increases in size as they approach the cyst cavity, appearing swollen with pale cytoplasm, keratinizing abruptly... It is differentiated from epidermoid cyst by absence of punctum and location... Wide excision is the treatment of choice but recurrences are common... Knowledge about morphology of different cystic lesion and its behavior is essential to come to diagnosis... Many benign cystic lesions can have unusual presentation and can be clinically misdiagnosed.

No MeSH data available.


Related in: MedlinePlus