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A large proliferating trichilemmal cyst masquerading as squamous cell carcinoma.

Alam K, Gupta K, Maheshwari V, Varshney M, Jain A, Khan AH - Indian J Dermatol (2015 Jan-Feb)

Bottom Line: 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.Thus, complete excision is recommended for all benign proliferating variants owing to their potential for locally aggressive behavior and malignant transformation.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.

ABSTRACT
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.

No MeSH data available.


Related in: MedlinePlus

Variably sized lobules of squamous cells with central keratinization (H and E, ×40)
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Figure 2: Variably sized lobules of squamous cells with central keratinization (H and E, ×40)

Mentions: A 70-year-old female presented to skin outpatient department with complaint of a slowly growing mass on the scalp for the past 2 years [Figure 1]. The patient was otherwise healthy with no significant medical history. No history suggestive of trauma and chronic irritation except hair combing was present. On examination, the lesion was firm, mobile, painless, and measured 6 × 5 × 3 cm and was not fixed to the underlying bone. There was no regional lymphadenopathy. Systemic examination was normal. Chest roentgenogram did not reveal any evidence of pulmonary metastasis. Contrast-enhanced computed tomography scans of the brain also did not show any evidence of intracranial invasion. Laboratory investigations were unremarkable. Excisional biopsy was done and histopathology revealed well-demarcated tumor with variably sized lobules of squamous epithelium [Figure 2] undergoing an abrupt change into eosinophilic amorphous keratin without granular cell layer (trichilemmal keratinization) with formation of parakeratotic cells without granular cell layer [Figure 3]. Glycogen-rich vacuolated cells were also seen [Figure 4]. The diagnosis of proliferating trichilemmal tumor (PTT) was made.


A large proliferating trichilemmal cyst masquerading as squamous cell carcinoma.

Alam K, Gupta K, Maheshwari V, Varshney M, Jain A, Khan AH - Indian J Dermatol (2015 Jan-Feb)

Variably sized lobules of squamous cells with central keratinization (H and E, ×40)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4318032&req=5

Figure 2: Variably sized lobules of squamous cells with central keratinization (H and E, ×40)
Mentions: A 70-year-old female presented to skin outpatient department with complaint of a slowly growing mass on the scalp for the past 2 years [Figure 1]. The patient was otherwise healthy with no significant medical history. No history suggestive of trauma and chronic irritation except hair combing was present. On examination, the lesion was firm, mobile, painless, and measured 6 × 5 × 3 cm and was not fixed to the underlying bone. There was no regional lymphadenopathy. Systemic examination was normal. Chest roentgenogram did not reveal any evidence of pulmonary metastasis. Contrast-enhanced computed tomography scans of the brain also did not show any evidence of intracranial invasion. Laboratory investigations were unremarkable. Excisional biopsy was done and histopathology revealed well-demarcated tumor with variably sized lobules of squamous epithelium [Figure 2] undergoing an abrupt change into eosinophilic amorphous keratin without granular cell layer (trichilemmal keratinization) with formation of parakeratotic cells without granular cell layer [Figure 3]. Glycogen-rich vacuolated cells were also seen [Figure 4]. The diagnosis of proliferating trichilemmal tumor (PTT) was made.

Bottom Line: 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.Thus, complete excision is recommended for all benign proliferating variants owing to their potential for locally aggressive behavior and malignant transformation.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.

ABSTRACT
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.

No MeSH data available.


Related in: MedlinePlus