Letter - Clinical
Proliferating trichilemmal tumor
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More rarely, it can affect other topographies such as the neck, trunk, groin, mons pubis, vulva, gluteal region, and skull base.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">This report describes the case of a 52-year-old male patient, with no comorbidities, who sought medical care complaining of a lesion on the scalp, with discomfort on palpation, that had been growing for about a year. He had a personal history of scalp cyst removal years before. On clinical examination, a tumor-like, erythematous lesion with a pedunculated structure in the center, measuring approximately 3 cm in its largest diameter, was observed in the parieto-occipital region (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The main hypothesis was trichilemmal cyst with atypical clinical presentation and, for this reason, an incisional spindle biopsy was performed, measuring about 2 cm in its largest diameter for anatomopathological analysis. Histopathology showed a dermal tumor, with no connection with the epidermis, consisting of an expansive lobular proliferation of squamous cells with ample eosinophilic cytoplasm and abrupt keratinization, without the formation of a granular layer - trichilemmal-type keratinization ‒ in the central portion of the lobes (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Some of these cells had atypical nuclei, but no mitosis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), findings consistent with a proliferating trichilemmal tumor. The patient was referred for complete excision of the lesion and showed good evolution, with no signs of recurrence to date.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The anatomopathological analysis is crucial for the diagnosis of PTT, because clinically, as in the case reported herein, it can be mistaken for a trichilemmal cyst, or other adnexal tumors.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> What histopathologically characterizes this tumor is the proliferation of squamous cells with trichilemmal keratinization (defined by the abrupt transition from nucleated to anucleated epithelial cells, with the absence of a granular layer) and varying degrees of atypia.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> The presence of poorly-defined borders, high-grade atypia, aneuploidy, necrosis, cellular pleomorphism and atypical mitoses are related to malignancy (malignant proliferating trichilemmal tumor) and, in this case, distant metastases may rarely appear, even years after the excision of the primary tumor.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3,5</span></a> Immunohistochemistry can be used to help in the detection of malignancy.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Treatment consists of surgical excision, with margins ranging from 1 cm to large resections, depending on the histopathology of the tumor.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a> Radiotherapy and chemotherapy have been described as alternative or adjuvant treatments.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a> To reduce the risk of recurrence, the evaluation of the margins with Mohs micrographic surgery is the procedure of choice,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3,4</span></a> as well as the close follow-up of these patients.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0025" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors' contributions</span><p id="par0030" class="elsevierStylePara elsevierViewall">Andrea Abê Pereira: Critical review of the literature; drafting and editing of the manuscript; approval of the final version of the manuscript; design and planning of the study.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Jéssica Lüders Bueno: Critical review of the literature; approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Ana Letícia Boff: Drafting and editing of the manuscript; collection, analysis and interpretation of data; critical review of the manuscript.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Paulo Ricardo Martins Souza: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis and interpretation of data; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors' contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-09-16" "fechaAceptado" => "2021-11-11" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "⋆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Private Practice, Porto Alegre, RS, Brazil.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1246 "Ancho" => 1675 "Tamanyo" => 251495 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tumor in the parieto-occipital region</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1548 "Ancho" => 3341 "Tamanyo" => 1679094 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A and B) Proliferation of lobular squamous tumor islands in the dermis, without connection with the epidermis. There is trichilemmal-type keratinization, consisting of compact and eosinophilic keratin in the center, in two distinct areas (Hematoxylin & eosin, ×40)</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1866 "Ancho" => 1675 "Tamanyo" => 1000466 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Squamous cells with atypical nuclei, but without mitosis. Towards the central part of the tumor island there is abrupt keratinization of the trichilemmal type (Hematoxylin & eosin, ×400)</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Proliferating trichilemmal tumors: a review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.K. Satyaprakash" 1 => "D.J. Sheehan" 2 => "O.P. Sangüeza" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1524-4725.2007.33225.x" "Revista" => array:6 [ "tituloSerie" => "Dermatol Surg." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 23 | 6 | 29 |
| 2024 October | 155 | 86 | 241 |
| 2024 September | 157 | 88 | 245 |
| 2024 August | 164 | 124 | 288 |
| 2024 July | 136 | 113 | 249 |
| 2024 June | 112 | 92 | 204 |
| 2024 May | 98 | 71 | 169 |
| 2024 April | 113 | 92 | 205 |
| 2024 March | 108 | 71 | 179 |
| 2024 February | 103 | 92 | 195 |
| 2024 January | 111 | 57 | 168 |
| 2023 December | 604 | 93 | 697 |
| 2023 November | 221 | 133 | 354 |
| 2023 October | 223 | 98 | 321 |
| 2023 September | 74 | 90 | 164 |
| 2023 August | 60 | 37 | 97 |
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