A Case of Eyelid Desmoplastic Trichilemmoma

PURPOSE: Desmoplastic trichilemmoma is a rare variant of trichilemmoma first described in 1990. Desmoplastic trichilemmoma on the eyelid has not been previously reported in Korea. We report our experience with a case of desmoplastic trichilemmoma of the eyelid. CASE SUMMARY: A 72-year-old male patient presented with a round mass on the upper eyelid, which was noticed 1 year prior and caused irritation and itching. Excisional biopsy of the mass was performed. Histopathological examination revealed findings suggestive of a desmoplastic trichilemmoma. There was no local recurrence during the 2-year follow-up. CONCLUSIONS: Desmoplastic trichilemmoma should be considered when determining the type of eyelid mass.

Simultaneous Development of Three Different Neoplasms of Trichilemmoma, Desmoplastic Trichilemmoma and Basal Cell Carcinoma Arising from Nevus Sebaceus

Nevus sebaceus is a hamartoma of the sebaceous gland that occurs congenitally, from which various secondary tumors can arise with a prevalence of 5%–6%. Benign neoplasms commonly arise from nevus sebaceous, but they have a very low malignant potential. Two neoplasms may occasionally arise within the same lesion, but it is rare for three or more neoplasms to occur in a nevus sebaceus simultaneously. A 61-year-old male patient was admitted to our hospital for a 4 cm×2.5 cm growing tumor in a verrucous form arising within a periauricular nevus sebaceus in the post auricle of the left ear that had developed 30 years earlier. The nodule was diagnosed as 3 different types of tumors: trichilemmoma, desmoplastic trichilemmoma, and basal cell carcinoma. To our knowledge, this is the first report of the coexistence of three different tumors arising from nevus sebaceous. It contain malignant neoplasm also. Surgeons should be aware of the need for close monitoring and early complete surgical excision of sebaceous nevus in order to improve patient outcomes.

A Case of Multiple Eyelid Trichilemmoma Associated with Cowden Syndrome

PURPOSE: To report a case of multiple eyelid trichilemmomas associated with Cowden syndrome. CASE SUMMARY: A 27-year-old woman presented with multiple upper and lower eyelid skin masses that developed over several years. The masses were as large as whitish millet, and were around the upper and lower eyelid margin and the face. The patient had previously undergone subtotal thyroidectomy for a thyroid mass and a mass excision for extremity hemangioma. Excisional biopsy was performed for the diagnosis, and trichilemmoma was diagnosed based on histopathologic examination. Consequently, multiple trichilemmoma associated with Cowden syndrome was diagnosed, and breast evaluations for existence of further masses were recommended. On breast examinations, intraductal papilloma and fibroadenoma were detected. CONCLUSIONS: The trichilemmoma was a hair-follicle benign tumor that also appeared on the skin around the eyelid. If multiple trichilemmoma is diagnosed, an association with Cowden syndrome should be considered as well as presence of masses in other organs.

A Case of Trichilemmoma on the Right Shoulder / 대한피부과학회지

Trichilemmoma is a benign, solitary, small tumor that might often be misdiagnosed as a basal cell carcinoma or verruca. It is usually seen on the face, and especially on the nose and cheeks. A 79-year-old Korean man presented with a 2.0x2.0 cm-sized nodular mass on his right shoulder and the lesion was histopathologically diagnosed as a trichilemmoma. The atypical clinical appearance and localization of his neoplasm did not help us diagnose the lesion, and the histological findings were the only clues for making the diagnosis of trichilemmoma.

Desmoplastic Trichilemmoma Arising in a Nevus Sebaceus

PURPOSE: Desmoplastic trichilemmoma is a rare variant of trichilemmoma. Histologically, it has a typical characteristic of trichilemmoma with epithelium of central portion and dense fibrous interstitium. There are only 4 reported cases of desmoplastic trichilemmoma arised in a nevus sebaceus, so we present a case of desmoplastic trichilemmoma arised in a nevus sebaceus with literature review. METHODS: A 46-year-old female was clinically diagnosed as nevus sebaceous on left side of the forehead. Considering the facial contour, the mass was totally excised elliptically and direct closure was feasible with undermining subcutaneous layer. RESULTS: Pathology report confirmed desmoplastic trichilemmoma developed from a nevus sebaceus and all tumor margins were negative. There were no evidences of tumor recurrence after surgical treatment. CONCLUSION: Desmoplastic trichilemmoma developed from a nevus sebaceus is a very rare tumor. Variant tumors can be developed from nevus sebaceus, so surgeon should be cautious in excising the mass totally and confirm the final pathology report.

A Case of Trichilemmoma Arising in Nevus Sebaceus / 대한피부과학회지

In adulthood, nevus sebaceus is frequently associated with trichoblastoma and syringocystadenoma papilliferum. However, trichilemmoma rarely develops in nevus sebaceus. We report a case of nevus sebaceus associated with trichilemmoma in a 45-year-old female patient. She had three erythematous-to-normal skin-colored, well-demarcated verrucous-surfaced nodules on the right temporal area of the scalp, which were pea-to-bean sized. The histologic findings revealed characteristic features of nevus sebaceus. In the epidermis of the lesion, there were lobulated tumors consisting of clear cells with palisading columnar basal cells in the margin, and these were surrounded by a prominent basement membrane. The findings were consistant with trichilemmoma arising in nevus sebaceus.

Nevus Sebaceus Associated with Trichilemmoma, Trichilemmal Carcinoma and Trichoblastoma / 대한피부과학회지

Nevus sebaceus is located on the scalp or the face as a single lesion and is already present at birth. In adulthood, various types of appendage tumor may develop secondarily within the lesion of the nevus sebaceus. A syringocystadenoma papilliferum is the most common secondary benign tumor that has been found in 8% to 19% of the lesion of nevus sebaceus. The malignant tumors arising from nevus sebaceus are basal cell carcinoma, squamous cell carcinoma, apocrine carcinoma and malignant eccrine poroma. The combination of a variety of tumor was found in the lesion of nevus sebaceus. We report a case of nevus sebaceus in a 66-year-old male associated with trichilemmoma, trichilemmal carcinoma and trichoblastoma.

A Case of Desmoplastic Trichilemmoma / 대한피부과학회지

Desmoplastic trichilemmoma is a rare variant of trichilemmoma characterized by typical features of trichilemmoma with abundant desmoplastic stroma. We report herein a 54-year-old man presented with 2-year history of a solitary bean sized verrucous nodule on the occipital scalp. Histologically, the tumor showed a well-defined lobular growth extending from the epidermis into the dermis with abundant central desmoplastic stroma. Epithelial lobules at the margins of the neoplasm showed the typical features of trichilemmoma composed of glycogen-rich clear cells and peripheral palisading columnar cells. In contrast, at the center the cells assume a more random pattern of cords and strands traversed by the hyaline stroma, mimicking invasive carcinoma. It was diagnosed desmoplastic trichilemmoma by the distinctive histologic appearance and totally excised.

A Case of Desmoplastic Trichilemmoma / 대한피부과학회지

Desmoplastic trichilemmoma is a rare variant of trichilemmoma and usually occurs as small solitary papules on the face. We report a case of desmoplastic trichilemmoma on the right nostril. The histologic findings revealed well-demarcated lobular growth with central desmoplastic stroma. Periphery of the lesion showed the typical feature of trichilemmoma, whereas the center of the lesion was replaced by dense fibrous stroma.

A Case of Desmoplastic Trichilemmoma / 대한피부과학회지

The case of an unusual desmoplastic variant of trichilemmoma arising in the face of a 72-year-old man is reported. Desmoplastic trichilemmoma is characterized by the presence of a densely sclerotic stroma, surrounded by lobules of epithelial cells with features of outer root sheath differentiation, including glycogen-rich, clear cytoplasms and peripheral palisading. In the central part of the tumor, irregular cords and nests of epithelial cells entrapped in the desmoplastic stroma are found. The pathological appearance can mimic trichilemmal carcinoma, morpheic basal cell carcinoma, and squamous cell carcinoma. Recognition of this benign neoplasm as such will prevent misdiagnosis and unnecessary aggressive treatment.

A case of desmoplastic trichilemmoma / 대한피부과학회지

Desmoplastic trichilemmoma is a rare variant of trichilemmoma. A 46-year-old woman presented with a verrucous papule on the face. Histologically, well-circumscribed lobular growth with abundant central desmoplastic stroma was seen. Peripheral area of tumor lobules showed the usual feature of trichilemmoma, whereas the center of tumor was replaced by irregular cords and nests of basaloid or malpighian cells entrapped in a dense stroma, mimicking invasive carcinoma. It was diagnosed desmoplastic trichilemmoma by the distinctive histologic appearance and totally excised.

A Case of Nevus Sebaceus Associated with Trichilemmoma / 대한피부과학회지

We reported a case of nevus sebaceus associated with trichilemmoma in a 19-year- old female patient. The lesion was a 2 x 2 cm sized yellowish verrucous plaque with two 0.3 x 0.3 cm sized dome-shaped papules. Histopathological examinat,ion revealed hyperkeratosis, papillomatosis and acanthosis, proliferation of sebaceus glands, presence of apocrine gland and mild inflammatory cellular infiltration around superficial vessels. In the epidermis of the lesion, there were two foci of lobulated mass consisted of clear cells with columnar basal cells and thick basement membrane.

A Case of Trichilemmoma on the Scalp / 대한피부과학회지

Tricilemmoma is a benign, solitary tumor that may be clinically misdiagnosed as basal cell carcinoma or verruca. It affects frequently the face of elderly rnen. We present herein a case of trichilemrnoma in a 70-year-old Korean wornan who had a slowly growing tumor on the scalp for 50 years. The histopathologic findings revealed lobular acanthosis of glycogeri rich clear cells and palisade of columnar cells resting on prominent basement membrane.