Tricoblastoma con estudio inmunohistoquímico: reporte de caso / Trichoblastoma with immunohistochemical study: case report

Resumen Introducción: El tricoblastoma es una neoplasia que por su baja frecuencia no se sospecha clínicamente, pero que debe ser diferenciada de un carcinoma de células basales a través del estudio histopatológico. Objetivo: Reportar un tumor sumamente raro que se presenta en sitios donde es frecuente observar carcinomas basocelulares. Caso clínico: Se presenta el caso de una paciente de 34 años, quien mostraba un nódulo deconsistencia firme y bordes definidos en la región frontal derecha. En laevaluación histológica, se encontró un nódulo hipodérmico bien circunscrito,constituidopormasasynidosdecélulasbasaloidesgrandesconnúcleoovoideo y nucléolo visible con empalizada periférica y algunos folículos rudimentarios. Ante estos signos histopatológicos, se planteó el diagnóstico diferencial con carcinoma de células basales y tricogerminoma,yaqueestasneoplasiaspresentanelementos comunes. La inmunohistoquímica mostró que las células tumorales eran positivas en mayor o menor porcentaje parap63,p53,CK20,Bcl2yCD10. Conclusiones: Pensar en el diagnóstico de un tricoblastoma es un reto, ya que tiene características similares al carcinoma de células basales y a otros tumores benignos foliculares como el tricogerminoma. Por ello, es necesario interrelacionar los hallazgos histomorfológicos con los resultados inmunohistoquímicos.

Abstract Introduction : Trichoblastoma is a neoplasm that is not clinically suspected due to its low frequency but must be differentiated from basal cell carcinoma through histopathological study. Aim : To report an extremely rare tumor that occurs in places where it is common to see basal cell carcinomas. Clinical case : The case of a 34-year-old patient is presented, who showed a nodule of firm consistency and defined edges on the right side of the forehead. In the histological evaluation a well-circumscribed hypodermal nodule was found consisting of masses and nests of large basaloid cells with an ovoid nucleus and visible nucleolus with peripheral palisade and some rudimentary follicles. Given these findings, the differential diagnosis with basal cell carcinoma and trichogerminoma was raised, since these neoplasms have common elements. Immunohistochemistry showed that tumor cells were positive in a higher or lesser percentage for: p63, p53, CK20, Bcl2 and CD10. Conclusions : Diagnosingatrichoblastoma is a challenge since it has characteristics similar to basal cell carcinoma and other benign follicular tumors such as trichogerminoma, so it is necessary to interrelate the histomorphological findings with the immunohistochemical results.

Tricoblastoma de localización acral, una ubicación infrecuente: reporte de un caso / Acral location trichoblastoma, a location infrequent: report of a case

Tricoblastoma es una neoplasia anexial benigna de la piel, de difícil diagnóstico clínico, por su baja prevalencia y por la ausencia de características clínicas patognomónicas. Por esta razón, es la biopsia la que hace el diagnóstico definitivo, ya que se suele confundir con otras neoplasias anexiales. Se presenta caso clínico de una mujer de 87 años con historia de cinco años de evolución de lesión nodular, sésil y simétrica ubicada en la falange proximal del primer ortejo del pie izquierdo, la cual había presentado un crecimiento progresivo en los últimos seis meses, refiriendo molestias leves con el calzado, sin mayores complicaciones. La biopsia excisional de la lesión, es informada como tricoblastoma. El escaso conocimiento del tricoblastoma lleva a la incorrecta interpretación de su forma clínica, lo que resulta relevante, pues su principal diagnóstico diferencial corresponde al carcinoma basocelular (CBC). Se presenta el caso clínico por lo infrecuente de su localización, lo que indujo a confusión del diagnóstico. No se debe olvidar que el tricoblastoma es una neoplasia anexial benigna, que puede presentarse en cualquier sitio en el que existan folículos pilosebáceos, por lo que hay que considerarlo dentro de los diagnósticos diferenciales de cualquier neoplasia anexial.

Trichoblastoma is a skin benign adnexal neoplasm, clinical diagnosis is difficult because presents a low prevalence, it has not any pathognomonic clinical characteristics and it's often mistaken with other adnexal tumors; so the biopsy makes the definitive diagnosis. We report the case of a woman of 87 years with a history of 5 years of evolution of a nodular, sessile and symmetrical lesion located in the proximal phalanx of the first left toe, which had presented a progressive growth in the last 6 months, she presented mild discomfort with footwear, without major complications. The excisional biopsy of the lesion, was reported as a trichoblastoma. Poor knowledge of trichoblastoma leads to a clinical misinterpretation, which is relevant, because its main differential diagnosis corresponds to basal cell carcinoma (BCC). A case located on an extremely rare location is presented, which led to confusion in clinical diagnosis. You must not forget that trichoblastoma is an adnexal benign tumor, which can occur at any site with pilosebaceous follicles, so we should consider in the differential diagnoses of any skin adnexal neoplasms.

Rhomboid cutaneous flap for defect correction after resection of trichoblastoma on dogs' face / Retalho cutâneo romboide para correção de defeito gerado após ressecção de tricoblastoma em face de cão

ABSTRACT: Surgical excision of neoplasms usually requires a large incision with safety margin, resulting in large cutaneous defects. Skin flaps permit closure of extensive cutaneous defects that would not be closed directly. The rhomboid cutaneous flap can be used in places of the body where a rhomboid defect with internal angles of 60 and 120 degrees can be made. The aim of this paper is to report the her use for reconstruction of the defect created after resection of a tumor on dogs' face . Total removal of the tumor and a safety margin was performed, and then the surgical defect was reconstructed with a rhomboid cutaneous flap. The final result was satisfactory, with an esthetically and functional acceptable scar, a without deformities to the oral commissure or eye. The cutaneous flap was considered a viable alternative for reconstruction of large surgical defects, of relatively simple execution and good functional and cosmetic results.

RESUMO: Remoção cirúrgica de neoplasias geralmente exige uma excisão ampla com margem de segurança, o que resulta em grandes defeitos cutâneos. Retalhos cutâneos propiciam a possibilidade de fechar defeitos de pele extensos que não seriam fechados por sutura direta. O retalho cutâneo romboide pode ser usado em locais do corpo onde seja possível a criação de defeito romboide com ângulos internos de 60 e 120 graus. Neste trabalho, relata-se a utilização do referido retalho cutâneo para reconstrução de um defeito cirúrgico gerado após ressecção de tumor em face de cão. Foi realizada a excisão total do tumor com margem de segurança, seguida pela reconstrução do defeito resultante com retalho cutâneo romboide. O resultado final obtido foi satisfatório, com formação de uma cicatriz esteticamente aceitável e funcional, sem deformidades da comissura labial ou do olho. O retalho mostrou-se como uma alternativa viável para reconstrução de grandes defeitos cirúrgicos, de simples execução e com bons resultados funcionais e cosméticos.