Pilar neoplasms differentiate towards resemble various parts of the normal hair follicle. Trichilemmal keratinization black arrow at the center of the tumor islands is remarkable a. Cutaneous cysts represent a large proportion of the specimens submitted for histopathological examination and comprise a wide spectrum of entities. In pilar sheath acanthoma, there is a lobular proliferation of benign squamous epithelium in the dermis figure 1, 2. The less common keratinous cysts are of pilar or trichilemmal type and proliferating trichilemmal tumour is infrequent. A proliferating pilar tumor ppt is a rare neoplasm arising from the isthmus of the outer root sheath of the hair follicle, commonly called as proliferating trichilemmal cyst and was first described by jones in 1966.
Department of pathology, government medical college, miraj. Benign proliferating pilar tumor dr sarmas dermpath. Malignant degeneration figure 5 and subsequent metastasis has been well documented. Multiple proliferating pilar tumors with porokeratotic. The fibrous capsule varies in thickness, but is usually thin. Mptt is a rare tumor occurring mainly on the scalp and. Proliferating trichilemmal tumor ptt is a wellcircumscribed dermal or subcutaneous neoplasm with squamoid cytologic features and trichilemmaltype of keratinization. Background proliferating trichilemmal tumors ptts are uncommon lesions whose histologic hallmark is the presence of trichilemmal keratinization. Solid with pushing borders and lobulated contour, usually involves epidermis but may open into skin surface. This tumor is usually located in the scalp of advanced aged female patients and may present with additional ulceration, infection and sometimes lymph node metastasis 2. Inverted follicular keratosis is a benign tumor of the follicular infundibulum that was first described by helwig in 1954.
It is also commonly called a proliferating trichilemmal cyst or, less commonly, proliferating follicularcystic neoplasm. The tissue undergoes a series of steps before it reaches the examiners desk to be thoroughly examined microscopically to arrive at a particular diagnosis. With chapters on organbased approaches with specific protocols for morphologic, molecular examination, and pathological observations governing the therapeutic management of the diseases. Different terminologies have been used to describe this tumor, p it mainly occurs on the scalp in elderly. In most cases there is only one lesion and occur in elderly women. David weedon ao md frcpa fcaphon, in weedons skin pathology third edition, 2010. A large proliferating trichilemmal cyst masquerading as squamous. It is mostly a benign neoplasm and has potential for malignant transformation. Colonization of epithelial pilar neoplasms by melanocytes doi. Benign proliferating pilar tumor bppt, cases by diagnosis, cyst, dermal tumor, dermatopathology in practice tumor, dermatopathology pattern diagnosis, hair tumor, quick diagnosis, skin adnexal tumor. Colonization of epithelial pilar neoplasms by melanocytes.
In this report, we present a case of malignant pilar tumor of the scalp with multiple nodal metastases at presentation. Methods and protocols provides a comprehensive guide to the current issues in histopathology. Proliferating trichilemmal cyst ptc, also known as pilar tumor, is a rare benign skin neoplasm with outer root sheath differentiation. Conventional culture confirmation of tissue biopsies often fail to identify any pathogen as, first of all. Lowgrade malignant proliferating pilar tumor simulating a. Pilar tumor is a malign epithelial tumor originating from the hair follicle 1. To achieve this it is important that the tissue must be prepared in such a manner. A diagnosis of malignant proliferating pilar tumor may involve the following. The lining cells may have a granular layer similar to an. Malignant proliferating trichilemmal tumor northwestern.
Ptt is thought to originate from the trichilemmal cyst tc and have the potential for malignant transformation, at which point it is termed a malignant proliferating trichilemmal tumor mptt. Simple approach to histological diagnosis of common skin adnexal tumors ahmed a alhumidi department of pathology, college of medicine, king saud university, riyadh, saudi arabia abstract. Pathology of pilar sheath acanthoma dr sampurna roy md. An 84yearold man with a 3x3 cm tumor of the nasal dorsum is described.
The size and features of surgical pathology gross room depend on the. Histopathology for the diagnosis of infectious diseases e gupta, p bhalla, n khurana, t singh abstract histopathological examination of tissue biopsies for the identification of infectious organisms is a very important diagnostic tool. Proliferating pilar tumor ppt, or cyst, is a neoplasm of trichilemmal keratinization first described by wilsonjones 1 in 1966. Proliferating trichilemmal cyst with lymphadenopathy. The nodule was composed of squamous epithelium without atypia, forming interlacing lobules with abrupt keratinization and without a granular layer a and b. Difficulty can arise when these lesions rupture and. Specimen to charge code rapid finder list specimencpt cribsheet march 2011. To our knowledge, this is the first documented case of a trichilemmal carcinoma with neuroendocrine differentiation and melanocyte colonization, which is suggested by the trabecular growth pattern.
Article pdf available in american journal of clinical pathology. Transitional changes between an ordinary trichilemmal cyst and proliferating trichilemmal pilar tumour are seen. Fixation, tissue processing, histologyand immunohistochemistry procedures for diagnosis of animal tse bse, scrapie, atypical scrapie,cwd pathology department, apha. Histopathology of skin adnexal tumors a two year retrospective study at a tertiary care hospital international journal of scienti. There is no evidence to prove that oily foods and chocolatebased products have an influence on benign proliferating pilar tumor. The histopathology of cutaneous sarcoidosis consists of aggregates of histiocytes with giant cell formation and sparse lymphocytic. Pilar tumor is a rare neoplasm arising from the external root sheath of the hair follicle and is most commonly observed on the scalp. Proliferating trichilemmal tumor ptt is a benign tumor originating from the hair follicle. Pilar sheath acanthoma is a rare, benign follicular hamartoma described first in 1978 by mehregan and brownstein. The tissue undergoes a series of steps before it reaches the examiners desk to be thoroughly examined microscopically to arrive at.
This neoplasm was first recognizedby wilsonjones in 1966 as an entity that had the histologic capacity to simulate squamous cell carcinoma. Proliferating trichilemmal tumor ptt is a rare neoplasm arising from the isthmus region of the outer hair root sheath of the hair follicle. Histologically the tumor was a malignant proliferating trichilemmal tumor mptt. A large proliferating trichilemmal cyst masquerading as. Chapter 1 introducton histopathology definition it is a branch of pathology which deals with the study of disease in a tissue section. Our goal is to report a case of proliferating trichilemmal tumor. A malignant proliferating trichilemmal tumor simulating a. The tissue undergoes a series of steps before it reaches the diagnosis.
It was first described by wilsonjones as a proliferating epidermoid cyst in 1966. A wide local excision was performed and the tissue was sent for histopathological examination which revealed a lowgrade malignant pilar tumor. Malignant proliferating trichilemmal tumor hindawi. Cutting soft materials has been done forever and is nowadays encountered in a large range of processes, from precision surgery 1, histology 2, to food industry 3,4, and also in everyday life. A moderate incidence of squamous cell papilloma of the nonglandular forestomach, benign granulosa cell tumor of the ovary, lymphoma of the hemopoietic system. Pure tumors are multinodular, may be huge may coexist with trichilemmal cyst microscopic histologic description. Diagnostic and therapeutic considerations, in the form of adjuvant radiotherapy, are subsequently discussed. An interesting case report of ulcerated proliferating. Histopathology techniques histopathology definition. Excisional biopsy of the mass was performed and the pathologic diagnosis returned as malignant, proliferating trichilemmal pilar tumor. With the above findings, a diagnosis of lowgrade malignant pilar tumor was offered. This neoplasm was first recognized by wilsonjones in 1966 as an entity that had the histologic capacity to simulate squamous cell carcinoma. Pilar sheath acanthoma is a rare, benign follicular tumor found almost exclusively on the upper lip of older individuals. Histopathological results revealed trichilemmal cyst pilar tumor.
Skin adnexal tumours are thought to be rare entities, can cause diagnostic dilemmas in routine histopathological practice and are essentially recogfigure 1. Proliferating trichilemmal cyst pathology dermnet nz. Rapidly growing tumor on the scalp jaad case reports. It is often difficult to distinguish a proliferating pilar tumor from a malignant neoplasm such as squamous cell carcinoma. Although sarcoidosis can present with papules and plaques on the scalp, it is a diagnosis of exclusion.
The prognosis for benign proliferating pilar tumor is excellent with appropriate treatment, since it is a benign cyst. Proliferating trichilemmal tumor ptt is an uncommon appendageal skin. On further examination the patient had no evidence of metastatic disease. For instance, malignant proliferating pilar tumors are more likely to stain positive with p53 and ki67 relative to benign proliferating pilar tumors and trichilemmal cysts, and cd34 immunoreactivity may distinguish a malignant proliferating pilar. Differential diagnosis of proliferating trichilemmal cyst pathology. Wide local excision has been the standard treatment. Squamous cell carcinoma ackerman believed all these lesions are a form of squamous cell carcinoma, but this opinion is not widely held. Histopathology, proliferating trichilemmal cyst, scalp. Malignant pilar tumor, pilarcyst, proliferating pilar tumor, proliferating trichilemmal cyst. How is malignant proliferating pilar tumor diagnosed. Immunohistochemical ihc analysis revealed definite membrane positivity for cd34 in more than 70% of tumor cells, with normal vascular endothelial cells acting as internal control figure 3a. It is a wellcircumscribed dermal or subcutaneous neoplasm with squamoid cytologic features and trichilemmal type of keratinization. Histopathology of skin adnexal tumors a two year retrospective study at a tertiary care.
Simple approach to histological diagnosis of common skin. Pilar sheath acanthoma usually involves the skin of the upper lip and presents as a small papule with a central pore histology of pilar sheath acanthoma. Most adnexal neoplasms are uncommonly encountered in routine practice, and pathologists can recognize a limited number of frequently encountered tumors. Follicular adenoma follicular adenoma is defined as a benign encapsulated tumor with follicular cell differentiation showing a uniform pattern throughout the confine nodule figure 1a. In contrast, microcystic adnexal carcinoma morphologically displays foci of calcification, epitheloid cell granulomas, adherence to follicles and adnexal structures, enunciation of keratin, immune reactivity to pleckstrin homology like domain family a member.
A discussion of cutaneous neoplasms involving the scalp. Herein we present a 48 years old female who presented with 3 years history of recurrent painful skin lesions that sometimes get worse and become bigger and. The incidence of ppt is unknown given the paucity of cases and the possible. Additional and relevant useful information for benign proliferating pilar tumor. Blue pilar tumors differentiate towards elements of the inferior segment of the hair follicle. A proliferating pilar tumor ppt is a rare neoplasm arising from the isthmus region of the outer root sheath of the hair follicle. Malignant proliferating pilar tumor typically occurs as a single cyst that grows slowly.
Clinically resembles a comedo and is characterized by a central pore like opening plugged with keratin. The tumor was surgically removed, reconstruction was with a forehead flap. Trichilemmal tumor is an uncommon histopathological entity. Proliferating pilar tumors lie on a spectrum with malignant ppt, which is a rare adnexal neoplasm first described by saida et al 2 in 1983. Although it is a benign tumor, ptt may be locally aggressive and in very rare cases the tumor may become malignant. However, multiple cysts may also be seen, when a family history of the condition is present. The subcutaneous lesion was mobile and without overlying skin ulceration. It is a branch of pathology which deals with the study of disease in a tissue section.
It is a somewhat controversial entity, having been regarded by some as a variant of seborrheic keratosis or verruca vulgaris. Squamous cell carcinoma proliferating trichilemmal tumour is characterized by abrupt keratinization, minimal pleomorphism, low mitotic activity, sharp circumscription, foci indistinguishable from a trichilemmal cyst, calcification and absence of a premalignant lesion such as actinic keratosis. Pdf we studied proliferating pilar tumors ppts to establish histologic. The histopathological evaluation found solid islands standing backtoback in a desmoplastic basement and a neoplastic formation composed of.
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