Eruptive Tumors of the Follicular Infundibulum: An Unexpected Diagnosis of Hypopigmented Macules

Abstract

BackgroundTumor of the follicular infundibulum (TFI) is considered as a rare benign neoplasm providing two distinctive clinical patterns: the solitary and the eruptive form. The clinical presentations resemble many other dermatologic conditions and require histopathological study to make a definite diagnosis.ObjectiveTo inform physicians of a clinical presentation of TFI.Case ReportWe report on a 50-year-old man who presented with multiple asymptomatic hypopigmented macules resistant to the treatments. The histopathological study was consistent with tumors of the follicular infundibulum.ConclusionHypopigmented macules are one of the more common clinical presentations in dermatological practices. It is important to include TFI in the differential diagnosis when a patient with hypopigmented lesions does not respond to the treatment based on the clinical diagnosis.Electronic supplementary materialThe online version of this article (doi:10.1007/s13555-015-0079-0) contains supplementary material, which is available to authorized users.

Eruptive tumors of the follicular infundibulum in photo-exposed skin

“…These lesions may occur in younger patients and can assume a variety of clinical manifestations including multiple hypopigmented macules, papules, or atrophic plaques with irregular or angulated borders. 1 , 2 Similar to their solitary counterparts, multiple TFI almost always cluster on the head and neck region. However, recently Haddad et al 5 reported a case in which TFI not only involved the head and neck but also the posterior calves.…”

“…An eruptive variant, known as infundibulomatosis , has been described and may present as multiple hypopigmented macules or papules, with irregular borders. 1 , 2 In addition, TFI may be associated with other cutaneous neoplasms, such as basal cell carcinoma, nevus sebaceous, and trichilemmoma, among others, 3 and with Cowden syndrome. 4 More recently, an atypical clinical variant involving the face and posterior calves was described in the Brazilian literature.…”

Tumor of follicular infundibulum – reappraisal in a series of 28 patients with critical review of the literature

“…24 Multiple eruptive lesions of TFI, also called infundibulomas, 4,5 account for around 7% of cases. 12 They tend to affect the head/neck and trunk and then typically present as small, well defined hypopigmented papules or more frequently macules as shown in figures of several previous publications, [4][5][6][7][8][9][10][11][12][13][14][15][16][18][19][20][21] simulating seborrheic ker-atosis, type stucco keratosis. Clinical images from Kossard et al 4 are presented as an excellent representative example of such cases (Figure 9).…”

“…It comprises the infundibulum, isthmus, bulge, stem, and bulb 26 . As part of its morphological alterations TFI has been described as a neoplastic process isolated and multiple, 1–22 but also as a secondary, reactive phenomenon. Thus, originally considered to represent a distinctive epithelial neoplasm, subsequent publications noted TFI features in the vicinity of other lesions.…”

“…Tumor of follicular infundibulum (TFI) occurs as a solitary or multiple papule or macule, in the latter frequently involving the head and neck area, in the elderly resembling stucco keratosis 1–22 …”