Multiply Recurrent Trichilemmal Carcinoma With Perineural Invasion and Cytokeratin 17 Positivity

Allee, Julie E.; Cotsarelis, George; Solky, Benjamin A.; Cook, Jonathan L.

doi:10.1046/j.1524-4725.2003.29241.x

Cited by 29 publications

(38 citation statements)

References 22 publications

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“…[1] With a slight male predilection, [2] the TLC which is a rare adnexal malignant tumor developing from the outer root sheath of hair follicles, frequently occurs on sun-exposed skin of elderly individuals; face and ears being the commonest sites. [1,2] Actinic damage, burn scar formation, long term low dose irradiation exposure and malignant transformation from trichilemmoma have been hypothesized, [5][6][7][8] but the exact pathogenesis of TLC still remains vague. Although it is difficult to remark on the exact causative, particular for the case presented here, vicinity of actinic dermal degeneration on histopathologic examination suggest the solar damage as the highly probable underlying cause.…”

Section: Discussionmentioning

confidence: 99%

“…[2] In this manner, patients may be mistaken for either benign or malignant cutaneous tumors including the actinic keratosis, nodular melanoma, BCC, or variants of SCC. Moreover, similar with the present case, patients may be inappropriately managed due to this misdiagnosis and may experience sobering recurrences.…”

Section: Discussionmentioning

confidence: 99%

“…[1] Although it may appear as multiple lesions on non-sun-exposed skin, the usual presentation is a nondescript solitary papule/nodule appearing on the sun-exposed, hair-bearing areas, such as the face or ears in elderly individuals. [2] In absence of distinct clinical features TLC may be misdiagnosed as actinic keratosis, nodular melanoma, basal cell carcinoma (BCC), or squamous cell carcinoma (SCC). [3,4] Wide excision with clear margins is the current standard care option for TLC.…”

Section: Introductionmentioning

confidence: 99%

“…Notwithstanding of its malignant appearance on cytological examination, clinically the TLC exhibits an indolent tumor behavior with rare local relapses after surgical removal of the primary lesion. [2] However, surgery can either be rejected by the patient or be awkward with resultant cosmetic problems on particular locations such as the facial area. Hence, other treatment modalities, including the radiotherapy (RT) may prove beneficial for this patients group.…”

Section: Introductionmentioning

confidence: 99%

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Adjuvant radiotherapy in management of trichilemmal carcinoma of left nasal alae with positive surgical margins: A case report

Topkan

Güler

Bal

et al. 2016

CRCP

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Background: Trichilemmal carcinoma (TLC) is a rare adnexal malignant tumor developing from the outer root sheath of hair follicles with no distinct clinical features which might clinically be misdiagnosed as actinic keratosis, nodular melanoma, basal or squamous cell carcinoma. Albeit no consensus exists on standard treatment of TLC, tumor excision with adequate clear margins is the current widely accepted treatment consideration with no previous literature on use of radiotherapy (RT) in definitive or postoperative settings. Case presentation: A 60-year-old woman who was repeatedly treated with cryotherapy located on her left nasal alae for an initial diagnosis of actinic keratosis and diagnosed as TLC at last surgery was referred for RT of microscopic surgical margins. The patient was treated with 6 MeV electron beam RT prescribed to surgical bed plus 1-cm margins at all directions, namely the planning target volume. The total and per fraction doses were 60 and 2 Gy, respectively, which is commonly practiced for any skin tumor with positive margins. The treatment was well tolerated with no acute or chronic complications. The patient was alive with no local, regional, or distant recurrences at the 49 months of her follow-up. Conclusions: Although the follow-up period is relatively short and further evidence is needed to confirm the exact role of RT in adjuvant treatment of TLC, the outcomes of present rare case of a nasal TLC suggests that adjuvant RT in patients with positive surgical margins may provide satisfactory local tumor control.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Adjuvant radiotherapy in management of trichilemmal carcinoma of left nasal alae with positive surgical margins: A case report

Topkan

Güler

Bal

et al. 2016

CRCP

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“…One case report described CK 17 and c-erb-B2 expression in a trichilemmal carcinoma, a pattern purported to confirm the outer root sheath derivation of this neoplasm. 85 The 'hair differentiation' keratins are said to include CK 7, 8, 18 and 19; CD34 expression is also a feature said to support outer root sheath differentiation. 86,87 Malignant proliferating pilar tumor…”

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confidence: 99%

Malignant adnexal neoplasms

2006

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Malignant cutaneous adnexal neoplasms are one of the most challenging areas of dermatopathology. Tumors of the pilosebaceous apparatus can occur as single-lineage neoplasms or may manifest as complex proliferations with multilineal differentiation patterns including not only the germinative component of the hair bulb, the inner or outer root sheath epithelium and the sebaceous gland and duct, but also the sweat duct components that relate to the apocrine secretory apparatus which empties into the follicle near the follicular bulge. Eccrine and apocrine neoplasms present a bewildering array of morphologies, which often defy precise classification. The purpose of this review is to discuss in detail the malignant neoplasms of the cutaneous adnexae and their benign and prognostically indeterminate mimics. Modern Pathology (2006) 19, S93-S126. doi:10.1038/modpathol.3800511Keywords: eccrine carcinoma; sebaceous neoplasia Malignant tumors of the pilosebaceous apparatus, their mimics and precursors IntroductionTumors of the pilosebaceous unit can occur in isolation or in combination with complex proliferations showing multilineal differentiation patterns encompassing those of sweat ducts, epidermis and stroma with its varied components. In this review, we will focus upon the malignant adnexal proliferations, considering benign entities mainly insofar as they impact the diagnostic approach to adnexal carcinoma. We will first turn to the malignant sebaceous neoplasms, their precursors and their mimics. Sebaceous adenoma Clinical FeaturesThe sebaceous adenoma is a benign neoplasm that manifests clinically as a pale yellow nodular lesion, typically of the face, that expresses itself clinically after the age of 50. Tumors range in size from o1 to 45 cm. [1][2][3][4][5][6] These lesions are associated with the Muir-Torre syndrome, comprising the coexpression of cutaneous neoplasms, including those of sebaceous type with well-differentiated squamous epithelial neoplasms, and visceral malignancies, including carcinomas of the breast, ovary, gastrointestinal tract and larynx. [7][8][9][10][11][12][13][14] An occasional patient may manifest a malignant lymphoma of nodal or extranodal type. 10,12,14 Sebaceous neoplasms in the setting of Muir-Torre syndrome are often difficult to classify, showing overlap features between all of the prototypic forms of sebaceous neoplasm ranging from hyperplasia to carcinoma. 13 HistologyThe prototypic sebaceous adenoma manifests 1-2 layers of germinitive cells which mature to form central sebocytes, and have an architecture comprising a sharply circumscribed sebaceous lobule surrounded by a compressed pseudocapsule of dermal stroma ( Figure 1a). The overlying epidermis may be attenuated, but sometimes forms a collarette around the peripheral aspect of the neoplasm. Unlike sebaceous hyperplasia, occasional mitoses may be seen in the lobules of a sebaceous adenoma and in concert with this nucleoli may be somewhat prominent, but the pleomorphism, hyperchromasia and individual cell necrosis of the se...

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