DERMATOPATHOLOGY CASES: Self-Assessment Cases: Editor - Dr Sampurna Roy MD

Digital Images of interesting cases that will include the full spectrum of Dermatopathology, presented in the form of quiz.

The answer of the cases include related links and recent abstracts of articles.

Wednesday, September 1, 2010

Answer of Dermatopathology Case 65

Trichilemmal Carcinoma

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Trichilemmal carcinoma of the upper eyelid: a case report.Korean J Ophthalmol.
2009 Dec;23(4):301-5. Epub 2009 Dec 4.
We report a very rare case of trichilemmal carcinoma (TLC) involving the upper eyelid. To the best of our knowledge, this is the first report of trichilemmal carcinoma of the upper eyelid in Korea. A 51-year-old man presented to our hospital complaining of a bloody discharge from his left upper eyelid. He had a soft and lobulated mass on the palpebral conjunctiva. An incisional biopsy revealed trabecular growth of tumor cells with clear cytoplasm, prominent nucleoli, frequent mitoses, and foci of trichilemmal keratinization. Immunohistochemically, the lesion was positive for p53 and negative for CD 34. A diagnosis of TLC was made, and total excision of the mass and reconstruction of the eyelid were performed. Trichilemmal carcinoma is a rare malignant tumor, though it appears to be an indolent neoplasm with no metastatic potential. The treatment of choice for trichilemmal carcinoma of the eyelid is complete excision with tumor-free margins due to the locally invasive nature of the lesion.

Trichilemmal carcinoma arising in seborrheic keratosis: a case report and published work review. J Dermatol.2008 Dec;35(12):782-5.
The secondary skin malignancies arising in seborrheic keratosis (SK) are uncommon, and the causal association between the pre-existing lesion and subsequent malignant transformation remains uncertain. Among these enigmatic conditions, trichilemmal differentiation and/or neoplasms in SK have rarely been reported thus far. Herein, we describe a case of invasive trichilemmal carcinoma arising in a long-standing SK of the abdominal skin, and clinicopathologically review this rare complication with a computerized medical published work search (PubMed) and citations from earlier reports. To our knowledge, only four cases of trichilemmal tumors arising in SK have been observed, and, interestingly, all cases, including ours, were Japanese. Four of five cases (80%) developed the tumors in non-sun-exposed SK, and indeed had no apparent actinic damage in the histology. The pre-existing SK itself is more likely to act as the primary pathogenic event for developing the secondary trichilemmal tumors than a coincidental phenomenon and a consequence of skin damage by cumulative sun exposure.

Trichilemmal carcinoma--a rare tumor: case report.Acta Dermatovenerol Croat. 2008;16(1):28-30.Acta Dermatovenerol Croat. 2008;16(1):28-30.
Trichilemmal carcinoma is a rare cutaneous cancer that usually occurs on photoexposed areas in elderly individuals. Most of the time, there is a unique lesion that presents a papulonodular aspect with possible keratosis or ulceration on the top of it. We report on a case of this rare tumor, discussing various aspects of this entity and possible therapy. Simple excision with adequate safety margin is a safe, low-cost and effective mode of treatment for this type of carcinoma. Although a rare form of neoplasia, trichilemmal carcinoma has good prognosis when treated correctly.

Trichilemmal carcinoma: a rare cutaneous malignancy: a report of two cases. Dermatol Surg. 2004 Jan;30(1):113-5.
BACKGROUND: Trichilemmal carcinoma is a rare cutaneous malignancy that usually occurs on the sun-exposed areas of older individuals. The lesion is usually solitary and may present as an exophytic or polypoid nodule that maybe hyperkeratotic with ulceration.
OBJECTIVE: To present two cases of trichilemmal carcinoma, one occurring in a kidney transplantation patient.
METHODS: Two case reports and a discussion of the rare carcinoma are presented.
RESULTS: Both lesions were treated with Mohs micrographic surgery without sign of recurrence after several years.
CONCLUSION: Trichilemmal carcinoma is a rare cutaneous malignancy that can be seen in both immunocompetent and immunosuppressed hosts. Mohs micrographic surgery should be considered among the surgical options to avoid a wide surgical excision in these patients.