Trichilemmal Cyst Research Articles

Transcriptional repressor GATA binding 1 (TRPS1) immunoexpression in normal skin tissues and various cutaneous tumors.

Transcriptional repressor GATA binding 1 (TRPS1) is a transcription factor recently shown to play a role in the development of breast and liver cancer. Here, we evaluate TRPS1 immunoexpression in normal skin tissues and various cutaneous tumors. TRPS1 immunohistochemistry was performed in 109 cases of primary cutaneous tumors and 19 cases of metastatic carcinomas. TRPS1 expression was also evaluated in the normal skin tissues. The normal epidermis was TRPS1-. In contrast, the eccrine apparatus, epithelial compartment of the hair follicles, hair papilla, sebaceous glands, and anogenital mammary-like glands were TRPS1+. In primary cutaneous tumors, TRPS1 positivity varied in poroma (2/3), nodular hidradenoma (4/5), spiradenoma (4/4), cutaneous mixed tumor (5/5), trichilemmal cyst (7/8), proliferating trichilemmal tumor (1/3), pilomatricoma (9/9), sebaceoma (2/5), extramammary Paget disease (13/13), sebaceous carcinoma (2/2), actinic keratosis (3/10), Bowen disease (7/12), and squamous cell carcinoma (1/5) cases. All cases of seborrheic keratosis, basal cell carcinoma, Merkel cell carcinoma, and malignant melanoma were TRPS1-. All metastatic breast carcinoma cases (8/8) were highly positive for TRPS1, while all but one of the other metastatic tumor cases were TRPS1-. TRPS1 immunoexpression was observed in several skin appendages and cutaneous tumors.

1302 Should All Excised Suspected Epidermoid and Pilar Cysts Undergo Histological Analysis?

Abstract Aim Within our department, there is variation as to whether excised suspected epidermoid and pilar cysts (both often referred to as sebaceous cysts) are sent for histology. This study aimed to assess the clinical risk of not routinely sending these lesions for histological examination. Method A retrospective review was undertaken of consecutive patients undergoing excision biopsy of suspected epidermoid/pilar cysts between September 2016 and August 2021. Data recorded included pre-operative suspected diagnosis, operative diagnosis, histology results and whether these results had been reviewed by the surgical team. Results 202 patients underwent excision of suspected cysts from a single District General Hospital. 112 were pre-operatively diagnosed by Registrars and 85 by consultants. In 177 cases a sample was sent for histology (88%). In 113 of these cases, the result was reviewed by the surgical team (64%). The concordance between pre-operative diagnosis and histology was 73.8%. Concordance in pre-operative diagnosis with histology results was similar between Registrars and Consultants (80% vs 73.8%, p = 0.007). The concordance between the operative diagnosis and histology was 82.1%. Of the 36 cases misdiagnosed at operation, histology revealed malignancy in one case (basal cell carcinoma) and pre-malignancy in another (keratoacanthoma). Conclusions In our study, there is a high concordance between operative diagnosis and histology (82.1%) with a relatively low risk of missing malignant or premalignant lesions (2/177, 1.1%). Given the potential economic savings, it may be possible for the surgeon to safely select which cysts need histological review rather than routinely sending all specimens.

Trichilemmal cyst: a simple cyst having the potential of complications-revisited

Trichilemmal cyst: a simple cyst having the potential of complications-revisited

Proliferating Pilar Tumors in the Scalp Over a Period of 23 Years in a General Hospital in Mexico City.

Proliferating pilar tumors are an unusual skin tumor, and they have a cystic component with trichilemmal keratinization and epithelial proliferation. These arise from the outer root sheath of hair follicles. It mainly affects women. The scalp is the most affected area. Diagnosis can be made by biopsy. Surgical excision is the best treatment option. Report the frequency of proliferating pilar tumors in the scalp in general hospital in Mexico over a period of 23 years. The authors reviewed the database of the dermatopathology service of the General Hospital "Dr Manuel Gea González" from 1999 to August 2022, selecting diagnosticated cases of proliferating pilar tumor, pilar cyst, trichilemmal cyst, or proliferating trichilemmal cyst in the scalp. The authors discovered 17 cases, 13 were women, the average age was 54.9 years, all the tumors affecting the scalp, and just 3 cases were reported as malignant. In comparison with the existing data, the authors can observe that most of their patients were women and the scalp is the most affected area. Most did not present associated symptoms. As the authors can see, most are benign and long-lasting: however, the authors cannot ignore that a small percentage can be malignant.

Demodicidosis of an Intertragic Notch of the Ear That Was Misdiagnosed as a Skin Tumor: A Case Report

<i>Demodex</i> mite infestation has variable clinical manifestations including eruptions, erythema, pustules, facial hyperpigmentation, rosacea-like lesions, and perioral dermatitis. A 62-year-old man came with a 2-year history of a slowly enlarging, asymptomatic lesion in the intertragic notch of the left ear, and the findings from an ultrasound conducted by a radiologist suggested a benign skin tumor such as an epidermal or trichilemmal cyst. After total excision, histopathology of a section of the specimen showed multiple follicular infundibula containing <i>Demodex</i> folliculorum in the dermal layer, and the perifollicular tissue showed granulomatous change with lymphomononuclear inflammation. This article presents a rare clinical symptom of <i>Demodex</i> mites in the form of a tumor-like lesion on the face.

DP16 Trichilemmocysticus naevus: a rare birthmark treated successfully with erbium ablative laser

Abstract We report a rare case of a 58-year-old woman with a naevus trichilemmocysticus. The patient presented to a tertiary dermatology centre with longstanding skin changes to her trunk. The changes had been apparent since childhood and became more prominent in her teens. Examination showed a linear Blaschkoid distribution of subtle hyperpigmentation and warty follicular prominence to the left submammary region, extending to the left upper back, where comedones and cystic papules were also noted. Histopathology confirmed the presence of cysts containing keratin, lined by trichilemmal-type squamous epithelium, representing trichilemmal cysts. The overlying epidermis appeared normal. Given the Blaschkoid distribution and the presence since childhood, it was thought that this most likely represented a naevus trichilemmocysticus. Tantcheva-Poor et al. described and named this as a rare type of organoid naevus-type lesion in 2007 (Tantcheva-Poor I, Reinhold K, Krieg T, Happle R. Trichilemmal cyst nevus: a new complex organoid epidermal nevus. J Am Acad Dermatol 2007; 57:S72–7). Only seven cases have been identified and reported in the literature. These have been characterized by multiple follicular filiform hyperkeratoses and trichilemmal cysts in a Blaschkoid distribution. Most cases described involve extensive areas of the skin and present with disfiguring lesions. Histology reports confirm epidermal acanthosis with deep invaginations filled with massive orthokeratosis, parakeratotic columns and an absent granular layer (isthmic or trichilemmal differentiation) with keratosis in sebaceous ducts and acrosyringia. Our patient is currently undergoing successful treatment with erbium laser under local anaesthesia, in order to improve the texture and appearance of the birthmark. This has been achieved by ablation to the warty areas to the level of upper papillary dermis, with focal deeper ablation to the skin overlying each cyst, followed by the use of a meibomian cyst curette for enucleation.

A rare tumor of atypical scrotal location

Apocrine hidrocystoma is a rare benign adnexal tumor considered a cystic proliferation of the apocrine glands, rather than simple retentive cysts of the apocrine sweat glands [3]. It occurs most often in adults on the neck and head and especially on the external canthus of the eye [1,2]. They vary in size from 3 to 15 millimeters and are most often pigmented, blue, blue-black, grayish, translucent or violet in color. Apocrine hidrocystomas located in other sites such as the shoulders, fingers, abdomen and genital region have been rarely described.Differential diagnoses of apocrine hidrocystomas of scrotal location include eccrine hidrocystomas, blue nevus, melanoma, median raphe cyst, milium grain, epidermoid or pilar cyst, and hemolymphangioma

Giant Trichilemmal Cysts Mimicking an ox Horn associated with an Occipital Lipoma: An Observation at the Dermatology Hospital of Bamako

Summary: The pilar cyst or trichilemmal is a benign tumour of the skin appendages. This tumour develops on the isthmic part of the pilar follicle and is characterised histologically by trichilemmal keratinisation. We report a case of bilateral giant temporal trichilemmal cysts with a giant occipital lipoma. Observation: This is a 53-year-old patient who presented with multiple scalp lesions that had been present for three years. On clinical examination, there were two bilateral symmetrical temporal tumours with an occipital mass. Histology revealed a trichellemmal cyst for the temporal and a lipoma for the occipital.

Scrotal trichilemmal cysts: a case report.

We discuss the case of a 60-year-old male patient who presented to the clinic with a right-sided scrotal swelling, which was identified as a right-sided inguinal hernia on examination, and multiple small swellings on the scrotal skin identified as TCs. The patient had scrotoplasty after hernia surgery to remove the cysts and reconstruct the excised scrotum. Following scrotoplasty, the patient's discomfort was resolved, and cosmetic satisfaction was achieved. Excision is required if TCs become infected or for esthetic reasons. In the event of big cysts, full scrotal wall resection followed by scrotoplasty is necessary. The thigh fasciocutaneous flap is used to cover the denuded testes after scrotoplasty. The procedure's advantages include a good outcome, low morbidity, early discharge, and great esthetic outcomes. We present a literature review about multiple TCs in the scrotum and their surgical management. This case will guide surgeons and future researchers in dealing with similar cases in the future.

Histopathologic profile of cutaneous cystic lesions in teaching hospital, Nnewi, South-east, Nigeria

Background A cyst is an enclosed space or abnormal sac within a tissue, usually containing fluid or semisolid matter and lined by epithelium. Aims and objectives To study all the cutaneous cystic lesions with respect to age, sex, anatomic site, and histologic types in a population of Nnewi, South-East Nigerian. It also aimed at highlighting the importance of histology in evaluating and preventing misdiagnoses encountered in cutaneous cystic lesions. Patients and methods A retrospective review was performed on the histopathology register on all histologically diagnosed cutaneous cysts at the Histopathology Department of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria from 2011 to 2019. Results A total of 94 cutaneous cystic lesions, accounting for 1.3% (94/7204) of all surgical biopsy specimens, were included in this study. An overall clinicopathological correlation showed 26.6% (25/94) accuracy, but 73.4% were incorrectly diagnosed, with 7.4% (5/69) of cases misdiagnosed clinically as malignant lesions and one case of malignant cystic lesion diagnosed clinically as benign cyst. There were 49 males and 45 females, giving a slight male predominance, with male to female ratio of 1.1 : 1. The age ranged from 6 weeks to 79 years, with a mean±SD age of 26.5±21.1 years, and a peak age group of 0–10 years, representing 29.8% (28/94). Benign cutaneous cystic lesions were far commoner than malignant ones and included majorly epidermal inclusion cyst [37.2% (35/94)], pilar cyst [17.0% (16/94)], thyroglossal cyst [12.8% (12/94)], and dermoid cyst [8.5% (8/94)]. The only malignant cutaneous cyst was immature cystic teratoma [1.06% (1/94)]. The anatomic site most frequently affected was the head and neck [63.8% (60/94)]. Conclusion Histopathologic evaluation is still the gold standard in eliminating misdiagnosis of these lesions. Epidermal inclusion cysts followed by pilar cysts were commonest cutaneous cystic lesions in our environment and occur more at the third decade and above, whereas cystic hygroma, dermoid cysts, and brachial cyst were predominant at the first decade of life.

Intracranial posterior fossa proliferating trichilemmal tumor: first case report.

Proliferating trichilemmal tumors (PTT) are rare benign lesions that predominantly occur in elderly women and usually affect the scalp. They originate from the outer root sheath of hair shafts and have trichilemmal differentiation on histopathological examination. Compared to trichilemmal cysts, PTTs show increased cell proliferation and variable cytological atypia. We report the first case of a patient with an intracranial PTT in the posterior fossa. The clinicoradiological presentation and surgical management of the patient as well as the possible pathogenesis of this tumor are discussed.

Bronchogenic cyst: a diagnostic challenge as cervical swelling

Introduction: Bronchogenic cyst is a developmental anomaly of primitive foregut, usually diagnosed at birth or soon after. Commonly seen as intrapulmonary and mediastinal pathology, it is also reported at other sites, including neck, as a subcutaneous swelling. It seldom produces symptom unless it keeps growing due to persistent secretion and produces compressive symptoms. Abscess formation, discharging sinus or malignant transformation may occur rarely. Case report: A 26 years old male presented with a midline suprasternal swelling. Clinical examination revealed a 6x4cm size soft, mobile, nontender, cystic swelling which did not move upward on deglutition or on protrusion of tongue. Radiological evaluation of neck confirmed a cystic lesion in subcutaneous plane. Differential diagnosis of Thyroglossal cyst, dermoid cyst, branchial cyst, bronchogenic cyst, and Trichilemmal cyst were considered. Histological examination following excision confirmed the diagnosis of Bronchogenic cyst. Discussion: Surgery is the treatment of choice in cases of cervical cystic swellings which merit a wide range of differential diagnosis. Diagnosis of Bronchogenic cyst is confirmed by typical respiratory epithelial lining with interspersed goblet cells and smooth muscle fibres in the cyst lining.

The Value of Ultrasound for Differentiating Trichilemmal Cysts From Epidermoid Cysts.

This study was aimed to evaluate the diagnostic performance of ultrasound (US) in differentiating trichilemmal cysts (TCs) from epidermoid cysts (ECs). Based on clinical and ultrasound features, a prediction model was established and validated. 164 cysts in the pilot cohort and another 69 in the validation cohort diagnosed with TCs or ECs histopathologically were evaluated. The same radiologist performed all ultrasound examinations. For clinic features, TCs tended to occur in females compared with ECs (66.7 vs 28.5%; P < .001). In addition, TCs were prone to occur in the hairy area compared with ECs (77.8 vs 13.1%; P < .001). For ultrasound features, the internal hyperechogenicity and cystic change were more likely to appear in TCs in comparison with ECs (92.6 vs 25.5%; P < .001; 70.4 vs 23.4%; P < .001, respectively). Upon the features mentioned above, a prediction model was established with the areas under the receiver operating characteristic curves of 0.936 and 0.864 in the pilot and validation cohorts, respectively. US is promising for differentiating TCs from ECs and is valuable for their clinical management.

Rare Evolution of a Trichilemmal Cyst: A New Observation of Carcinomatous Degeneration

The trichilemmal cyst, also called the hair cyst, is an infrequent adnexal tumor that derives from the isthmic portion of the hair follicle. It is an oftensolitary tumor with preferential localization of the scalp. Its evolution is generally benign. Malignant cases are very rare and sometimes aggressive. Only about fifty cases are reported in the literature. We report a new observation of carcinomatous degeneration illustrating the difficulty of the therapeutic management of this aggressive form. It was a 55-year-old patient with no significant pathological antecedents who, since 2012, has had voluminous and numerous scalp swelling, slow and indolent evolution. The management was surgical with excision of 13 cysts initially. Pathological examination showed an appearance consistent with proliferative trichilemma cysts without evidence of malignancy. The patient had a recurrence of cystic lesions after five years. She was reoperated with excision of three cysts whose histopathological examination showed a well-differentiated keratinizing squamous cell carcinoma developed on one of the cysts. We decided on a surgical revision with extensive excision of the tumor followed by recovery by a sliding flap and rotation. The evolution was favorable with a follow-up of two years. The main take away of our case is the locally aggressive character of this malignant form which necessitate an extensive surgical excision, thus posing the problem of reconstruction.

Clinicopathological Appraisal of Cutaneous Cysts: A 2-Year Retrospective Observational Study

Background: Cysts, primarily epidermal and trichilemmal, are commonly seen in clinical practice. Rupture, infection, inflammation, and rarely malignant transformation may complicate the cysts. This study aims to analyze the clinicohistological features of cutaneous cysts. Materials and Methods: A retrospective review of patients with the diagnosis of cyst confirmed on histopathology over the past two years (2020–2021) was performed. Clinical details comprised of age, gender, site of involvement, size, duration, and associated symptoms. Histological examination included cyst wall lining, type of keratinization, complications like rupture, inflammation, foreign body giant cell reaction, calcification, and malignant change. Results: A total of 324 cases with mean age of 37.9 years and equal gender distribution were identified. Most frequent diagnosis was epidermal cyst in 89.8%, followed by trichilemmal cyst in 8.9% of cases. Rare types included follicular hybrid cyst, verrucous cyst, vellus hair cyst, and steatocystoma. Most common complication was cyst rupture in 54.3% of epidermal cysts. Proliferating epidermal and proliferating trichilemmal cysts were noted in one and two cases, respectively. Two cases revealed malignancy arising in the wall of epidermal cyst. Limitations: The retrospective study design and non-availability of follow-up data, especially for proliferating cysts and cysts with malignant transformation were the main limitations of this study. Conclusion: Histopathologic examination of excised cutaneous cysts is paramount in reaching accurate diagnosis of the type of cyst and associated secondary changes to enable appropriate management.

PILAR CYST- REPORT OF A RARE CASE

We report a case of pilar cyst in a 50 year old female with a swelling in the left parietal region. Gross findings revealed a cystic cavity with multiple infoldings. The characteristic histopathologic feature of a pilar cyst with absence of granular layer and swollen cells were evident. Attention to detail, prompt diagnosis and treatment based on the signs and symptoms are a must for patient welfare.

Malignant proliferating trichilemmal tumor of thigh: a case report of an unusual location of a rare cutaneous adnexal tumor

Proliferating trichilemmal tumour (PTT) is a well-circumscribed dermal or subcutaneous neoplasm with squamoid cytologic features and trichilemmal-type of keratinization. Usually, proliferating trichilemmal cysts are benign, although rarely, can undergo malignant transformation, at which point they are referred to as malignant proliferating trichilemmal tumours (MPTTs). Ninety percent of PTTs occur on the scalp, but they have also been found on the forehead, nose, back, chest, abdomen, buttocks, elbow, wrist, mons pubis and vulva. Here a case of an 89-year-old woman with a malignant proliferating trichilemmal tumour of right thigh is discussed, which is a very rare site for occurrence of the same.

Ancient Schwannoma: A Case Report

Schwannomas are common, slow-growing benign tumors derived from Schwann cells lining the nerve sheath which are rarely developed from the scalp. There are several types of schwannoma; however, ancient schwannoma is a rare benign tumor. We present a case of a 36-year-old man with an approximately 3 × 2-cm palpable mass on the left parietal area of his scalp that slowly grew over 5 years. The tumor was surgically excised and confirmed by immunohistochemistry, indicating an “ancient schwannoma” different from a trichilemmal or dermoid cyst.

Histopathological study of scalp tumors and tumor like lesions

Introduction: A variety of inflammatory and neoplastic scalp lesions is encountered in clinical practice, which can be attributed to trauma, infection, abscess, allergic reaction, or tumor. Though a majority of scalp involvement is by benign processes, still it can be a site of malignant neoplasm.Aims and objectives 1.To study the morphological, histopathological types and clinico-pathological correlation of various scalp tumors.2.To know the proportion of benign and malignant lesions in the scalp lesions.3.To compare the data and other investigations with similar studies from other regions.Materials and methods: The present retrospective study is conducted in the department of pathology, B.J. Medical college and civil hospital, Ahmedabad over a duration of 5 years. A total of 105 cases of scalp lesions were evaluated. Scalp biopsies with clinical suspicion of a tumor which presented with a swelling, with or without pain or with non-healing ulcer were included in the study. The spectrum of lesions that appeared in the scalp were tabulated. Results: In our study, total 105 cases were observed during period of five years. Out of the total of 105 cases majority of them were benign accounting for 92.38% of all cases and malignant cases accounting for 7.62% of all cases. The sex distribution of scalp lesions in the present study was slightly greater in male accounting for 60% cases. Out of 105 cases majority are non-tumorous keratinous cysts accounting for 53.3% of all cases with trichilemmal cyst being most common. Conclusion: Benign tumors and tumor like lesions are more common than malignant tumors. Although mostly benign diagnosis and treatment of these lesions pose significant challenge due to distinct histopathological features. A high index of clinical suspicion is essential to ensure early detection of malignancies and initiate treatment.

Smegma remains a diagnostic dilemma

A healthy, uncircumcised, two-year-old male presented with a six-month history of an asymptomatic, mobile, yellowish nodule near the base of the glans penis. An examination revealed a 1 × 0.5 cm, yellowish-white, soft, and mobile nodule between the glans and the foreskin of the penis (Fig. 1). No signs of infection or irritation were noted and the rest of the body was free of lesions. Ultrasound revealed soft tissue thickening, excluded a solid formation. The urine dipstick test was negative. Based on the clinical features, the diagnosis of a smegma cyst was reached. A smegma cyst is composed of epithelial debris, fat, and proteins and is covered by a well-formed, epithelial wall [1]. When there is no covering sac of lump, it is called the smegma pearl. Frequently located on the ventral surface of the glans, within the subpreputial space, the urethral meatus is not affected and the prepuce is partially retractable. It develops in uncircumcised patients. As phimosis resolves the inner foreskin, adhesions begin to undergo a gradual process of separation from the glans penis. Smegma may become entrapped during this process, forming smooth, palpable pearls [2]. It is neither damaging nor irritating. The differential diagnosis concerns either acquired or congenital penile cysts (e.g., trichilemmal cysts, preputial Epstein pearls, dermoid cysts, median raphe cysts, para meatal cysts, mucoid cysts, epidermoid cysts, pilosebaceous cysts, juvenile xanthogranuloma) [3]. Given the paucity of published reports, these collections are a diagnostic challenge for clinicians unfamiliar with this entity and a source of concern for parents. Smegma pearls are a benign entity. Bimanual retraction or gentle expression may be performed with a risk of paraphimosis, irritation, and recurrence [2,3]. Thus, these techniques must be discussed with the parents considering the spontaneous resolution. In the case of chronic evolution, smegma may evolve to preputial stones in adults and the elderly. No investigations or treatments are required. Only monitoring and parental reassurance are recommended.