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Trichoadenoma in a Mature Cystic Teratoma: a Rare Finding P

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Trichoadenoma in a Mature Cystic Teratoma: a Rare Finding P Trichoadenoma In A Mature Cystic Teratoma: A Rare Finding P. Kaur, R. Bansal, M. Madan, Nutan Pathology Department, Giansagar Medical College and Hospital, Banur, Dist Patiala, Punjab, India Abstract trichoadenoma has also been described briefly. Skin adnexal tumors arising in dermoid cysts Keywords: of the ovary are exceedingly rare. We report a trichoadenoma arising in a dermoid cyst in trichoadenoma, mature cystic teratoma a 42-year-old female. The histopathology of Introduction hospital on day 5 after surgery. The left ovarian Mature teratomas, which are almost all cystic mass measured 8 x 6 x 3.5 cm. The outer surface (dermoid cysts), account for approximately was tan and smooth. Cut section was partly solid 25% of all ovarian tumors, and 30% of and partly cystic. Multiloculated cysts filled with benign ovarian tumors. They usually develop cheese-like material and hairs were seen. Slides in children or women of the reproductive age were prepared, stained with hematoxylin-eosin group(1). Histologically, they are composed of and seen under the light microscope. variable proportions of tissue originating from Sections from the cystic areas showed a lining the ectoderm, mesoderm, and endoderm. Cystic of keratinizing stratified squamous epithelium, cavities are lined by mature epidermis. Although including sebaceous glands, sweat glands and skin appendages and neural tissue are extremely hair. Neural tissue, respiratory and gastric common, there are only few case reports of skin epithelium, fat, bone and thyroid follicles were adnexal tumors arising in a mature teratoma. also identified. We report a case of ovarian teratoma with a One of the sections taken from the solid area trichoadenoma. To the best of the authors’ showed numerous horn cysts surrounded by knowledge, this is the first report describing eosinophilic cells. A single layer of flattened this rare benign skin adnexal tumor, in a mature granular cells was also seen interpolated between cystic teratoma of the ovary. the horn cysts and surrounding eosinophilic cells. Case Report A diagnosis of trichoadenoma was made. A 42 year old female presented in the emergency department with pain in the abdomen and vomiting. Ultrasonographic examination showed a large, predominantly cystic left adnexal mass, measuring 7.1 x 6.1 cm, with a highly echogenic component. Left ovary was not separately defined. The possibility of a dermoid cyst was suggested by the radiologist. The patient underwent exploratory laparotomy with hysterectomy and bilateral salpingo- ophorectomy. The patient’s post-operative course was uneventful and she was discharged from the Correspondence: Dr. Puneet Kaur, 361-R model town, Fig. 1: Low power view showing keratinizing squamous Jalandhar, 144003, India. Email: [email protected] epithelium and skin appendages. (H&E x 40) 65 Trichoadenoma In A Mature Cystic Teratoma, P. Kaur, et al. Fig. 3: High power view of the horn cysts, eosinophilic Fig. 2: Low power view showing multiple horn cysts cells and intervening attenuated granular cell layer lined by eosinophilic cells. (H&E x 100) (H&E x 400) Discussion The eosinophilic cells greatly resemble Benign and malignant somatic tumors arising the eosinophilic cells that are often seen in trichoepithelioma located between the basophilic in mature cystic teratomas of the ovary are a (6) rare but recognized phenomenon. Despite the cells and the central horn cysts The central benign nature of mature teratomas, considerable cystic cavity shows epidermoid keratinization interests have been paid on them because of the and resembles the cross section of infundibular portion of pilosebaceous canal without any unusual histogenesis caused by the totipotency (6, 7, 8) of these tumors. evidence of hair follicle formation A variety of benign and malignant neoplasms The finding of a trichoadenoma adds to like blue naevi(9) glomus tumor(10) squamous cell the versatility of the tumors that can arise in a carcinoma(11) have been seen in benign cystic teratoma and further highlights the totipotency teratomas. All these neoplasms with somatic of the latter. type features arise from the germ cell elements of the teratoma. However, the presence of a skin adnexal tumor, benign or malignant is a rare finding in a mature cystic teratoma. Few cases of sebaceous adenoma(2), sebaceous carcinoma(4), and microcystic adnexal carcinoma(3) have been reported in mature cystic teratomas. But we were unable to find any reports citing the presence of a trichoadenoma in a teratoma. Trichoadenoma is a rare benign, well differentiated solitary and slowly growing tumor of the hair follicle, first described by Nikolowski in 1958(5) Microscopic study of trichoadenoma characteristically shows numerous horn cysts throughout the dermis, surrounded by eosinophilic epithelial cells. 66 G. J. O. Issue 9, 2011 References 1. Pantoja E, Noy MA, Axtmayer RW, et al. Ovarian 7. Brenn T, McKee PH. Tumors of the hair follicle. dermoids and their complications: comprehensive In: McKee PH, Calonje E, Granter SR, editors. historical review. Obstet Gynecol Surv 1975; 30:1- Pathology of the Skin with Clinical Correlations. 3 rd 20. ed. Elsevier: Mosby; 2005. p. 1519-63. 2. Chumas JC, Scully RE. Sebaceous tumors arising in 8. Yamaguchi J, Takino C. A case of trichoadenoma ovarian dermoid cysts. Int J Gynecol Pathol. 1991; arising in the buttock. J Dermatol 1992; 19:503-6. 10:356–363. 9. Kudo M. The nature of “blue nevus” in cystic teratomas 3. Yoon HK, Park SM, Joo JE.Combined microcystic of the ovary. An ultrastructural evidence for Schwann adnexal carcinoma and squamous cell carcinoma cell origin. Acta Pathol Jpn. 1985; 35:693–698. arising in the ovarian cystic teratoma. J Korean Med 10. Silver SA, Tavassoli FA. Glomus tumor arising Sci. 1994; 9(5):432-435. in a mature teratoma of the ovary: report of a case 4. Vartanian R K, McRae B, Hessler RB.Sebaceous simulating a metastasis from cervical squamous Carcinoma Arising in a Mature Cystic Teratoma of carcinoma. Arch Pathol Lab Med. 2000;124:1373– the Ovary. Int J Gynecol Pathol. 2002; 21(4):418-21 1375 5. Reibold R, Udeutsch W, Fleiner J. Trichoadenoma of 11. Hirakawa T, Tsuneyoshi M, Enjoji M. Squamous cell Nikolowsky-review of four decades and seven new carcinoma arising in mature cystic teratoma of the cases [in German]. Hautarzt 1998; 49:925-8. ovary. Clinicopathologic and topographic analysis. Am J Surg Pathol.1989;13:397–405. 6. Klein W, Chan E, Seykora JT. Tumors of the epidermal appendages. In: Elder DE, Elenitsas R, Johnson BL, Murphy GF, editors. Levers histopathology of the skin. 9 th ed. Lippincott: Williams and Wilkins; 2005. p. 867-926. 67.
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