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Solitary Skin Colored Papule on His Nose for 15 Years Present Illn

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Solitary Skin Colored Papule on His Nose for 15 Years Present Illn Case 6 Histopathology: (S08-9362) (Fig 6.3) A 59-year-old Thai man from Bangkok - Well-circumscribed, non-encapsulated nodular tumor Chief complaint: Solitary skin colored papule on his nose for involving the entire dermis 15 years - The tumor composed of multiple lobules of basaloid cells Present illness: The patient had asymptomatic solitary skin with foci of adenoid change, surrounded by densely colored papule at nose for 15 years which gradually increased cellular fibromyxoid stroma in size. - The tumor cells are small, basophilic and palidsading Personal history: HT, Dyslipidemia, COPD, old CVA nuclei at the periphery Family history: No family history of similar skin lesion - The stroma composed of both stellate and spindle cell Physical examination: fibroblasts Solitary 1×1.5 cm. atrophic and telangiectatic skin colored nodule at nose which is rubbery consistency, movable Diagnosis: Trichoblastoma and not tender. Presenter: Wikanda Panmanee Consultant: Natta Rajatanavin Discussion: Trichoblastoma is a benign skin neoplasm that mostly originating from follicular germinative differentiation. They differ from trichoepitheliomas in size, location, and lack of keratinizing cysts1 and have also been referred to as immature trichoepitheliomas. Clinically, trichoblastomas present as asymptomatic, solitary, non-ulcerated, skin-colored to brown or bluish-black papules or nodules which are up to 1.0 cm in size situated mostly on the head Fig 6.1 Fig 6.2 and neck, particularly on the scalp and face of adults. Multiple lesions have been described. Trichoblastomas are commonly larger, deeper and more nodular than classical trichoepithelioma. They are also commonly observed in association within a pre-existing nevus sebaceous2 or may occasionally coexist with a basal cell carcinoma3. Cutaneous lymphadenoma (adamantinoid trichoblastoma) is a rare appendage tumor classified as a variant of trichoblastoma3. It presents mainly in adults in the fourth to fifth decades as a solitary, skin-colored nodule situated on the head and neck. Fig 6.3 23 24 Trichoblastomas are best subdivided according to the pre- Reference dominant morphologic pattern into 1. Gilks CB, Clement PB, Wood WS. Trichoblastic fibroma. Am J Dermatopathol 1989; 11: 397 1. Large nodular (including pigmented) 2. Cribier B, Scrivener Y, Grosshans E. Tumors arising in nevus sebaceous: a study 2. Small nodular (including adamantinoid or of 596 cases. J Am Acad Dermatol 2000; 42: 263–8. lymphadenoma) 3. Ackerman AB et al. Neoplasms with Follicular Differentiation. New York, Ardor 3. Retiform (giant solitary trichoepithelioma) Scribendi, 2001. 4. Cribriform (classic trichoepithelioma) 4. Schulz T, Proske S, Hartschuh W, Kurzen H, Paul E, Wunsch PH et al. High- Grade Trichoblastic Carcinoma Arising in Trichoblastoma: A Rare Adnexal 5. Racemiform (nonclassic trichoepithelioma) Neoplasm Often Showing Metastatic Spread. Am J Dermatopathol 2005; 27(1): 6. Columnar (desmoplastic trichoepithelioma) variants 9-16. Exact subclassification is difficult in some lesions 5. Seo Kyung-Jin, Yoo Jinyoung, Kang Seok-Jin, Jung Ji-Han, Lee Hye-Kyung Lee because of the presence of more than one predominant Kyo-Young. Trichoblastic Carcinoma arising in Trichoblastoma- A Case Report. morphologic pattern3. Korean J Pathol 2007; 41(4): 274-277. 6. Timothy H McCalmont. Adnexal neoplasms. In: Bolognia JL, Jorizzo JL, Rapini It has been debated whether malignant transformation nd RP. Dermatology. 2 ed. Spain: Elsevier. 2008: 1697-1698. of trichoblastoma occurs. The concept was forwarded that 7. Sajben FP, Rose EV. The use of the 1.0 mm handpiece in hign energy,pulsed basal cell carcinoma is as a malignant neoplasm of follicular CO2 laser Destructionof facial adnexal tumors. Dermatol Surg. 1999; 25: 41-4. germinative cells and should be named trichoblastic 8. Shaffelburg M, Miller R. Treatment of multiple trichoepithelioma with carcinoma4. Trichoblastic carcinoma is a rare malignant electrosurgery. Dermatol Surg. 1998; 24: 1154-6. neoplasm of follicular germ cell origin which only few trichoblastic carcinomas arising in trichoblastomas have appeared on the literature5 and they seem to have a higher potential for distant metastasis4. Treatment for solitary lesion is surgical excision3. But some recommendations suggest observing because of its low incidence for malignant transformation6. However, multiple facial trichoblastomas can be cosmetically disabling and many affected patients desire some type of intervention. Because of number of lesions, conventional excision is not usually indicated. Other ablative approaches, including laser or electrosurgical destruction, have been employed with some success7, 8. 25 26 .
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