Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Art & Psychiatry
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Conference Oration
Conference Summary
Continuing Medical Education
Cosmetic Dermatology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
Editor Speaks
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Miscellaneous Letter
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News & Views
Observation Letter
Observation Letters
Original Article
Original Contributions
Pattern of Skin Diseases
Pediatric Dermatology
Pediatric Rounds
Presedential Address
Presidential Address
Presidents Remarks
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Review Article
Review Articles
Revision Corner
Self Assessment Programme
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Study Letter
Study Letters
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapy Letter
Therapy Letters
View Point
What’s new in Dermatology
View/Download PDF

Translate this page into:

Net letter
doi: 10.4103/0378-6323.86507
PMID: 22016296

Giant proliferating trichilemmal malignant tumor

Jose Aneiros-Fernandez1 , Jose M Jimenez-Rodriguez2 , Aurelio Martin1 , Salvador Arias-Santiago3 , Angel Concha1
1 Department of Pathology, Virgen de las Nieves Hospital, Granada, Spain
2 Department of Plastic Surgery, Virgen de las Nieves Hospital, Granada, Spain
3 Department of Dermatology, University San Cecilio Hospital, Granada, Spain

Correspondence Address:
Jose Aneiros-Fernandez
Department of Pathology, Virgen de las Nieves Hospital, Avd.Madrid s/n Granada
How to cite this article:
Aneiros-Fernandez J, Jimenez-Rodriguez JM, Martin A, Arias-Santiago S, Concha A. Giant proliferating trichilemmal malignant tumor. Indian J Dermatol Venereol Leprol 2011;77:730
Copyright: (C)2011 Indian Journal of Dermatology, Venereology, and Leprology


Proliferating trichilemmal cyst is a benign tumor that originates in the outer root sheath of hair follicle. Usually, it is located on the scalp in older women, but also have been reported in other sites such as back, chest, axilla, groin, gluteal region, thigh, vulva, and face. [1] Malignant transformation of proliferating trichilemmal cyst is confirmed only on histological findings. This tumor has a variable biologic behavior with local recurrence and lymph node metastasis. [2]

We have recently observed a case of giant malignant proliferating trichilemmal tumor in a 63-year old man affecting the arm, wrist, and back of hand. Magnetic resonance imaging showed it to be a solid tumor affecting middle-distal radio ulna to metacarpal [Figure - 1]; however, tendinous structures were preserved. Clinical examination revealed a focally ulcerated, exophytic tumor, limiting the mobility of the fingers, measuring 14 × 9 cm 2 with 3 years of evolution [Figure - 2]a. He noticed a rapid increase in size 3 months ago. He had no prior trauma to this area, and had no prior dermatologic problem. There was no papable lymphadenopathy. Histopathology of the lesion showed typical cystic areas with trichilemmal keratinization [Figure - 2]b, showing irregular nests with deep desmoplastic stroma [Figure - 2]c. The tumor cells showed marked nuclear atypia and abundant mitotic activity. Immunohistochemistry was focally positive for CK7, CK8, and CK18, and negative for AML, CD34. Surgical excision was performed with wide margins and axillary dissection without evidence of metastasis. At 3 months, there was no tumor recurrence.

Figure 1: Magnetic resonance imaging showing solid tumor, which affected middle-distal radio ulna to metacarpal
Figure 2: (a) Showing exophytic, ulcerative tumor (14 × 9 cm2) in the back of the hand-arm. (b) The tumor is composed of irregularly shaped lobules of squamous epithelium undergoing an abrupt change into amorphous keratin (H and E, ×20). (c) At higher magnification, the tumor cells showed nuclei with atypia and mitosis (H and E, ×400)

There are less than 30 published cases of malignant proliferating trichilemmal tumor, showing 12 cases of metastatic disease, with an average of 30%. Metastases may be noticed at the time of diagnosis or until 30 years later. [3] Ye et al. [4] proposed three groupings of proliferating pilar tumors (PPTs) within a series of 76 cases with regard to histologic criteria and correlated these criteria with malignant potential. Group 1 PPTs, benign lesions that had no recurrence, displayed well circumscribed margins, modest nuclear atypia, and no pathologic mitoses, necrosis, or vascular or neural invasion. Group 2 PPTs, low-grade malignant lesions that may recur, exhibit in addition irregular and locally invasive margins and involvement of deep dermis and subcutis. Group 3 PPTs, high-grade malignant tumors with a tendency toward recurrence and lymph node metastasis, manifest invasive patterns of growth with prominent nuclear pleomorphism, atypical mitoses, necrosis, and possible vascular or neural invasion. Group 1 may be regarded as benign, group 2 as having the potential for locally aggressive growth, and group 3 as also having metastatic potential. The latter two categories might be equated with low and high grades of malignancy among PPTs of the skin. [4]

Malignant proliferating trichilemmal tumor with human papillomavirus type 21 in a patient with epidermodysplasia verruciformis had been reported. There is no specific immunohistochemical marker of malignant trichilemmal differentiation (absence of CD34, AML, etc.) and although they are positive for cytokeratin 8, cytokeratin 18 and 5/6 does not allow differentiation from squamous cell carcinoma. [5] The only information that allows us to establish the diagnosis and differentiate it from squamous cell carcinoma is the presence of solid and cystic areas showing a sharp keratinization with extensive amorphous eosinophilic keratin, and an invasive component with marked nuclear atypia, necrosis, and mitosis. The treatment of these lesions is local excision with a margin of 1 cm, sometimes may require radiation therapy to prevent recurrence and chemotherapy for metastatic disease. [5] This neoplasm is most commonly found on the scalp and on back of the neck. We report this case of malignant proliferating trichilemmal tumor giant infrequent location on the hand.

Garg PK, Dangi A, Khurana N, Hadke NS. Malignant proliferating trichilemmal cyst: A case report with review of literature. Malays J Pathol 2009;31:71-6.
[Google Scholar]
Park BS, Yang SG, Cho KH. Malignant proliferating trichilemmal tumor showing distant metastases. Am J Dermatopathol 1997;19:536-9.
[Google Scholar]
Folpe AL, Reisenauer AK, Mentzel T, Solomon AR. Proliferating trichilemmal tumors: Clinicopathologic evaluation is a guide to biologic behavior. J Cutan Pathol 2003;30:492-8.
[Google Scholar]
Ye J, Nappi O, Swanson PE, Patterson JW, Wick MR. Proliferating pilar tumors: A clinicopathologic study of 76 cases with a proposal for definition of benign and malignant variants. Am J Clin Pathol 2004;122:566-74.
[Google Scholar]
Haas N, Audring H, Sterry W. Carcinoma arising in a proliferating trichilemmal cyst expresses fetal and trichilemmal hair phenotype. Am J Dermatopathol 2002;24:340-4.
[Google Scholar]

Fulltext Views

PDF downloads
Show Sections