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Gao S, Xu Q, Lan Y, He L. Recurrent trichilemmal carcinoma of the periorbital region treated with IMRT radiotherapy: A case report and a review of literature. Medicine (Baltimore) 2023; 102:e34038. [PMID: 37327304 PMCID: PMC10270555 DOI: 10.1097/md.0000000000034038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/29/2023] [Indexed: 06/18/2023] Open
Abstract
RATIONALE Trichilemmal carcinoma (TLC) is a rare malignant cutaneous adnexal tumor usually accept surgery. This report describes an elderly patient with recurrence TLC of the periorbital region after surgery who was subsequently treated with IMRT radiotherapy. After 2-years follow-up visit, there was no progress or metastasis. INTRODUCTION TLC is a rare malignant cutaneous adnexal tumor. It usually occurs on sun-exposed areas in elderly people but rarely occurs in the periorbital region. Most cases accept surgery or micrographic Mohs surgery. Recurrence or metastasis of this neoplasm was seldom reported in the medical literature after enough tumor-free margin surgery. And radiotherapy was seldom reported in the treatment for patients of TLC. PATIENT CONCERNS Here we report an elderly patient with recurrence TLC of the periorbital region after surgery who was subsequently treated with radiotherapy with a total dose of 66 Gy. Two years later, the patient was admitted head, neck, chest, abdomen CT scan, and no progress or metastasis was detected after 2-years follow-up. DIAGNOSIS Trichilemmal carcinoma of the periorbital region. INTERVENTIONS We describe the clinical characteristics, pathological features, and choice of examination methods of a patient with TLC in the periorbital region. And we use the radical radiotherapy to treat this case. OUTCOMES There are no progress or metastasis after 2-years follow-up. CONCLUSION Radiotherapy is a good option for patients with TLC if the patient refuses surgery or fails to achieve a satisfactory tumor-free margin or relapses after surgery.
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Affiliation(s)
- Shan Gao
- Cancer Prevention and Treatment Institute of Chengdu, Department of Otolaryngology-Head and Neck Surgery, Chengdu, China
| | - Qin Xu
- Cancer Prevention and Treatment Institute of Chengdu, Department of Oncology, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China
| | - Yanli Lan
- Cancer Prevention and Treatment Institute of Chengdu, Department of Otolaryngology-Head and Neck Surgery, Chengdu, China
| | - Lang He
- Cancer Prevention and Treatment Institute of Chengdu, Department of Oncology, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China
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Sun J, Zhang L, Xiao M, Li S, Chen R, Li Y, Yang Y. Systematic analysis and case series of the diagnosis and management of trichilemmal carcinoma. Front Oncol 2023; 12:1078272. [PMID: 36727056 PMCID: PMC9886092 DOI: 10.3389/fonc.2022.1078272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023] Open
Abstract
Background Trichilemmal carcinoma (TLC) is a rare malignant cutaneous adnexal neoplasm, with no relatively comprehensive research. Objective The aim of this study is to perform an updated statistical analysis so as to better understand TLC's epidemiology, clinical features, diagnosis, and treatment. Methods The diagnosis and treatment of three TLC cases in our department were summarized. Then, all TLC cases published in the literature were retrieved for a comprehensive analysis, followed by the analysis of global trends and regional distribution, demographic characteristics, clinical features, pathogenesis, histopathological features, and treatment and prognosis of TLC. Results Of the 231 cases, the incidence of TLC has shown an upward trend recently, especially in China, in Asia. The susceptible population is men aged 60-80 and women over 80, and the most prone location is head and neck. The phenotype of TLC is not always typical and may be misdiagnosed because of the coexistence of other diseases. There is a linear relationship between the diameter and its duration or thickness. UV, locally present skin lesions, trauma, scarring, organ transplantation, and genetic disorders may trigger the occurrence of TLC. Periodic acid-Schiff staining and CD34, but not Epithelial Membrane Antigen (EMA), were helpful in the diagnosis of TLC. Although effective, surgical excision and Mohs micrographic surgery need further improvement to reduce recurrence of TLC. Carcinoma history is an independent risk factor for TLC recurrence. Limitations The limitation of this study is the lack of randomized controlled trial on TLC treatment and recurrence. Conclusion TLC has the possibility of invasive growth and recurrence, especially in patients with longer duration and carcinoma history.
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Affiliation(s)
- Jiachen Sun
- Department of Dermatology, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lihua Zhang
- Department of Pathology, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Minglu Xiao
- Department of Dermatology, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shiyi Li
- Department of Burns and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Runkai Chen
- Department of General Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ying Li
- Department of Pathology, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yuguang Yang
- Department of Dermatology, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China,*Correspondence: Yuguang Yang,
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Current Treatment Options for Cutaneous Adnexal Malignancies. Curr Treat Options Oncol 2022; 23:736-748. [DOI: 10.1007/s11864-022-00971-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/03/2022]
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Jia Q, Yuan Y, Mao D, Wen G, Chen X. Trichilemmal Carcinoma of the Scalp in a Young Female: A Case Report. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2022; 15:139-143. [PMID: 35115802 PMCID: PMC8805741 DOI: 10.2147/ccid.s349797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/11/2022] [Indexed: 11/30/2022]
Abstract
Trichilemmal carcinoma (TC) is a rare malignant cutaneous adnexal neoplasm originating from the outer root sheath of hair follicles, which occurs commonly in sun-exposed areas of the elderly. Here, we introduce a case of a 24-year-old woman with TC on her scalp.
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Affiliation(s)
- Qiuyu Jia
- Department of Dermatology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Yunyan Yuan
- Department of Dermatology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Dandan Mao
- Department of Dermatology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Guangdong Wen
- Department of Dermatology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Xue Chen
- Department of Dermatology, Peking University People's Hospital, Beijing, People's Republic of China
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5
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[Management of malignant adnexal neoplasms of the skin]. Hautarzt 2021; 72:619-632. [PMID: 34137901 DOI: 10.1007/s00105-021-04829-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
Malignant adnexal neoplasms of the skin are a heterogeneous group of rare malignancies with eccrine, apocrine, sebaceous and follicular differentiation. Essential clinical practice recommendations for the overall management of these cancers are presented. Moreover, specific evidence-based findings according to diagnosis, therapy and follow-up of porocarcinoma, sebaceous carcinoma and microcystic adnexcarcinoma will be explained.
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Płachta I, Kleibert M, Czarnecka AM, Spałek M, Szumera-Ciećkiewicz A, Rutkowski P. Current Diagnosis and Treatment Options for Cutaneous Adnexal Neoplasms with Follicular Differentiation. Int J Mol Sci 2021; 22:4759. [PMID: 33946233 PMCID: PMC8125718 DOI: 10.3390/ijms22094759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 12/30/2022] Open
Abstract
Neoplasms derived from follicular tissue are extremely rare. Clinically, they are reported as non-symptomatic, slow-growing nodules. These lesions are mainly benign, but the malignant type can occur. Mainly middle-aged people (50-60 years of age) are affected. These carcinomas are mainly localized on the head and neck or torso. They can be locally aggressive and infiltrate surrounding tissue and metastasize to regional lymph nodes. In the minority of cases, distant metastases are diagnosed. Quick and relevant diagnosis is the basis of a treatment for all types of tumors. The patient's life expectancy depends on multiple prognostic factors, including the primary tumor size and its mitotic count. Patients should be referred to a specialized skin cancer center to receive optimal multidisciplinary treatment. This article tries to summarize all the information that is currently available about pathogenesis, diagnosis, and treatment methods of follicular tumors.
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Affiliation(s)
- Iga Płachta
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (I.P.); (M.K.); (M.S.); (P.R.)
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Marcin Kleibert
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (I.P.); (M.K.); (M.S.); (P.R.)
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Anna M. Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (I.P.); (M.K.); (M.S.); (P.R.)
| | - Mateusz Spałek
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (I.P.); (M.K.); (M.S.); (P.R.)
| | - Anna Szumera-Ciećkiewicz
- Department of Pathology and Laboratory Diagnostics, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland;
- Department of Diagnostic Hematology, Institute of Hematology and Transfusion Medicine, 00-791 Warsaw, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (I.P.); (M.K.); (M.S.); (P.R.)
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Romeu M, Foletti J, Chossegros C, Dales J, Berbis P, Cribier B, Guyot L. Les tumeurs cutanées malignes à différentiation pilaire de la face et du cuir chevelu : mise au point diagnostique et thérapeutique. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2017; 118:95-102. [DOI: 10.1016/j.jormas.2017.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 06/02/2016] [Accepted: 01/11/2017] [Indexed: 12/01/2022]
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Sia PI, Figueira E, Allende A, Selva D. Malignant hair follicle tumors of the periorbital region: A review of literature and suggestion of a management guideline. Orbit 2016; 35:144-56. [PMID: 27171562 DOI: 10.1080/01676830.2016.1176048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Malignant hair follicle tumors are rare skin adnexal malignancies that have a predilection for the head and neck region. They can be categorized into a number of different subtypes. Histologically, they are distinct from their benign counterpart. To the best of our knowledge, there is no extensive review of these malignancies, especially in the periorbital region. We aim to provide a literature review and a guideline for management of these malignant tumors in the periorbital region. Database from Medline, PubMed, Embase, and Google Scholar were consulted. A total of 16 cases from the literature on hair follicle malignancies in the periorbital region were included in this review. The clinical presentations, diagnostic patterns, investigations used, and best management approach of these tumors are discussed. The American Joint Committee on Cancer (AJCC) 7(th) edition carcinoma of the eyelid staging system was used to describe their behaviors. We recommend wide excision surgery and a close follow-up for these tumors. Tumors presenting with a late stage require work-up for distant metastasis and consideration for exenteration procedures. The role of radiotherapy and chemotherapy in this context is still uncertain.
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Affiliation(s)
- Paul Ikgan Sia
- a South Australian Institute of Ophthalmology and Discipline of Ophthalmology & Visual Sciences , University of Adelaide , Adelaide , Australia
| | - Edwin Figueira
- a South Australian Institute of Ophthalmology and Discipline of Ophthalmology & Visual Sciences , University of Adelaide , Adelaide , Australia
| | - Alexandra Allende
- b Douglass Hanly Moir Pathology , Sydney , New South Wales , Australia
| | - Dinesh Selva
- a South Australian Institute of Ophthalmology and Discipline of Ophthalmology & Visual Sciences , University of Adelaide , Adelaide , Australia
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Wilkie MD, Munir N, Roland NJ, Lancaster J. Trichilemmal carcinoma: an unusual presentation of a rare cutaneous lesion. BMJ Case Rep 2013; 2013:bcr-2012-008369. [PMID: 23605822 DOI: 10.1136/bcr-2012-008369] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Trichilemmal carcinoma (TC) is a rare cutaneous neoplasm which is derived from adnexal keratinocytes, is histologically invasive, contains cytologically atypical clear cell neoplasm and is in continuity with the epidermis and/or follicular epithelium. However, the diagnostic criteria and even the existence of TC have been contentious. We report the case of a 92-year-old woman with TC of the head and neck region who presented with an unusually long history. She was treated successfully with wide local excision. Important aspects in presentation, differential diagnosis, including histopathological features and management are discussed.
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Affiliation(s)
- Mark David Wilkie
- Department of Otorhinolaryngology Head & Neck Surgery, University Hospital Aintree, Liverpool, UK.
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Lacarrubba F, Nasca MR, Micali G. Advances in the use of topical imiquimod to treat dermatologic disorders. Ther Clin Risk Manag 2011; 4:87-97. [PMID: 18728724 PMCID: PMC2503670 DOI: 10.2147/tcrm.s1109] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Imiquimod (IQ) is an immune-response modifying agent, first approved by FDA for the topical treatment of external genital and perianal warts in 1997. It induces, through stimulation of Toll-like receptors (TLRs) localized on the surface of antigen-presenting cells, synthesis and release of several endogenous pro-inflammatory cytokines such as interferon-α (IFN-α), tumor necrosis factor-α (TNF-α) and interleukins (IL) 6 and 12, which in turn stimulate both the innate and acquired immune pathways, resulting in upregulation of natural antiviral and antitumor activity. IQ 5% cream has been used for the treatment of a wide variety of dermatologic conditions in which the immune system is thought to play a role in regression of the disease. In some disorders, such as genital and perianal warts, actinic keratoses, basal cell carcinomas, Bowen’s disease and molluscum contagiosum, relative safety and efficacy are supported by randomized controlled trials of IQ. However, it is common for patients to experience local skin reactions, which can range from mild to severe in intensity, but usually resolve 1–2 weeks after interrupting treatment. Additional randomized trials are encouraged to assess safety and efficacy of IQ in the treatment of an even wider range of cutaneous disorders.
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Seo SH, Kim GW, Sung HW. Imiquimod as an adjuvant treatment measure for desmoplastic trichoepithelioma. Ann Dermatol 2011; 23:229-31. [PMID: 21747627 DOI: 10.5021/ad.2011.23.2.229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 05/08/2010] [Accepted: 06/10/2010] [Indexed: 11/08/2022] Open
Abstract
Desmoplastic trichoepithelioma is a rare benign adnexal tumor. Although it is a benign lesion, patients often want to treat it due to cosmetic concerns when it occurs in an easily visible site. For our two cases, topical 5% imiquimod was an attractive treatment option as it is applied by the patients themselves and it has minimal side effects, including leaving no scar. However, the lesions recurred after clinical remission. To the best of our knowledge, this is the only report on utilizing imiquimod to treat a benign adnexal tumor, and especially desmoplastic trichoepithelioma.
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Affiliation(s)
- Sang-Hee Seo
- Department of Dermatology and Medical Research Institute, Yangsan Pusan National University Hospital, Yangsan, Korea
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Kulahci Y, Oksuz S, Kucukodaci Z, Uygur F, Ulkur E. Multiple recurrence of trichilemmal carcinoma of the scalp in a young adult. Dermatol Surg 2010; 36:551-4. [PMID: 20187891 DOI: 10.1111/j.1524-4725.2010.01498.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Yalcin Kulahci
- Department of Plastic and Reconstructive Surgery, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey.
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Wagstaff AJ, Perry CM. Topical imiquimod: a review of its use in the management of anogenital warts, actinic keratoses, basal cell carcinoma and other skin lesions. Drugs 2008; 67:2187-210. [PMID: 17927284 DOI: 10.2165/00003495-200767150-00006] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Topical imiquimod 5% cream (Aldara) is an immune response modulator that is indicated for the treatment of external anogenital warts, superficial basal cell carcinoma and actinic keratoses. The cream is applied two to five times per week for varying periods, depending on the indication. Topical imiquimod cream has also been evaluated in the treatment of several other skin conditions. Immunomodulatory therapy with topical imiquimod 5% is an effective option for the approved indications. The drug appears to be relatively well tolerated, with the option of breaks from treatment as required for local skin reactions (which are common). Systemic reactions have been reported. Treatment of human papillomavirus- and UV-associated skin lesions with topical imiquimod offers a noninvasive, tissue-sparing alternative to ablative treatment options. However, well designed trials of the sustained, long-term efficacy and tolerability of topical imiquimod versus those of common treatment approaches including surgery and other topical alternatives are required before the place of the drug in the management of these lesions can be finalised. Nonetheless, while other treatments for anogenital warts, superficial basal cell carcinoma or actinic keratoses are available, the advantages of self treatment linked with the demonstrated efficacy of topical imiquimod offer an attractive alternative for many patients.
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