Trichilemmal carcinoma with a cutaneous horn

Corneal Perforation Caused by Eyelid Margin Trichilemmal Carcinoma: A Case Report and Review of Literature

Background

Trichilemmal carcinoma (TLC) is a rare malignant adnexal tumor most commonly found in the elderly, usually affecting the scalp, eyelids, neck and face. Here, we first reported a rare case of corneal perforation caused by eyelid margin TLC.

Case Presentation

A 68-year-old female presented with 2 months history of unprovoked redness, pain and blurred vision in the left eye. On slit-lamp examination, a 1 × 2 mm sized aseptic corneal perforation embedded by iris prolapsed was noted. Upon detailed case investigation, we speculated that the severe meibomian gland dysfunction (MGD) and subsequent Blepharokeratoconjunctivitis (BKC) could have led to corneal perforation. The patient underwent penetrating keratoplasty to prevent ulcer enlargement and infection. However, several tiny nodules gradually developed on the eyelid margin postoperatively, accompaniedby with bleeding, burst and madarosis postoperatiely. Subsequently, biopsy revealed the growth of TLC on the eyelid margin, and lesionectomy was immediately conducted During the 1-year follow-up period, no local recurrence or metastasis was observed.

Conclusions

To date, there has not been any report of corneal perforation caused by eyelid margin TLC. Consideration of the clinical presentation, feature and histopathologist will be benefit for the dignoses and treatment of TLC. Ensuring a smooth eyelid margin by total excision of TLC and consistent followup of patient will avoid recurrence.

Trichilemmal carcinoma of the upper eyelid: a case report

We report a very rare case of trichilemmal carcinoma (TLC) involving the upper eyelid. To the best of our knowledge, this is the first report of trichilemmal carcinoma of the upper eyelid in Korea. A 51-year-old man presented to our hospital complaining of a bloody discharge from his left upper eyelid. He had a soft and lobulated mass on the palpebral conjunctiva. An incisional biopsy revealed trabecular growth of tumor cells with clear cytoplasm, prominent nucleoli, frequent mitoses, and foci of trichilemmal keratinization. Immunohistochemically, the lesion was positive for p53 and negative for CD 34. A diagnosis of TLC was made, and total excision of the mass and reconstruction of the eyelid were performed. Trichilemmal carcinoma is a rare malignant tumor, though it appears to be an indolent neoplasm with no metastatic potential. The treatment of choice for trichilemmal carcinoma of the eyelid is complete excision with tumor-free margins due to the locally invasive nature of the lesion.

Pilomatricomal Horn

We describe a pilomatricomal horn on the right arm of a 39-year-old man. Although initially the tumor was clinically thought to be a verruca vulgaris, the microscopic features were similar to those found in classic pilomatricoma, except for the epidermal location and the presence of a cutaneous horn. Light microscopy showed replacement of the epidermis by basaloid cells, with masses of cornified material containing shadow cells that formed a cutaneous horn. Whereas classic pilomatricoma is confined to the deep reticular dermis or subcutis, the present case represents a unique heretofore unreported epidermal variant of pilomatricoma that pathologists should be aware of to differentiate it from malignant epidermal tumors.

Trichilemmal carcinoma of the upper eyelid

INTRODUCTION

Trichilemmal carcinoma (TLC) is a rare adnexal tumour related to the external hair sheath. We describe the first case of TLC on the upper eyelid to be treated with Mohs micrographic surgery.

CASE REPORT

A 65-year-old man presented with a 2-month history of a firm 4 mm left upper eyelid nodule. An incisional biopsy revealed an infiltrative, lobulated tumour composed of large, polygonal, clear cells. A diagnosis of trichilemmal carcinoma was made and the patient underwent Mohs micrographic surgery. At follow-up 2 years later, there was no evidence of recurrence.

CONCLUSION

The pathogenesis of TLC remains unclear, with actinic damage, longterm low dose irradiation and transformation from benign trichilemmoma having been postulated. Trichilemmal carcinomas must be differentiated from other malignant clear cell tumours of the eyelid and the correct diagnosis made promptly as TLC takes an indolent clinical course, in which metastasis is a rare event, despite the tumour's cytologically malignant appearance. We recommend Mohs micrographic surgery as a treatment modality for this tumour, due to its potential for locally aggressive growth and local recurrence.

Tricholemmal carcinoma in continuity with trichoblastoma within nevus sebaceus

A nodule arising within the nevus sebaceus on the vertex of the scalp of a 68-year-old woman was histopathologically and immunohistochemically investigated. We also used immunohistochemistry to investigate the cytokeratin (CK) distribution of the outer root sheaths of normal terminal hair follicles. The nodule consisted of two parts, a main exophytic part with a lobular proliferation and a small peripheral part with the features of trichoblastoma. The main exophytic lesion consisted of lobular aggregations composed of both or either basaloid cells and clear cells with the silhouette and cytology of malignancy. The columnar clear cells were aligned in a palisade at the periphery of the aggregations of clear cells, and the aggregations located in the superficial dermis were connected to the follicular infundibular structures. Almost all of the neoplastic aggregations were diffusely positive for CK7 (OV/TLR/30), and the innermost or inner cells of the neoplastic aggregations were positive for CK17; a similar staining pattern to that in the lower portion of the outer root sheath between the A and B fringes in normal terminal hair follicles. The exophytic part of the lesion was a malignant neoplasm with differentiation mainly toward the lower segment of the outer sheath between the A and B fringes of the terminal hair follicle, namely tricholemmal carcinoma. Our case may represent a collision of two distinctive neoplasms (tricholemmal carcinoma and trichoblastoma), however, an intimate relationship between these two neoplasms also should be considered.

Trichilemmal carcinoma in an African American

BACKGROUND

Trichilemmal carcinoma is an uncommon cutaneous neoplasm found primarily on the sun-exposed skin of the elderly.

OBJECTIVE

To report a case of trichilemmal carcinoma presenting as a forehead nodule in an African American patient.

METHODS

Case report and review of the literature.

RESULTS

Our patient is the first reported case in the English language literature of trichilemmal carcinoma in an African American individual with skin phototype VI.

CONCLUSION

The occurrence of trichilemmal carcinoma in our African American patient suggests the diagnosis of trichilemmal carcinoma be added to the differential diagnosis of a nodule on the head region in this patient population.