Malignant Follicular Tumors

The major two malignant follicular tumors, pilomatrix carcinoma (pilomatrical carcinoma) and trichilemmocarcinoma (trichilemmal carcinoma) (Fig. 23) have been discussed under their benign counterparts, pilomatrixoma and trichi-lemmoma respectively. Under the lumper philosophy, it has been proposed that both these are simply variants of squamous carcinoma, with shadow cells or clear cells being prominent features.

Reference:

1. Hardisson D, Linaves MD, Cuevas-Santos J, Contreas F. Pilomatrix carcinoma: a clinicopathologic study of six cases and review of the literature. Am J Dermatopathol 2001; 23: 394-401.

Nevus Comedones
The smaller secondary follicles have their own Figure 1 Trichofolliculoma. Mature follicles trichohyaline granules and hair shafts, unlike Figure 3 Nevus comedonicus. This is a empty into "mother of all follicles." dilated pore of Winer. birthmark with groups of comedones.
Dilated Pore Winer And Epidermal Cyst

Figure 6 Trichoepithelioma. Basaloid aggregates with papillary mesenchymal bodies, Figure 5 Trichoepitheliomas. Fleshy papules fibrotic stroma without retraction from the

Figure 4 Nevus comedonicus. Grouped comedones.

Figure 6 Trichoepithelioma. Basaloid aggregates with papillary mesenchymal bodies, Figure 5 Trichoepitheliomas. Fleshy papules fibrotic stroma without retraction from the on central face.

tumor, and horn cysts.

Trichoepithelioma Dermatopathology

Figure 7 Desmoplastic trichoepithelioma. (A) Scanning magnification with strands of basaloid cells, and horn cysts. (B) Higher magnification. Note: Fibrotic stroma and no stromal retraction Figure 8 Trichoadenoma. Papule with central from the tumor. dell resembling sebaceous hyperplasia.

Figure 7 Desmoplastic trichoepithelioma. (A) Scanning magnification with strands of basaloid cells, and horn cysts. (B) Higher magnification. Note: Fibrotic stroma and no stromal retraction Figure 8 Trichoadenoma. Papule with central from the tumor. dell resembling sebaceous hyperplasia.

Trichoadenoma
Figure 9 Trichoadenoma. (A) Scanning magnification of horn cysts with squamoid appearance. (B) Higher magnification of horn cysts.

Figure 10 Pilomatrixoma. Erythematous papule elevates the skin ("tent sign").

Trichoadenoma

Figure 12 Pilomatrixoma. (A) Scanning magnification of cystic nodule with keratinous Figure 11 Pilomatrixoma Gross specimen of material and shadow cells in the center with basaloid cells around the edge. (B) Higher nodule having appearance like a cyst magnification of basaloid cells, shadow cells, and cells in transition that are losing their nuclei.

Figure 12 Pilomatrixoma. (A) Scanning magnification of cystic nodule with keratinous Figure 11 Pilomatrixoma Gross specimen of material and shadow cells in the center with basaloid cells around the edge. (B) Higher nodule having appearance like a cyst magnification of basaloid cells, shadow cells, and cells in transition that are losing their nuclei.

Pilar Cyst

Figure 14 Proliferating pilar cyst. Gross cut specimen showing cystic nodule with proliferation of wall.

Figure 13 Proliferating pilar cyst. A relatively nonspecific nodule.

Figure 14 Proliferating pilar cyst. Gross cut specimen showing cystic nodule with proliferation of wall.

Proliferating Pilar Cyst
Proliferating Pilar CystTrichilemmoma
Figure 16 Trichilemmoma. (A) Scanning view of lobule of pale squamous proliferation growing downward. (B) Higher magnification of lobule of pale squamous lobule with palisade of basal cells.
Figure 17 Inverted follicular keratosis. Downward growing lobule with more squamous eddies and less of a clear cell appearance than trichilemmoma.
Fibrofolliculoma Pathology
Figure 18 Tumor of follicular infundibulum. Shelves of pale epidermis bridge between follicles.
Tumor The Follicular Infundibulum
Figure 19 Birt-Hogg-Dube syndrome. Skin-colored papules are smooth and not conspicuous.
Fibrofolliculoma Pathology

Figure 21 Trichodiscoma. The fibrous stroma of fibrofolliculoma is seen without the follicular strands.

Figure 20 Fibrofolliculoma. Delicate epithelial strands extend from the follicle into the fibrous stroma.

Figure 21 Trichodiscoma. The fibrous stroma of fibrofolliculoma is seen without the follicular strands.

Fibrofolliculoma Pathology
Figure 22 Trichoblastoma. (A) Scanning magnification of a basaloid lobule in the deep dermis. (B) Higher magnification of basaloid lobules without stromal retraction.
Telogen Effluvium Crown
Figure 23 Trichilemmocarcinoma. Proliferation of invasive atypical pale cells resembles clear cell squamous cell carcinoma.

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