Case Number : Case 28 Posted By: Guest

Phillip McKee - Overseas consultations (USA) Wrote:

Many thanks to Richard for his most illuminating comments. You see, we can all teach each other. That is one of the great benefits of this site and of posting your thoughts. The more interactive it is the better. Obviously cutaneous lymphadenoma is the correct diagnosis. Well done, all of you. See you tomorrow. Phillip

Submitted on 19/07/2010 21:19
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Ana Cristina Ruiz - Universidad CES (Medellín, Colombia ) Wrote:

Cutaneous lymphadenoma (trichoblastoma)

Submitted on 19/07/2010 18:08
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Richard Carr - Warwick (UK) Wrote:

That is a very interesting academic question. It is rare (not surprised Wayne has not had one come across the desk in routing reporting). I just checked my slide collection database and there are 6 in my collection (sorry to lazy to get them out) but only 2 of these are local cases. Described by Santa Cruz, Barr and Headington in only 1991!! Clearly Dr Akerman along with just a handful of other pathologists will have seen more than 10 in their lifetime. When I reviewed the literature in 2007 I noted that some authors had reported papillary mesenchymal bodies in cutaneous lymphadenoma (CL) but other not. I must admit the few cases I have seen lacked obvious papillary mesenchymal cells (pretty much a pre-requisite for all the other variants of trichoblastoma except demoplastic trichoepithelioma that Ackerman calls collumnar trichoblastoma!). Interestingly Merkel cells (highly typical of benign follicular adnexal tumours) has been found in 3/5 cases of CL in one series which is quite good evidence for folliclar origin (but not proof as we also noted Merkel cells had been reported in hidradenoma). Interestingly one group found a lot of reactive S100, CD1a positive cells in both lymphadenoma and trichoblastoms generally. Bcl2 also stains CL in a peripheral pattern (like TE/TBs). In view of the presence of sebaceous differentiation (in CL) some authors favour a pilosebaceous (more probably sebaceous) while some have noted lumina and suggested a lymphotropic syringoma! Being a bit of Akermanophile! I would go with the great man and say probably a true folliculo-sebaceous-apocrine unit tumour but predominantly "follicular" (not surprising that you will get the lumina as part of the apocrine or sebaceous duct). However it is such a nicely distinctive tumour cutaneous lymphadenoma is a perfectly acceptable label and so well known by dermatopathologists but arguably not that helpful to those learning pathology or clinicians. I would therefore not mention adamantinoid trichoblastoma in my report but clearly state "CL is a distinctive benign adnexal tumour of probable follicular origin"!!

Submitted on 19/07/2010 17:56
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Wayne Grayson - (Johannesburg, South Africa) Wrote:

I don't think this could be anything but a cutaneous lymphadenoma. I am patiently waiting for a case of my own to grace my microscope one day!

Submitted on 19/07/2010 16:46
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Phillip McKee - Overseas consultations (USA) Wrote:

Good morning all. You are all doing very well. Richard do you personally think that it should be classified in the trichoblastoma group and if yes, Why?

Submitted on 19/07/2010 16:17
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Eman El-Nabarawy - Dermatology Department,Faculty of Medicine, Cairo university. (Egypt.) Wrote:

I agree.Cutaneous Lymphadenoma.Great picture.

Submitted on 19/07/2010 15:14
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Juan Carlos Garces - Hospital Oncológico / Hospital Luis Vernaza (Guayaquil Ecuador) Wrote:

Good morning.. agree with Cutaneous Lymphadenoma

Submitted on 19/07/2010 14:42
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Rodrigo Restrepo - Universidad Pontificia Bolivariana (Medellin, Colombia) Wrote:

Cutaneous lymphadenoma

Submitted on 19/07/2010 13:36
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Marcela Saeb Lima - MSL Dermatopato (Mexico City) Wrote:

Cutaneous lymphadenoma.... beautiful!

Submitted on 19/07/2010 13:07
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Richard Carr - Warwick (UK) Wrote:

Cutaneous lymphadenoma (adamantinoid trichoblastoma - Ackerman et al)

Submitted on 19/07/2010 10:54
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

I can see lobules of basaloid cells with some degree of peripheral palisading. The lobules are embeded in fibrous stroma. There is intense infiltrate of small lymphocytes within the lobules and some lymphocytes in the stroma. This is Cutaneous Lymphadenoma. Wounderful picture!

Submitted on 19/07/2010 06:25
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