Case Number : Case 35 Posted By: Guest

Phillip McKee - Overseas consultations (USA) Wrote:

This field comes from a nevus sebaceus. Whether you call it follicular induction or a superficial trichoblastoma-like proliferation doesn't really matter. Either works for me! Basaloid folicular hamartoma is a good differential diagnosis. It is this sort of proliferation that in the past was mistakenly regarded as a superficial BCC. Although BCC may develop in a nevus sebaceus, it is a very rare event.

Submitted on 28/07/2010 21:18
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Marwa Fawzi - Dermatology Department,Faculty of Medicine, Cairo university. (Egypt) Wrote:

I agree with basaloid follicular hamartoma,as absence of horn cysts making trichoepithelioma the 2nd DDx.

Submitted on 28/07/2010 17:10
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Phillip McKee - Overseas consultations (USA) Wrote:

Yes, in the center of the field is a typical blood vessel showing features of a "hemangiopericytomatous" pattern

Submitted on 28/07/2010 14:55
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Phillip McKee - Overseas consultations (USA) Wrote:

Good morning all. Once again you are doing very well. Eman, I will check yesterday's case and respond about the vessels. Phillip

Submitted on 28/07/2010 14:52
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

I agree with my colleague Dr Amira and with Dr Wayne about the possibility of basaloid follicular hamartoma. It crossed my mind earlier due to the branching anastomosing nature seen in the upper left quadrant. I favoured trichoepithelioma due to the characteristic stroma and hair papillae (abortive follicle) like structures. Still agree that BFH is a good ddx.

Submitted on 28/07/2010 14:48
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Wayne Grayson - (Johannesburg, South Africa) Wrote:

I think this is a basaloid follicular hamartoma.

Submitted on 28/07/2010 14:43
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Eman El-Nabarawy - Dermatology Department,Faculty of Medicine, Cairo university. (Egypt.) Wrote:

Dear Dr Mckee, we are so graetful for this marvellous effort. I would like to ask about the amazing photo of monphasic synovial sarcoma,does it show a typical hemangiopericytomatous pattern? As I am not familiar with this pattern. Thanks a lot.

Submitted on 28/07/2010 14:05
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Amira Tawdy - Cairo University (Egypt) Wrote:

Tricoepithelioma is my first thought but I would like to add basaloid follicular hamartoma as well

Submitted on 28/07/2010 09:26
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Marcela Saeb Lima - MSL Dermatopato (Mexico City) Wrote:

Follicular induction in a nevus sebaceous

Submitted on 28/07/2010 08:12
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

I would like to add that the basaloid islands show focal continuity with the epidermis. As much as I know this favours trichoepithelioma over trichoblastoma as trichoblastoma shows no epidermal connections. So if follicular induction in nevus sebaceous is meant to be development of trichoblastoma, then I will not be comfortable with this idea in this section. Moreover, I don't see the epidermal changes or apocrine structures of nevus sebaceous. Waiting to know the correct diagnosis!!

Submitted on 28/07/2010 07:51
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

I can see islands of basaloid cells with peripheral pallisading, no stromal retraction and characteristic highly cellular stroma with lots of fibroblasts. In the centre there are structures resembling hair papillae or abortive hair follicles. I will go for trichoepithelioma.

Submitted on 28/07/2010 06:52
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Eman El-Nabarawy - Dermatology Department,Faculty of Medicine, Cairo university. (Egypt) Wrote:

Trichoepithelioma. Still find the DD of nevus sebaceous with follicular induction is a very good idea.

Submitted on 28/07/2010 06:18
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Juan Carlos Garcés - Hospital Oncológico / Hospital Luis Vernaza (Guayaquil Ecuador) Wrote:

Good evening, Basically agree with Rodrigo...But the stroma is special..very cellular with small vessels.. could be a scar of a previos escision of a basaloid tumor like trichoepitelioma or trichoblastoma

Submitted on 28/07/2010 02:15
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Rodrigo Restrepo - UPB (Mdlln. Colombia) Wrote:

Follicular induction in nevus sebaceous

Submitted on 27/07/2010 23:17
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