Case Number : Case 283 Posted By: Guest

Iskander Chaudhry - Central Manchester Trust (Manchester, U.K.) Wrote:

Dear All The final diagnosis is Trichilemmoma! Richard excellent points including the clinical bit at the end! Phillip Should be back tomorrow to resume the spots and may add to this comment

Submitted on 12/07/2011 03:37
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Richard Carr - Warwick (UK) Wrote:

Very tricky. Initial low power impression was trichilemmoma with some tumour of the follicular infundibulum-like features (they way the lesion hangs of the epidermis). That tumour is actually misnamed as it shows predominent differentiation towardst eh follicular isthmus. That said I feel the background peripehral cells here are poroid. We do have some central cystic spaces (can be seen in trichilemmoma with "follicular mucin" but in this case might just represent cystic lumina. I thought the more amorphous collagen focally was more typical of hidradenoma and desmoplastic trichilemmoma. Agree immunos should be very helpful. Trichilemmoma is almost always CD34 positive in our hands and the BerEP4, EMA, CEA, CK7 might highlight the glands in hidradenoma. Whoops just remembered clinical correlation!! forgot phillip is now giving clinicals - final diagnosis = Trichilemmoma!

Submitted on 12/07/2011 02:52
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Mohammad alqudah - MRI (Manchester) Wrote:

I cant see thickened basment membrane nor peripheral palisading to label this as tricholemmom. still differential between clear cell hidradenoma and poroma

Submitted on 11/07/2011 19:49
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Hazem Hamed - Department of Histopathology, Imperial College (LONDON) Wrote:

Trichilemmoma

Submitted on 11/07/2011 15:15
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Diana Alvarez - (The Netherlands) Wrote:

Trichilemmoma

Submitted on 11/07/2011 14:22
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Marwa Fawzi - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Trichilemmoma

Submitted on 11/07/2011 13:31
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Reubina Wadee - NHLS/Wits University (Johannesburg, South Africa) Wrote:

This is a benign clear cell skin adnexal tumour. I would consider the following differential diagnosis in this case: trichilemmoma, clear cell hidradenoma and poroma. My favoured diagnosis is however a trichilemmoma.

Submitted on 11/07/2011 12:45
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Marie MD - () Wrote:

Tricholemmoma,inflamed. Tangentially cut, but could be desmoplastic variant.

Submitted on 11/07/2011 10:40
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Eman El-Nabarawy - Cairo University (Egypt) Wrote:

Nodular hidradenoma.

Submitted on 11/07/2011 10:31
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Juan Carlos Garcés - Hospital Oncológico / Hospital Luis Vernaza (Guayaquil Ecuador) Wrote:

Trichilemmoma

Submitted on 11/07/2011 09:19
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Pablo Ortega - Hospital Isidro Ayora -Dermatopathology Department (Loja-Ecuador) Wrote:

I think this tumor is a Desmoplastic Triquilemmoma.

Submitted on 11/07/2011 09:10
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James Carton - Imperial College (London) Wrote:

I would agree tricholemmoma with a small demsoplastic component. My first posting on the site - what a brilliant resource & thank you for posting so many fantastic instructive cases.

Submitted on 11/07/2011 08:16
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Marcela Saeb Lima - Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (Mexico City) Wrote:

I would favor desmoplastic trichilemmoma, however a differential could be hidradenoma

Submitted on 11/07/2011 08:10
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Rodrigo Restrepo - UPB/CES (Mdlln/Col) Wrote:

Nodular hidradenoma (clear cell hidradenoma)

Submitted on 11/07/2011 07:50
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Saleem Taibjee - Warwick () Wrote:

Trichilemmoma. The second image is showing the desmoplastic component which is a helpful clue.

Submitted on 11/07/2011 07:38
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Mohammad alqudah - MRI (Manchester) Wrote:

Nodular Hidradenoma vs Poroma.

Submitted on 11/07/2011 06:40
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ANDREW DANCKWERTS - NHLS, WITS UNIVERSITY (JOHANNESBURG, RSA) Wrote:

I FAVOUR A NODULAR HIDROADENOMA WITH FOCAL SQUAMOUS DIFFERENTIATION. TO SUPPORT THIS, THERE IS EVIDENCE OF ECCRINE CUTICLE FORMATION, WHICH I WOULD CONFIRM WITH EMA AND CEA IMMUNOHISTOCHEMICAL STAINS. ALSO, OCCASIONAL NUCLEAR GROOVES ARE NOTED. HOWEVER, IN AREAS THERE IS CONTINUITY FROM THE OVERLYING EPIDERMIS, RAISING THE POSSIBILITY OF AN ECCRINE POROMA - HOWEVER, NODULAR HIDRADENOMAS CAN SHOW EPIDERMAL EXTENSION, ALTHOUGH THIS IS MUCH MORE PREVALENT WITH ECCRINE POROMAS.

Submitted on 11/07/2011 05:30
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Mona Abdel Halim - Dermatology Department, Faculty of medicine, Cairo University (Egypt) Wrote:

Tumor composed of two types of cells, cells with esinophilic cytoplasm and clear cells. Focal connection to the epidermis. Foci of squamous differentiation (keratinization and dykeratotic cells). Scanning magnification shows cystic changes. There is No peripheral palisading, No thick esinophilic hyalinized basement membrane. Favour Nodular Hidradenoma.

Submitted on 11/07/2011 04:47
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