Case Number : Case 1973 - 21 Dec 2017 Posted By: Guest

Dear All 

Dr Chaudhry posted immuno on yesterday's case:

Best wishes

DPro Admin

Colloid milium

Dr Chaudhry posted his diagnosis to:

Oops, dark cells and shadow cells- it's a pilomatricoma!

Pilomatricoma

Yes, cystic pilomatricoma.

I'm not sure because the images are so low power. I would have said pilomatricoma as well.

My thoughts are hair cortex comedo (Spot Diagnosis 837) or possibly as multiple & patient is immune suppressed  trichodysplasia spinulosa - perhaps both!

small biopsy with areas showing features of inner root sheath differentiation and matrix differentiation. no other hair follicle parts differentiation seen (such as infundibulum and outer root sheath) in the superfical biopsy. still could be a superfical panfolliculoma.

Must be a shrewd observation, Henry. Although I can't clearly appreciate trichohyalin granules to indicate inner root sheath differentiation, McKee and Michal believe that pilomatricoma "although predominantly a tumor with matrical differentiation, careful inspection of early or well-established lesions often will reveal foci of clear cells with ltrichohyalin granules (differentiation toward the lower portion of inner root sheath) and blue-gray cornified cells (upper root sheath differentiation)."

Panfolliculoma is rare, you know.

The orange hue in the epithelium cells more superficial will equate to IRS differentiation - you'd need a slightly higher magnification to resolve the individual granules than here but the appearance is typical.

Hi Everyone,

Dr Phelp's final diagnosis is Trichodysplasia spinulosa.