February 26, 2014
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FA1
1472011
Hand Surgery, Vol. 19, No. 1 (2014) 131–133 © World Scientific Publishing Company DOI: 10.1142/S0218810414720113
TRICHILEMMAL CYST OF THE THIRD FINGERTIP: A CASE REPORT Cenk Melikoglu,* Fikret Eren,‡ Barış Keklik,* Cem Aslan,§ Mustafa Sutcu* and Emine Zeynep Tarini†
Hand Surg. 2014.19:131-133. Downloaded from www.worldscientific.com by CHINESE UNIVERSITY OF HONG KONG on 02/09/15. For personal use only.
*Plastic
and Reconstructive Surgery †Medical Pathology Sanliurfa Training Hospital, Sanliurfa, Turkey ‡Plastic
and Reconstructive Surgery GATA Haydarpasa Training Hospital, Istanbul, Turkey §
Plastic and Reconstructive Surgery Izimir Ataturk Training Hospital, Izmir, Turkey Received 13 January 2013; Accepted 8 August 2013 ABSTRACT Introduction: Trichilemmal cysts (TCs) are common skin lesions that occur in hairy areas. A TC involving a fingertip has not been previously described in the literature. We herein report a case of a TC occupying a fingertip region. Case presentation: A 43-year-old woman presented with a 1:5 1:5 cm nodular lesion on the third fingertip. The lesion was completely excised, and histopathological examination revealed a TC. Conclusion: TCs may involve atypical locations, such as fingertips, where there are no hair follicles. After surgical excision, a careful histopathological examination should be performed to differentiate TCs from proliferating pilar tumors. Keywords: Fingertip; Proliferating Pilar Tumor; Trichilemmal Cyst.
INTRODUCTION
CASE REPORT
Trichilemmal cysts (TCs) are common adnexal skin tumors that occur in hairy areas, usually on the scalp of elderly women.1 Proliferating pilar tumors (PTTs) are thought to arise from TCs and are associated with the risk of malignant transformation.1 We herein present a case of TC on the fingertip, which is an extremely rare localization.
A 43-year-old woman was admitted to our clinic with an eightyear history of a nodule on her third fingertip. Physical examination demonstrated a 1:5 1:5 cm soft mass on the ulnar side of the middle fingertip (Fig. 1A). X-ray examination revealed a radiopaque mass of the third finger (Fig. 2A). An operation was performed under local anesthesia. The lesion was
Correspondence to: Dr. Cenk Melikoglu, Istiklal Cd. Pasa Apt. No: 15 Yenisahir Sanliurfa, Turkey. Tel: (þ90) 505-276-7069, E-mail: [email protected] 131
February 26, 2014
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(A) Hand Surg. 2014.19:131-133. Downloaded from www.worldscientific.com by CHINESE UNIVERSITY OF HONG KONG on 02/09/15. For personal use only.
WSPC/135-HS
(B)
Fig. 1 Physical examination of the hand. (A) Pre-operative view. (B) Sixmonth post-operative result.
completely excised. The sutures were removed 10 days after surgery. Histopathological examination revealed a stratified squamous epithelium without a granular layer, which was consistent with a TC (Fig. 3). No recurrence was noted in the 6month follow-up period (Figs. 1B and 2B).
DISCUSSION TCs commonly present as smooth nodules of the scalp in elderly men and women.2,3 TCs are almost always benign, and malignant transformation is extremely rare. They may be sporadic or show autosomal dominant inheritance.4 Proliferating pilar tumors (PTTs) are thought to arise from TCs and are much less common.1 Compared with TCs, PTTs are larger and more atypical; they are also associated with a risk of
Fig. 3 Histopathological examination. The cyst wall is composed of pale stratified squamous epithelium without a granular layer. The cyst cavity is filled with homogenous keratin (hematoxylin and eosin, 400).
malignant transformation.1 Because of this potential risk, a differential diagnosis of PTT should be considered in cases of possible TC. Other differential diagnoses that should be considered are squamous cell carcinoma, pilomatrixoma, sweat gland tumors, dermatofibrosarcoma protuberans, cylindroma, basal cell carcinoma, and angiosarcoma.5,6 The literature describes only one other unusual localization of a TC on the hand: in the pulp of the index finger.7 Other unusual localizations of TC include the intraoral upper lip, vulva, nose, mons pubis, buttock, wrist, chest, and elbow.1,8 One additional report exists describing a TC in the neck region extending to the deep cervical structures with an unusual behavior.9 This is the first case report in the literature in which a TC presented on the fingertip, where there are no hair follicles.
CONCLUSION TCs may involve atypical locations, such as fingertips, where there are no hair follicles. Because of the malignant behavior of PTTs, TCs should be differentiated from PTTs. In addition, close postoperative follow-up and careful histopathological examination should be carried out after surgical treatment.
(A)
(B)
Fig. 2 Plain radiograph of the hand. (A) Pre-operative view. (B) Six-month post-operative result.
CONSENT Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A
February 26, 2014
11:17:32am
WSPC/135-HS
1472011
FA1
Trichilemmal Cyst of the Third Fingertip
copy of the written consent is available for review by the Editorin-Chief of this journal.
AUTHORS’ CONTRIBUTIONS FE, CA, and CM drafted the manuscript. CM, BK, and MS carried out the mass removal in the operating room. EZT performed the histopathological examination. All authors read and approved the final version of the manuscript.
Hand Surg. 2014.19:131-133. Downloaded from www.worldscientific.com by CHINESE UNIVERSITY OF HONG KONG on 02/09/15. For personal use only.
References 1. Satyaprakash AK, Sheehan DJ, Sangüeza OP, Proliferating trichilemmal tumors: a review of the literature, Dermatol Surg 33(9):1102–1108, 2007. 2. McKee, Colonje E, Granter SR, Pathology of the Skin with Clinical Correlations, 3rd ed., Elsevier Mosby, Philadelphia, PA.
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3. Leppard BJ, Sanderson KV, The natural history of trichilemmal cysts, Br J Dermatol 94(4):379–390, 1976. 4. Leppard BJ, Sanderson KV, Wells RS, Hereditary trichilemmal cysts. Hereditary pilar cysts, Clin Exp Dermatol 2(1):23–32, 1977. 5. Sau P, Graham JH, Helwig EB, Proliferating epithelial cysts, clinicopathological analysis of 96 cases, J Cutan Pathol 22(5):394–406, 1995. 6. Ye J, Nappi O, Swanson PE, Patterson JW, Wick MR, Proliferating pilar tumors: a clinicopathologic study of 76 cases with a proposal for definition of benign and malignant variants, Am J Clin Pathol 122(4):566– 574, 2004. 7. Ikegami T, Kameyama M, Orikasa H, Yamazaki K, Trichilemmal cyst in the pulp of the index finger: a case report, Hand Surg 8(2):253–255, 2003. 8. Perez LM, Bruce JW, Murrah VA, Trichilemmal cyst of the upper lip, Oral Surg Oral Med Oral Pathol Oral Radiol Endod 84(1):58–60, 1997. 9. Karaman E, Duman C, Yagiz C, Giant trichilemmal cyst at the neck region, J Craniofac Surg 20(3):961–962, 2009.
11:17:28am
WSPC/135-HS
FA1
1472011
Hand Surgery, Vol. 19, No. 1 (2014) 131–133 © World Scientific Publishing Company DOI: 10.1142/S0218810414720113
TRICHILEMMAL CYST OF THE THIRD FINGERTIP: A CASE REPORT Cenk Melikoglu,* Fikret Eren,‡ Barış Keklik,* Cem Aslan,§ Mustafa Sutcu* and Emine Zeynep Tarini†
Hand Surg. 2014.19:131-133. Downloaded from www.worldscientific.com by CHINESE UNIVERSITY OF HONG KONG on 02/09/15. For personal use only.
*Plastic
and Reconstructive Surgery †Medical Pathology Sanliurfa Training Hospital, Sanliurfa, Turkey ‡Plastic
and Reconstructive Surgery GATA Haydarpasa Training Hospital, Istanbul, Turkey §
Plastic and Reconstructive Surgery Izimir Ataturk Training Hospital, Izmir, Turkey Received 13 January 2013; Accepted 8 August 2013 ABSTRACT Introduction: Trichilemmal cysts (TCs) are common skin lesions that occur in hairy areas. A TC involving a fingertip has not been previously described in the literature. We herein report a case of a TC occupying a fingertip region. Case presentation: A 43-year-old woman presented with a 1:5 1:5 cm nodular lesion on the third fingertip. The lesion was completely excised, and histopathological examination revealed a TC. Conclusion: TCs may involve atypical locations, such as fingertips, where there are no hair follicles. After surgical excision, a careful histopathological examination should be performed to differentiate TCs from proliferating pilar tumors. Keywords: Fingertip; Proliferating Pilar Tumor; Trichilemmal Cyst.
INTRODUCTION
CASE REPORT
Trichilemmal cysts (TCs) are common adnexal skin tumors that occur in hairy areas, usually on the scalp of elderly women.1 Proliferating pilar tumors (PTTs) are thought to arise from TCs and are associated with the risk of malignant transformation.1 We herein present a case of TC on the fingertip, which is an extremely rare localization.
A 43-year-old woman was admitted to our clinic with an eightyear history of a nodule on her third fingertip. Physical examination demonstrated a 1:5 1:5 cm soft mass on the ulnar side of the middle fingertip (Fig. 1A). X-ray examination revealed a radiopaque mass of the third finger (Fig. 2A). An operation was performed under local anesthesia. The lesion was
Correspondence to: Dr. Cenk Melikoglu, Istiklal Cd. Pasa Apt. No: 15 Yenisahir Sanliurfa, Turkey. Tel: (þ90) 505-276-7069, E-mail: [email protected] 131
February 26, 2014
132
11:17:29am
FA1
1472011
C. Melikoglu et al.
(A) Hand Surg. 2014.19:131-133. Downloaded from www.worldscientific.com by CHINESE UNIVERSITY OF HONG KONG on 02/09/15. For personal use only.
WSPC/135-HS
(B)
Fig. 1 Physical examination of the hand. (A) Pre-operative view. (B) Sixmonth post-operative result.
completely excised. The sutures were removed 10 days after surgery. Histopathological examination revealed a stratified squamous epithelium without a granular layer, which was consistent with a TC (Fig. 3). No recurrence was noted in the 6month follow-up period (Figs. 1B and 2B).
DISCUSSION TCs commonly present as smooth nodules of the scalp in elderly men and women.2,3 TCs are almost always benign, and malignant transformation is extremely rare. They may be sporadic or show autosomal dominant inheritance.4 Proliferating pilar tumors (PTTs) are thought to arise from TCs and are much less common.1 Compared with TCs, PTTs are larger and more atypical; they are also associated with a risk of
Fig. 3 Histopathological examination. The cyst wall is composed of pale stratified squamous epithelium without a granular layer. The cyst cavity is filled with homogenous keratin (hematoxylin and eosin, 400).
malignant transformation.1 Because of this potential risk, a differential diagnosis of PTT should be considered in cases of possible TC. Other differential diagnoses that should be considered are squamous cell carcinoma, pilomatrixoma, sweat gland tumors, dermatofibrosarcoma protuberans, cylindroma, basal cell carcinoma, and angiosarcoma.5,6 The literature describes only one other unusual localization of a TC on the hand: in the pulp of the index finger.7 Other unusual localizations of TC include the intraoral upper lip, vulva, nose, mons pubis, buttock, wrist, chest, and elbow.1,8 One additional report exists describing a TC in the neck region extending to the deep cervical structures with an unusual behavior.9 This is the first case report in the literature in which a TC presented on the fingertip, where there are no hair follicles.
CONCLUSION TCs may involve atypical locations, such as fingertips, where there are no hair follicles. Because of the malignant behavior of PTTs, TCs should be differentiated from PTTs. In addition, close postoperative follow-up and careful histopathological examination should be carried out after surgical treatment.
(A)
(B)
Fig. 2 Plain radiograph of the hand. (A) Pre-operative view. (B) Six-month post-operative result.
CONSENT Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A
February 26, 2014
11:17:32am
WSPC/135-HS
1472011
FA1
Trichilemmal Cyst of the Third Fingertip
copy of the written consent is available for review by the Editorin-Chief of this journal.
AUTHORS’ CONTRIBUTIONS FE, CA, and CM drafted the manuscript. CM, BK, and MS carried out the mass removal in the operating room. EZT performed the histopathological examination. All authors read and approved the final version of the manuscript.
Hand Surg. 2014.19:131-133. Downloaded from www.worldscientific.com by CHINESE UNIVERSITY OF HONG KONG on 02/09/15. For personal use only.
References 1. Satyaprakash AK, Sheehan DJ, Sangüeza OP, Proliferating trichilemmal tumors: a review of the literature, Dermatol Surg 33(9):1102–1108, 2007. 2. McKee, Colonje E, Granter SR, Pathology of the Skin with Clinical Correlations, 3rd ed., Elsevier Mosby, Philadelphia, PA.
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3. Leppard BJ, Sanderson KV, The natural history of trichilemmal cysts, Br J Dermatol 94(4):379–390, 1976. 4. Leppard BJ, Sanderson KV, Wells RS, Hereditary trichilemmal cysts. Hereditary pilar cysts, Clin Exp Dermatol 2(1):23–32, 1977. 5. Sau P, Graham JH, Helwig EB, Proliferating epithelial cysts, clinicopathological analysis of 96 cases, J Cutan Pathol 22(5):394–406, 1995. 6. Ye J, Nappi O, Swanson PE, Patterson JW, Wick MR, Proliferating pilar tumors: a clinicopathologic study of 76 cases with a proposal for definition of benign and malignant variants, Am J Clin Pathol 122(4):566– 574, 2004. 7. Ikegami T, Kameyama M, Orikasa H, Yamazaki K, Trichilemmal cyst in the pulp of the index finger: a case report, Hand Surg 8(2):253–255, 2003. 8. Perez LM, Bruce JW, Murrah VA, Trichilemmal cyst of the upper lip, Oral Surg Oral Med Oral Pathol Oral Radiol Endod 84(1):58–60, 1997. 9. Karaman E, Duman C, Yagiz C, Giant trichilemmal cyst at the neck region, J Craniofac Surg 20(3):961–962, 2009.
