Trichilemmal carcinoma in a middle-aged man mimicking an occipital sebaceous cyst: A case report
DOI:
https://doi.org/10.5281/zenodo.21809215Keywords:
trichilemmal carcinoma, proliferating trichilemmal tumor, cutaneous adnexal neoplasms, immunohistochemistry, scalp, case reportAbstract
Trichilemmal carcinoma, or malignant proliferating trichilemmal tumor, is an uncommon cutaneous neoplasm of follicular origin that accounts for a minimal proportion of skin cancers and classically predominates in elderly women, with scalp localization. We describe a case of trichilemmal carcinoma in an adult man, diagnosed incidentally after surgical resection of a lesion initially interpreted as a sebaceous cyst. A 41-year-old man with a history of ocular toxoplasmosis and treated hypertension presented with a left occipital lesion of 9 months' duration that began as a punctate, mildly painful spot and grew progressively until it caused intense pain with minimal stimuli. Surgical resection was indicated under clinical suspicion of a sebaceous cyst. Gross and microscopic pathology showed a well-delimited neoplastic proliferation with two cell populations: a basophilic population with central necrosis and calcification, and a population of large eosinophilic cells with atypia and numerous mitoses. Immunohistochemistry showed positivity for cytokeratin 7 and epithelial membrane antigen in the larger cell population, positivity for cytokeratin 5/6 in the smaller population, and negativity for S100 and CD34 in both, findings consistent with trichilemmal carcinoma. The patient required no adjuvant treatment after complete resection. At four-month follow-up the operative scar showed no signs of local recurrence. This case illustrates an atypical presentation of trichilemmal carcinoma by age and sex, and underscores the need for a high index of diagnostic suspicion for cystic scalp lesions with evolving size or painful symptoms, as well as the central role of immunohistochemistry in diagnostic confirmation.
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