![]() Infiltrative, poorly differentiated sheets and cords of tumor cells. Trichilemmal tumor ulcerating and protruding from normal epidermis on the left, with the tumor on the right.įigure 3. Furthermore due to the presence of small calcifications, numerous mitotic figures, apoptic bodies, marked cellular atypia, prominent necrosis, and an invasive growth pattern, the final diagnosis of a malignant proliferating trichilemmal tumor was made ( Fig. This histopathology is in line with follicular differentiation, and therefore the diagnosis of a proliferating trichilemmal tumor rather than a cutaneous squamous cell carcinoma. Routine histopathologic analysis of the specimen demonstrated a tumor that was composed of a proliferation of squamous cells in which there were extensive areas of amorphous keratinization ( Fig. Further cutaneous margins were taken circumferentially and revealed no histologic abnormalities. Pathologic analysis of the sentinel nodes demonstrated three benign lymph nodes with hyperplastic features two were from the right axilla and one was from the left. ![]() The patient underwent bilateral axillary sentinel lymph node biopsies as indicated under the diagnosis of high-risk cutaneous squamous cell carcinoma. Gross view of 8.5 cm ulcerating mass.įinal reconstruction was deferred until the following day, as to obtain final margins as well as a lymphatic mapping for sentinel lymph node biopsy. Frozen section showed histologic abnormalities suggestive of squamous cell carcinoma.įigure 1. There were two ulcerations (2.5 cm and 3 cm) and the margins were widely clear. Gross examination demonstrated a well-encapsulated tumor involving the skin and subcutaneous tissue, 8.5 cm in greatest dimension, and a weight of 215 grams ( Fig. The specimen underwent an intraoperative pathologic analysis with frozen section. The pectoralis fascia was taken along with the tumor as a deep margin. There was clinical evidence of neovascularity to the tumor. A wide excision of the tumor with 1 cm gross circumferential margins was performed. Due to the high clinical suspicion for neoplasm, complete surgical excision of the mass was deemed necessary.Īt the time of surgery, with the patient supine, the mass was noted on the anterior chest overlying the sternum and right pectoralis muscle. An incisional biopsy of the mass was taken in the office, and pathologic analysis was notable only for necrotic tissue with abscess formation, and was otherwise negative for a neoplastic process. Shotty axillary lymphadenopathy was noted bilaterally. Upon physical exam, an 8.0 cm, exophytic, ulcerated mass was noted on her anterior chest, overlying the sternum. She also reported experiencing recent fevers, chills, and left neck and axillary swelling. The patient first noticed the mass 1 year prior with accelerated growth and ulceration occurring over the past 3 months. This 22-year-old Haitian-American female with no prior medical history, was referred to the Surgical Oncologist for evaluation of a large mass on her chest. We present an exceedingly rare case of a 22-year-old female with an 8.0 cm ulcerating mass of the anterior chest wall, which was initially diagnosed as a squamous cell carcinoma and later classified as malignant proliferating trichilemmal tumor. The potential for PTT to undergo transformation to a Malignant Proliferating Trichilemmal Tumor (MPTT) is unknown, with only about 40 cases of MPTT having ever b1een reported. ![]() These rare exophytic tumors are mainly confined to the scalp and back of the neck and most often reported in middle age females. Proliferating Trichilemmal tumors (PTT), also known as proliferating pilar tumors, are rare neoplasms of the external root hair sheath that are largely benign, cystic in nature, and characterized as containing trichilemmal keratin. Keywords: Malignant Proliferating Trichilemmal tumor Proliferating Trichilemmal tumor Squamous cell carcinoma Pilar tumor Epidermoid cyst Introduction In this case report we discuss the diagnosis, histo-pathological characteristics, and surgical treatment of such tumors. We present an exceedingly rare case of a 22-year-old female who presented with an 8 cm mass of her anterior chest which was initially diagnosed as a squamous cell carcinoma and later classified as malignant proliferating trichilemmal tumor. The potential for PTT to undergo transformation to a Malignant Proliferating Trichilemmal Tumor (MPTT) is unknown, with only about 40 cases of MPTT having ever been reported. Proliferating Trichilemmal tumors (PTT) are rare neoplasms of the external root hair sheath that are largely benign.
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