Innocuous Lesions and Not so Innocuous Lesions of the Skin and Soft Tissue

Background: Cystic lesions of the skin and soft tissue are often neglected and thought to be innocuous or harmless. These lesions need to be excised to exclude malignancy. The lesions may present in unusual sites and may also be of infective origin. Thus, there is an urgent need to determine the prevalence and identify the histopathological features of the cystic lesions as the innocuous appearing lesions may actually not be so innocuous. In addition, it is the histopathological features that determine the treatment modality. Aim: To determine the features and prevalence of the types of cysts in skin and soft tissue. Materials and Methods: A retrospective study of the cystic lesions of the skin and soft tissue was conducted. The records from the Department of Pathology, Saveetha Medical College were retrieved and reviewed for patients with cystic lesions of the skin and soft tissue over a one year period extending between January 2019 and December 2019. The records were examined for the following data : age, sex, type of lesion, clinical and histopathological diagnosis. Results: In all 109 cases with skin and soft tissue swellings were analyzed. Among these 53 were males and 56 were more females reported (51 %) of cystic swellings as compared to males (48%). Cystic lesions were most commonly encountered in the age group of 18 to 40 years, which suggests that there may be a role for trauma or occupation related occurrence. A variety of cysts were encountered such as epidermoid cysts (70%), Trichilemmal cyst (7%), and Ganglion (7%).Phaeohyphomycotic cyst, mucous retention cyst, hemangioma and pilomatrixoma. Epidermal cysts were more frequently encountered in males (54%) than females (46%).Most lesions occurred in the back. Conclusion: Epidermal cysts may frequently be associated certain syndromes, hence it is important to evaluate these cysts. In addition phaeohyphomycotic cysts may be mistaken for Ganglion, so histopathological examination is necessary to initiate appropriate therapy.

MALIGNANT PROLIFERATING TRICHILEMMAL TUMOR ONE CASE AND LITERATURE REVIEW

Proliferating trichilemmal tumors (PTTs) are uncommon lesions. PTT is thought to originate from the trichilemmal cyst (TC) and have the potential for malignant transformation, at which point it is termed a malignant proliferating trichilemmal tumor (MPTT). we report an observation of a 55-year-old lady patient presenting with a malignant proliferative trichilemmal tumor, emphasizing the aggressive, rapidly extensible and metastatic character. MPTTare aggressive tumors with a bad prognosis, the treatment of which is based on surgery with margins of 1 cm, lymph node dissection in the event of lymph node involvement and radio-chemotherapy.

Giant, Bleeding, and Ulcerating Proliferating Trichilemmal Cyst, With Delayed Treatment Due to Coronavirus Outbreak: A Case Report and Review of the Literature

We report a case of a large, ulcerating proliferating trichilemmal cyst in a 76-year-old woman, with clinical, radiological, macroscopic, and microscopic correlation. The outbreak of the Coronavirus pandemic delayed her treatment. We review the literature on proliferating trichilemmal cysts, which are relatively rare tumors, which, generally, are considered benign. However, we found a high rate of malign cases, which stresses the importance of rapid surgical excision and histological diagnosis. Even though our proband had delayed treatment, the tumor did not transform into a malignant form.

The Proliferating and Malignant Proliferating Trichilemmal Cyst: An Anatomo-Clinical Study of Three Cases

<b><i>Background:</i></b> The proliferating and malignant proliferating trichilemmal cysts (MPTC) are rare adnexal tumors. We report 3 cases through which we will detail the anatomo-clinical characteristics of these tumors. <b><i>Cases:</i></b> Two patients, 60 and 56 years old, consulted for multiple scalp nodules, one of which had changed with the appearance of a central ulceration. The removal of the remaining scalp nodules was in favor of PTCs. The third patient presented with an ulcerative lesion occupying the vertex. Skin biopsy found trichilemmal-type keratinization associated with areas of necrosis concluding with a MPTC. <b><i>Discussion:</i></b> The PTC is a transitional form between the trichilemmal cyst (TC) and the MPTC. The increase in the size of a TC and ulceration are sufficient signals to suspect this evolution.

Trichilemmal cyst of the neck: case report and review of the literature

Introduction: Trichilemmal cysts are lesions originating in the isthmus of the hair follicle. They are more common in women and occur in 90% on the scalp. Presentation of case: A 10-year-old female patient presented with a hard, slightly painful, nonexophytic mass in the right cervical region (Ia). After surgical resection in healthy margins, the diagnosis of trichilemmal cyst was made on histopathological examination. Discussion: The age of the patient as well as the cervical location of this type of lesion is an extremely rare presentation of trichilemmal cyst. Follow-up is rigorous in search of a triad: ichthyosis, keratosis, deafness, particularly in this patient. Conclusion: Close follow-up in this clinical case is indicated because the risk of malignant degeneration and development of similar lesions is present. Keywords: Follicular cyst; KID syndrome; Trichilemmal cyst; Neck surgery; Trichilemmal carcinoma

Imaging findings of trichilemmal cyst and proliferating trichilemmal tumour

Purpose The purpose of this study was to evaluate computed tomography and magnetic resonance imaging of benign trichilemmal cysts and proliferating trichilemmal tumours. Methods Nineteen histologically confirmed cutaneous lesions with trichilemmal keratinisation (12 trichilemmal cysts and seven proliferating trichilemmal tumours) were enrolled. Among them, 10 lesions (six trichilemmal cysts and four proliferating trichilemmal tumours) were examined by computed tomography, while 13 lesions (eight trichilemmal cysts and five proliferating trichilemmal tumours) were examined by magnetic resonance imaging. Computed tomography and magnetic resonance imaging characteristics were retrospectively reviewed. RESULTS Sixteen lesions (84%, 10 trichilemmal cysts and six proliferating trichilemmal tumours) occurred on the scalp. Lobulated margins were observed in five lesions (26%, three trichilemmal cysts and two proliferating trichilemmal tumours). With respect to computed tomography attenuation, calcification (>200 Hounsfield units) was observed in seven lesions (70%, five trichilemmal cysts and two proliferating trichilemmal tumours), hyperdense areas (≥80 and ≤200 Hounsfield units) in six (60%, three trichilemmal cysts and three proliferating trichilemmal tumours), and soft tissue density areas (<80 Hounsfield units) in nine (90%, five trichilemmal cysts and four proliferating trichilemmal tumours). On T1-weighted images, intratumoral hyperintensity was only observed in eight trichilemmal cysts but no proliferating trichilemmal tumours (100% vs. 0%, P<0.01). On T2-weighted images, hypointense rim and intratumoral hypointensity was observed in all 13 lesions (100%, eight trichilemmal cysts and five proliferating trichilemmal tumours), and linear or reticular hypointensity was observed in 10 (77%, six trichilemmal cysts and four proliferating trichilemmal tumours). Conclusion Trichilemmal cysts and proliferating trichilemmal tumours predominantly occurred on the scalp with calcification, and usually exhibited linear or reticular T2 hypointensity. Intratumoral T1 hyperintensity may be a useful imaging feature for differentiating trichilemmal cysts from proliferating trichilemmal tumours.

A Rare Case: Primary Venous Malformation in Parietal Bone

Primary intraosseous vascular malformations (PIVMs) are rare intraosseous lesions, accounting for approximately 0.5–1% of all intraosseous tumours. In this case report, we aimed to present a rare case of intraosseous vascular malformation causing a large lytic area in the parietal bone. A 25-year-old male patient was admitted to the clinic with a mass on the parietal bone. On physical examination, it was observed that the hair density on the mass was decreased, the mass had a soft consistency, and there was no pain on palpation. The patient was operated under local anaesthesia with a provisional diagnosis of a trichilemmal cyst. However, intraoperative diagnosis was a vascular malformation. There was a 3-cm full-thickness defect on the parietal bone caused by the lesion. The mass was excised completely while preserving the integrity of the dura. The resulting defect was reconstructed with bilateral rotation advancement flaps. The calvarial defect was not reconstructed due to equipment inadequacy. No complications were encountered in the postoperative period. Ninety-three PIVM cases have been reported in the skull since 1845. In very few of these cases, the mass is located in the parietal bone. The pathogenesis of PIVMs is not completely understood. The definitive diagnosis is made by histopathological examination. The therapeutic gold standard is surgery. Surgeons should keep in mind that radiological examination before the operation could prevent undesirable complications.

An Unusual Presentation of Proliferating Trichilemmal Tumor Developing in Psoriatic Plaque: A Case Report

Proliferating trichilemmal tumor (PTT) is a rare, mostly benign neoplasm which stems from the follicular outer root sheath epithelium. PTT occurs as a subcutaneous cystic nodule slowly enlarging to a larger noduler mass, and is usually localized on the scalp of elderly women. To the best of our knowledge, PTT localized on a psoriatic plaque has not been reported previously. Herein, we report an unusual case of benign PTT arising from a psoriatic plaque on the knee of a 63-year-old male patient. Keywords: proliferating trichilemmal tumor, psoriasis, trichilemmal cyst