A giant trichoblastic carcinoma

Abstract

Trichoblastic carcinoma usually occurs as a malignant transformation of the trichoblastoma, but is very rare. A 25-year-old man was admitted with trichoblastoma in the nuchal area with frequent recurrences since birth. The preoperative neck magnetic resonance image revealed lobulated soft tissue lesions involving superficial fascia and infiltrating into both proximal trapezius muscles. In our department, wide excision and reconstruction with a free anterolateral thigh flap were performed. Histological examination revealed skin adnexal carcinoma, originating from the hair follicles, consistent with trichoblastic carcinoma. There was no palpable mass 5 years postoperatively, and there was no recurrence on follow-up positron emission tomography-computed tomography. Trichoblastic carcinomas are rare and difficult to diagnose, but histopathological findings include atypical basaloid keratinocytes with crowded, hyperchromatic nuclei, and increased mitotic activity. The presence of hypercellular stroma is a criterion for distinguishing trichoblastic carcinoma from basal cell carcinoma. A rare giant trichoblastic carcinoma was reported, which was the biggest one in the literature.

Clinicopathological features of trichoblastomas and malignant variant: trichoblastic carcinoma

“…Malignant trichoblastoma has only been described in case reports in the literature. Pigmented forms such as trichoblastomas and giant forms have also been reported [14,15]. As in our patients, these lesions mostly affect the head and neck region [16] and the elderly, although, other locations such as the abdomen [17] and the paraspinal area [18] may also be involved.…”

“…The primary form of treatment reported in the literature involves surgical excision. There is no clear-cut consensus regarding the surgical margins, with some studies reporting excisions ranging between 0.5 cm and 1.5 cm [13][14][15]. In our patient, excision was performed to achieve a surgical margin of 1 cm, with primary repair.…”

Trichoblastic Carcinoma in the Glabella Treated With Mohs Micrographic Surgery

“…Trichoblastic carcinoma (TBC), or malignant trichoblastoma, is a rare malignant adnexal neoplasm. TBC is conventionally thought to develop within pre-existing trichoblastoma [ 1 ] but can also occur within trichoepithelioma in conjunction with genodermatoses such as multiple familial trichoepitheliomas or Brooke-Spiegler syndrome [ 2 - 4 ]. In contrast to prior views, a recent retrospective review reported that most cases (87%) seemed to have occurred spontaneously, though the authors noted that pre-existing benign lesions might have gone undetected before the diagnosis of TBC [ 5 ].…”