Malignant Proliferating Trichilemmal Tumour of the Scalp with Intra-Cranial Extension and Lung Metastasis—a Case Report

Abstract

Malignant proliferating trichilemmal tumour (MPTT) is a rare cutaneous tumour predominantly affecting the scalp, eyelids, neck and face of elderly women. It is a large, solitary, multilobulated lesion that may arise within a pilar cyst. These tumours are largely benign, often cystic and are characterized by trichilemmal keratinisation. However at times, the tumour has an aggressive clinical course and a propensity for distant metastasis. We report a case of a 29-year-old male who presented with a scalp swelling. Histology revealed malignant proliferating trichilemmal tumour of scalp. CT thorax showed multiple nodules in both lungs suggestive of lung metastasis. The patient underwent palliative radiotherapy and chemotherapy and expired 2 months after palliation. To the best of our knowledge, malignant proliferating trichilemmal tumour of the scalp with intracranial extension and lung metastasis is a rare condition, and only a handful of cases are reported till date. We report a case of malignant proliferating trichilemmal tumour of the scalp with intra-cranial extension and lung metastasis with relevant discussion at the same time.

Malignant proliferating trichilemmal tumour

“…PTTs can evolve into MPTTs by invading neighbouring tissues with the propensity to metastasise 20. Histologically, they demonstrate markers of malignancy such as nuclear polymorphism, atypical mitosis, foci of single cell necrosis, abrupt keratinisation and lymphovascular invasion 9 11.…”

A proliferating trichilemmal cyst in the perianal region: A case report

“…There are reports of local invasion in more aggressive tumors, recurrence after resection, and metastasis in the malignant form. Other therapeutic options have been proposed for such cases, including Mohs micrographic surgery, neoadjuvant therapy with radiation therapy, or even the use of the latter as the sole treatment [ 2 , 6 , 10 , 13 ].…”

Giant Aggressive Forehead Tumor: A 15-Year Follow-Up

“…The treatment of choice for those without metastasis is wide local excision with 1 cm of normal tissue. 9 Ethanol injection, lymph node dissection, radiotherapy, and chemotherapy can be used as adjuvant treatments in certain cases. 10…”