Recurrent and Metastatic Trichilemmal Carcinoma of the Skin Over the Thigh: A Case Report

Abstract

I n t r o d u c t i o nTrichilemmal carcinoma (TC) is a rare malignant tumor that develops from the external root sheath of the hair follicle. It usually is found in the skin of the face or ears of elderly women on areas that are exposed to the sun, and TC generally has an indolent clinical course (1,2). This condition is usually curable after a wide excision (2). TC must be differentiated from other skin abnormalities such as squamous cell carcinoma, basal cell carcinoma, keratoacanthoma, and invasive Bowen's disease (3-5). TC is a low-grade carcinoma with a low metastatic potential (6). Surgical excision is considered to be the first choice for curative treatment (7,8), and no other reliable treatment strategies for TC have yet been established (9).We report here on a case of metastatic TC involving the skin over the thigh and this was treated with cisplatin and cyclophosphamide combination chemotherapy. C a s e R e p o r tA 63-year-old woman presented with a mass lesion in the left thigh in September 2006. The medical history and family history were unremarkable. The lesion was 5×5×4 cm in size, with irregular margins and superficial erosion. The entire lesion was removed by performing wide surgical excision and the resection margin was free of tumor. The final diagnosis was TC, and the tumor was composed of several epithelial aggregations arranged in various growth patterns, including solid, lobular and trabecular patterns (Fig. 1). In addition, the skin biopsy revealed that the specimen included neoplastic cells with abundant, clear cytoplasm, and the cells showed prominent atypia and high mitotic activity (Fig. 2).Two years later, the patient was hospitalized with swelling of the left lower leg and enlargement of the left inguinal lymph nodes. The blood pressure was 140/90 mmHg, the pulse rate was 78 bpm, the Trichilemmal carcinoma (TC) is an uncommon cutaneous neoplasm that develops from the external root sheath of the hair follicle. It is considered to be a low-grade carcinoma with low metastatic potential. Local recurrence and metastasis are rare after surgical excision. We report here on a case of metastatic TC in the skin over the thigh, and this tumor was treated with cisplatin and cyclophosphamide combination chemotherapy.

A Case of Trichilemmal Carcinoma With Distant Metastases in a Kidney Transplantation Patient

“…The previous largest study including 26 cases of trichilemmal carcinoma showed that the overall 5-year survival rate reached 89.2% and many studies documented positive outcomes by a wide surgical excision of the primary lesion [6e8]. On the other hand, recurrence or metastasis has seldom been reported in the literature and only three cases of metastasis of trichilemmal carcinoma were reported and their prognosis was poor as same as our case [6,9]. Although transplant recipients receiving immunosuppressants are at a high risk of cancer, our case is the first case of trichilemmal carcinoma in transplant patients with aggressive tumor characteristics.…”

“…Considering the rapid firing multiple metastases, the benefits of surgical resections for metastatic lesions of trichilemmal carcinoma in the present case were uncertain, although the surgical resection represents an important therapeutic approach for other cancers that lack effective systemic treatment. In previous reports about metastatic trichilemmal carcinoma, cisplatinbased regimens were often used resulting in tumor growth control [6,9,13].…”

Unusual Invasion of Trichilemmal Umors: Two Case Reports

“…They both had an invasive tumor. Although There are some reports of metastatic cases and death from these tumors in the literature, the invasion of the dura is very rare [1,5,6]. The first case had dural invasion, which required dural reconstruction.…”

“…These tumors arise mainly in areas of dense hair follicle concentration: 90% occur on the scalp [1]. The usual clinical presentation is a subcutaneous cystic nodule.…”

Challenges in the diagnosis of cutaneous adnexal tumours

“…For example digital papillary adenocarcinoma (DPAC) has a 50% recurrence rate, with a 14% risk of metastasis (especially to lung),8 sebaceous carcinoma (SC) shows an overall 25% risk of lymph node or distant metastasis,9 and porocarcinoma is reported to have a 20% risk of local recurrence and metastatic rate 10 11. Meanwhile, some other malignant adnexal tumours, such as trichilemmal carcinoma, have a very low, if any, metastatic potential 12. Therefore, the correct classification of these tumours has a paramount significance in determining the patient's long-term survival and follow-up.…”