Trichilemmoma Arising in the Nasal Vestibule: Report of Three Cases with Special Emphasis on the Differential Diagnosis

Abstract

Trichilemmoma is a benign cutaneous epithelial tumor with differentiation towards cells of the outer hair root sheath and usually presents as a small papule on the face of middle-aged or older adults. We herein report three cases of trichilemmoma located in the nasal vestibule, including two of the conventional type and one of the desmoplastic variant. To our knowledge, only one case of trichilemmoma arising in the nasal vestibule has been previously reported. Trichilemmoma must be included in the differential diagnosis of epithelial lesions arising in this location. This is particularly important in the case of the desmoplastic trichilemmoma, a tumor that resembles invasive carcinoma such as desmoplastic squamous cell carcinoma, sclerosing basal cell carcinoma, and trichilemmal carcinoma. The circumscription of the lesion, the architectural pattern of epithelial cell cords and small nests merging with a desmoplastic stroma in the central area of the tumor, the expression of CD34, and the lack of an obvious squamous differentiation or basaloid foci favor the diagnosis of desmoplastic trichilemmoma. All these features help to rule out the diagnosis of carcinoma with significant clinical implications.

Linear trichilemmoma following a blaschkoid pattern: a clinical dilemma

“…On PubMed search, few articles have been reported of trichilemmoma on the nose. 16,17 To the best of our knowledge, this is the first case report of trichilemmoma following a blaschkoid pattern on the nose. Skin biopsy was done for one of the skin-coloured papules on the right side of the cheek, which showed no evidence of trichilemmoma on histopathology, this was done to rule out disseminated trichilemmoma.…”

“…Treatment consists of ablation, cryotherapy, shave, curettage and surgical excision. On PubMed search, few articles have been reported of trichilemmoma on the nose . To the best of our knowledge, this is the first case report of trichilemmoma following a blaschkoid pattern on the nose.…”

Trichilemmoma of the perioral area – Case report

“…It sometimes exhibits central ulceration as well as keratinization of the epidermal surface, which may be sufficient for the formation of pearls or a cutaneous horn. 3,4 It may also involve other locations, such as the neck, scalp, thoracic skin or vulva. 2,3 It presents a slow, progressive growth, and the evolution over time can vary from months to years, with its diameter rarely exceeding 1 cm.…”

“…3,4 It may also involve other locations, such as the neck, scalp, thoracic skin or vulva. 2,3 It presents a slow, progressive growth, and the evolution over time can vary from months to years, with its diameter rarely exceeding 1 cm. 5 The presence of multiple facial trichilemmomas is associated with Cowden syndrome, originally described by Costello in 1940 and named by Lloyd and Dennis in 1963.…”

“…10 Histopathologically, trichilemmomas are small and circumscribed lobular or multilobular proliferations, consisting of clear cells from the root of the hair follicle, usually with a large connection to the epidermal surface. 2,3,5 The cells' pale appearance is due to the accumulation of glycogen inside them and can be evidenced by periodic acid-Schiff (PAS) staining. 5 A papillomatous surface is common, reflecting the presence of verrucous hyperplasia with hypergranulosis.…”