Case for Diagnosis
Fast-Growing Occipital Tumor
Tumoración occipital de rápido crecimiento
E. Varas-Meis
, C. Prada-García, P. Fernández-Canga, M.Á. Rodriguez-Prieto
Corresponding author
Servicio de Dermatología, Complejo Asistencial Universitario de León, León, España
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Varas-Meis, C. Prada-García, P. Fernández-Canga, M.Á. Rodriguez-Prieto" "autores" => array:4 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Varas-Meis" "email" => array:1 [ 0 => "edu.varas.meis@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Prada-García" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Fernández-Canga" ] 3 => array:2 [ "nombre" => "M.Á." "apellidos" => "Rodriguez-Prieto" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Complejo Asistencial Universitario de León, León, España" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tumoración occipital de rápido crecimiento" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 459 "Ancho" => 900 "Tamanyo" => 202518 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×2.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">The patient was an 89-year-old woman who had been diagnosed 40 years earlier with multiple trichilemmal cysts, and had no other medical history of interest. She was referred to our clinic for an asymptomatic ulcerated lesion on the scalp that had appeared 2 months earlier.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed a solid-to-keratotic, exophytic, crateriform tumor of 4 cm in diameter located in the occipital region and adhered to deep planes (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The lesion was surrounded by multiple previously diagnosed trichilemmal cysts. No other lesions were detected, and lymph node enlargement was absent.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">The lesion was excised for pathological examination, which revealed a well-delimited and unencapsulated epithelial proliferation located in the superficial reticular dermis with an endophytic and exophytic growth pattern. This hyperplasia consisted of multiple partially cystic epithelial cords and lobules, with peripheral palisading and central trichilemmal keratinization. More detailed analysis revealed mild-to-moderate cellular atypia, with no aberrant mitoses or areas of necrosis (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis?</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Proliferating pilar tumor (PPT).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Course</span><p id="par0030" class="elsevierStylePara elsevierViewall">The patient showed no recurrence after 6 months of follow-up.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comment</span><p id="par0035" class="elsevierStylePara elsevierViewall">PPT is an adnexal tumor derived from the external radicular membrane of the hair follicle.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> It usually presents as an exophytic scalp tumor, in many cases with ulceration, bleeding, and/or superinfection, and typically affects women aged 40 years and older. However, cases involving tumors in atypical locations, including the thorax, back, buttock, nose, and vulva, have also been described.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> In most cases PPT arises from a pre-existing trichilemmal cyst, although de novo forms, which develop in the absence of pre-existing lesions, are also described.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Histologically, PPT is characterized by hyperplasia consisting of solid or partially cystic epithelial cords or lobules, with peripheral palisading and trichilemmal keratinization.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1–3</span></a> Areas of necrosis, anaplastic cells, and aberrant mitoses are common.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3,4</span></a> PPT can be associated with foreign body reaction, dystrophic calcification, squamous eddies, and areas of vacuolization or dyskeratosis.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2,4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">When differentiating PPT from squamous cell carcinoma, foci of trichilemmal keratinization, sharp delimitation, areas of calcification, and the absence of premalignant epidermal lesions help orient the diagnosis towards PPT.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> The differential diagnosis should also include sebaceous carcinoma, clear cell hidradenocarcinoma, pilomatrixoma, and trichoblastoma.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">PPT follows an unpredictable course and lies on a spectrum ranging from benign trichilemmal cysts with minimal epithelial proliferation to malignant PPT with local invasion, a tendency to recur, and occasional distant metastases.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3,5,8</span></a> An infiltrative pattern with cellular anaplasia, atypical mitoses, and/or areas of necrosis are considered histological markers of poor prognosis.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> The treatment of choice is exeresis with wide margins (1–2 cm) or Mohs micrographic surgery, although a good therapeutic response has also been reported in patients treated with radiotherapy.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In conclusion, we describe a representative case of a little-known adnexal lesion, knowledge of which is necessary in order to select the appropriate therapeutic measures.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Course" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-07-11" "fechaAceptado" => "2017-11-23" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Varas-Meis E, Prada-García C, Fernández-Canga P, Rodriguez-Prieto MÁ. Tumoración occipital de rápido crecimiento. Actas Dermosifiliogr. 2019;110:497–498.</p>" ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 647 "Ancho" => 750 "Tamanyo" => 63727 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 459 "Ancho" => 900 "Tamanyo" => 202518 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×2.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 498 "Ancho" => 900 "Tamanyo" => 226829 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×4.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Proliferating trichilemmal tumors: Clinicopathologic evaluation is a guide to biologic behavior" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.L. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 12 | 22 |
| 2024 October | 88 | 38 | 126 |
| 2024 September | 121 | 23 | 144 |
| 2024 August | 105 | 74 | 179 |
| 2024 July | 81 | 37 | 118 |
| 2024 June | 90 | 42 | 132 |
| 2024 May | 78 | 35 | 113 |
| 2024 April | 102 | 26 | 128 |
| 2024 March | 85 | 25 | 110 |
| 2024 February | 76 | 41 | 117 |
| 2024 January | 69 | 31 | 100 |
| 2023 December | 61 | 21 | 82 |
| 2023 November | 63 | 23 | 86 |
| 2023 October | 66 | 19 | 85 |
| 2023 September | 45 | 27 | 72 |
| 2023 August | 45 | 19 | 64 |
| 2023 July | 42 | 32 | 74 |
| 2023 June | 47 | 19 | 66 |
| 2023 May | 48 | 27 | 75 |
| 2023 April | 38 | 16 | 54 |
| 2023 March | 49 | 22 | 71 |
| 2023 February | 53 | 27 | 80 |
| 2023 January | 35 | 28 | 63 |
| 2022 December | 57 | 36 | 93 |
| 2022 November | 37 | 29 | 66 |
| 2022 October | 29 | 21 | 50 |
| 2022 September | 20 | 36 | 56 |
| 2022 August | 29 | 32 | 61 |
| 2022 July | 27 | 42 | 69 |
| 2022 June | 38 | 31 | 69 |
| 2022 May | 21 | 33 | 54 |
| 2022 April | 38 | 32 | 70 |
| 2022 March | 41 | 41 | 82 |
| 2022 February | 23 | 19 | 42 |
| 2022 January | 25 | 31 | 56 |
| 2021 December | 31 | 28 | 59 |
| 2021 November | 36 | 39 | 75 |
| 2021 October | 36 | 53 | 89 |
| 2021 September | 32 | 33 | 65 |
| 2021 August | 24 | 30 | 54 |
| 2021 July | 17 | 32 | 49 |
| 2021 June | 15 | 31 | 46 |
| 2021 May | 24 | 33 | 57 |
| 2021 April | 44 | 60 | 104 |
| 2021 March | 59 | 13 | 72 |
| 2021 February | 65 | 30 | 95 |
| 2021 January | 42 | 12 | 54 |
| 2020 December | 32 | 14 | 46 |
| 2020 November | 12 | 14 | 26 |
| 2020 October | 15 | 16 | 31 |
| 2020 September | 20 | 12 | 32 |
| 2020 August | 11 | 12 | 23 |
| 2020 July | 7 | 11 | 18 |
| 2020 June | 22 | 18 | 40 |
| 2020 May | 17 | 12 | 29 |
| 2020 April | 10 | 10 | 20 |
| 2020 March | 15 | 5 | 20 |
| 2020 February | 1 | 2 | 3 |
| 2019 May | 1 | 1 | 2 |
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