Case and Research Letter
Trichogerminoma: A Neoplasm With Follicular Differentiation and a Characteristic Morphology
Tricogerminoma: una neoplasia con diferenciación folicular y una morfología característica
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Lozano-Masdemont, V.J. Rodríguez-Soria, L. Gómez-Recuero-Muñoz, V. Parra-Blanco" "autores" => array:4 [ 0 => array:4 [ "nombre" => "B." "apellidos" => "Lozano-Masdemont" "email" => array:1 [ 0 => "belenmasdemont@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "V.J." "apellidos" => "Rodríguez-Soria" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "L." "apellidos" => "Gómez-Recuero-Muñoz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "V." "apellidos" => "Parra-Blanco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Dermatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Pathology, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tricogerminoma: una neoplasia con diferenciación folicular y una morfología característica" ] ] "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" => 746 "Ancho" => 995 "Tamanyo" => 274855 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Compact, pale round structures with an onion skin appearance, also defined as cell balls or nests of cells with pale cytoplasm and vesicular nuclei, characteristic of trichogerminoma. Hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×20.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Trichogerminoma was described in 1992,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> and few cases of this benign neoplasm with follicular differentiation have been reported.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2–6</span></a> Among the follicular tumors, trichogerminoma has certain easily recognizable morphological characteristics that warrant mention.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 71-year-old white man with no past history of interest. He was seen for an asymptomatic lesion that had appeared 6 years earlier on his left thigh and had grown rapidly in the previous months, tripling in size. Physical examination revealed a hard whitish nodule measuring 25<span class="elsevierStyleHsp" style=""></span>mm in diameter. The nodule was not tender and was not adherent to deeper planes (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1A</a>). Complete surgical excision of the lesion was performed without wide margins. Histology showed a well-defined nodule surrounded by a fibrous pseudocapsule, situated in the deep dermis and hypodermis, with no connection to the epidermis. The nodule was formed of lobules of basaloid cells with peripheral palisading, with no retraction cleft between the cells and the stroma (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1B</a>). There was abundant stroma with numerous fibroblasts. All sections contained dense round structures with an onion skin appearance or nests of cells with pale cytoplasm and elongated vesicular and sometimes pycnotic nuclei (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Few foci of keratinization were observed. No cytologic atypia was seen. Immunohistochemistry was positive for pancytokeratins AE1/AE3, cytokeratin (CK) 5/6, and p63 in both cell types (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). These structures in characteristics nests, in the context of a benign basaloid neoplasm with pilar differentiation, supported a diagnosis of trichogerminoma. There has been no recurrence after a year of follow-up.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Sau et al.,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> in their series of 14 cases, coined the term trichogerminoma in reference to tumor differentiation towards the germinal epithelium of the hair. The neoplasm they described was formed of lobules of basaloid cells and was characterized by agglomerations of densely packed cells in the form of round nests or cell balls, simulating hair bulbs. The lobules presented peripheral palisading, and there was a variable quantity of stroma between the lobules, with no cleft between the lobules and the epithelium, and no stroma between the nests. These images have previously been published in 2 figures in the study by Grouls et al.,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> with a diagnosis of trichoblastic fibroma.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Trichogerminoma is a tumor of middle-aged individuals (median age, 50 years) and is more common in men. It presents as solitary nodules, with no superficial changes other than telangiectasias.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> This tumor typically arises on the face and, less frequently, on the scalp, trunk and limbs.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–5</span></a> It is a slow-growing tumor with a benign behavior, and does not recur after complete surgical excision. However, we should draw attention to a case reported by Sau et al.,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> in which areas of undifferentiated carcinoma were detected at the time of diagnosis and subsequently metastasized, leading to the death of the patient.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Immunohistochemically the basaloid lobules are positive for cytokeratin markers, including AE1/AE3, CK5/6, and CK5/8,<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2–4</span></a> which could reflect differentiation towards the outer root sheath.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> The pale round structures characteristic of trichogerminoma show little or no immunoreactivity to the aforementioned cytokeratin markers; Kazakov<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> considered this likely to be artifactual, as the cells could be in apoptosis and contain less cytoplasm, though other authors consider this to be another characteristic finding to differentiate these lesions from trichoblastoma. Chen et al.,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> however, found less difference in CK5/6 positivity between the 2 areas, and this, together with our case, would support Kazakov's hypothesis. The pattern of immunoreactivity to another epithelial marker, p63 (of the p53 family, localized to the nucleus<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> and expressed in cells derived from the matrix and from the outer root sheath in tumors with follicular differentiation<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>), also does not differ between the 2 zones,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> as observed in our case.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The differential diagnosis should include basaloid cell tumors with follicular differentiation. For many authors, these tumors form a spectrum.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3</span></a> They present common elements and are classified according to which element predominates. Trichoblastoma, mentioned above, is characterized by lobules of basaloid cells with no connection with the epidermis, with peripheral palisading, and no retraction clefts. It forms structures similar to hair bulbs and dermal papillae, with no areas of pale cells with an onion skin appearance. The feature that differentiates trichoblastoma from trichoepithelioma is the predominance of the formation of corneal cysts. Trichilemmoma is connected to the epidermis and is characterized by clear cells with peripheral palisading. Finally, basal cell carcinoma is differentiated by its retraction cleft between the epithelium and the stroma and by its connection to the epidermis.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Despite the nonspecific clinical manifestations of this benign neoplasm, presenting as a deep solitary nodule with no epidermal involvement, its histology is characteristic and enables us to differentiate it from trichoblastoma, either as a different entity or as a variant. In the case we have presented, we draw attention to the stability of the lesion over a number of years, followed by rapid growth over a period of months, with no histologic evidence of malignancy.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Lozano-Masdemont B, Rodríguez-Soria VJ, Gómez-Recuero-Muñoz L, Parra-Blanco V. Tricogerminoma: una neoplasia con diferenciación folicular y una morfología característica. Actas Dermosifiliogr. 2016;107:789–791.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1050 "Ancho" => 1400 "Tamanyo" => 377517 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Hard, whitish nodule measuring 25<span class="elsevierStyleHsp" style=""></span>mm in diameter. The nodule, situated in the left thigh, was not adherent to deeper planes. B, Proliferation of basaloid cells with no retraction cleft with the stroma. Hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×4.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 746 "Ancho" => 995 "Tamanyo" => 274855 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Compact, pale round structures with an onion skin appearance, also defined as cell balls or nests of cells with pale cytoplasm and vesicular nuclei, characteristic of trichogerminoma. Hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×20.</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" => 1125 "Ancho" => 1500 "Tamanyo" => 769961 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Positive immunohistochemistry with no differences between the 2 cell types. A, Stain for pancytokeratins AE1/AE2. B, Stain for cytokeratin 5/6. C, Stain for p63.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Trichogerminoma. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 9 | 12 | 21 |
| 2024 Octubre | 89 | 53 | 142 |
| 2024 Septiembre | 78 | 31 | 109 |
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| 2021 Diciembre | 45 | 29 | 74 |
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| 2021 Agosto | 45 | 32 | 77 |
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| 2018 Diciembre | 4 | 0 | 4 |
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| 2018 Octubre | 3 | 0 | 3 |
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| 2017 Septiembre | 22 | 5 | 27 |
| 2017 Agosto | 26 | 1 | 27 |
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| 2017 Junio | 32 | 11 | 43 |
| 2017 Mayo | 25 | 5 | 30 |
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| 2017 Febrero | 18 | 5 | 23 |
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