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Skin - Nonmelanocytic tumors

Adnexal tumors-hair follicles

Trichilemmoma

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 5 July 2012, last major update June 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

General
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● Also called tricholemmoma
● Benign
● Derived from the outer root sheath of hair follicle
● Cowden’s syndrome: multiple trichilemmomas, multiple hamartomas in skin, oral mucosa, breast, thyroid and intestines, as well as malignancies at these sites

Clinical images
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Single disrete warty papule on the lip; flesh-colored

Gross description
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● Warty papule on face

Micro description
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● Lobular or plate-like growth of pale pink, glassy cells
● Often palisading at periphery, thickened basement membrane, occasional central keratinization
● Desmoplastic variant simulates malignancy

Micro images
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Trichilemmoma

Differential diagnosis
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● Trichilemmal carcinoma
● Tumor of the follicular infundibulum
● Clear cell basal cell carcinoma
● Eccrine poroma

Trichilemmal (tricholemmal) carcinoma

General
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● Indolent, with only rare metastases

Case reports
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● 51 year old man with bloody discharge from eyelid (Korean J Ophthalmol 2009 23:301)

Gross description
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● Papular, nodular, or exophytic mass of head/neck/scalp

Gross images
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Upper eyelid swelling and palpable, nontender, movable mass


Yellow, soft, multi-lobulated mass

Micro description
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● Lobular growth of clear tumor cells with trichilemmal-type keratinization, numerous mitotic figures, invasion of reticular dermis, ulceration

Micro images
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Various images

Positive stains
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● p53

Negative stains
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● CD34

Differential diagnosis
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● Trichilemmoma
● Basal cell carcinoma
● Squamous cell carcinoma

End of Skin - Nonmelanocytic tumors > Adnexal tumors-hair follicles > Trichilemmoma

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