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Desmoplastic trichilemmoma.

O Tellechea1, J P Reis, A P Baptista

  • 1Department of Dermatology, University Hospital, Coimbra, Portugal.

The American Journal of Dermatopathology
|April 1, 1992
PubMed
Summary
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Desmoplastic trichilemmoma (DT) is a benign skin tumor often mistaken for cancer. This study reveals DT arises from fibroblast activity, not viral infection or epithelial changes.

Area of Science:

  • Dermatopathology
  • Surgical Pathology
  • Oncology

Background:

  • Desmoplastic trichilemmoma (DT) is a rare, benign skin tumor.
  • It is often misdiagnosed clinically as basal cell carcinoma or papilloma.
  • DT presents as a solitary facial nodule, typically in older men.

Purpose of the Study:

  • To review cases of desmoplastic trichilemmoma.
  • To elucidate the histological features and immunohistochemical profile of DT.
  • To differentiate DT from malignant neoplasms and other benign lesions.

Main Methods:

  • Histopathological examination of seven DT cases.
  • Immunohistochemical analysis for human papilloma virus (HPV), epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), alpha-lactalbumin, keratin, factor XIIIa, and vimentin.

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Main Results:

  • DT exhibits a superficial lobular growth with peripheral trichilemmoma features and central pseudoinvasive cords within a desmoplastic stroma.
  • Immunohistochemistry ruled out HPV, EMA, CEA, and alpha-lactalbumin in the tumor epithelium.
  • Tumor epithelium expressed keratin, while stromal cells stained for vimentin but not factor XIIIa or keratin.

Conclusions:

  • The histological pattern, particularly the perilobular hyaline mantle, aids in differentiating DT from basal cell carcinoma and malignant trichilemmoma.
  • Findings suggest DT is not HPV-induced and the stroma results from fibroblast-mediated activity, not epithelial degeneration.
  • The stroma appears to be a fibroblast-mediated, dendrocyte-independent reaction.