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Case Report: A rapidly growing cyst on the scalp
Emma Short1, Aisling O'Shea1, Krishna Mukkanna2
1Department of Cellular Pathology, University Hospital of Wales, Cardiff, CF14 4XW, UK.
A rare scalp tumor, trichilemmal carcinoma, can mimic other skin lesions. This case highlights its challenging diagnosis and the need for surgical excision and follow-up due to metastasis potential.
Area of Science:
- Dermatology
- Oncology
- Pathology
Background:
- Trichilemmal carcinoma is a rare malignancy originating from the hair follicle's outer root sheath.
- Distinguishing it clinically and histologically from other skin neoplasms, such as squamous cell carcinoma, can be challenging.
Observation:
- A 62-year-old female presented with a 20-year history of scalp cysts, one of which rapidly enlarged and became painful.
- Initial clinical suspicion by healthcare providers was infection, leading to incision and antibiotic treatment.
Findings:
- Surgical excision revealed a 3 x 4 cm lesion.
- Microscopic examination confirmed trichilemmal carcinoma arising in a pre-existing pilar cyst, characterized by squamous epithelium with trichilemmal keratinization, nuclear pleomorphism, mitoses, and infiltrative architecture.
Implications:
- Despite being a low-grade tumor, trichilemmal carcinoma carries the risk of lymph node spread and distant metastasis.
- Adequate surgical excision and diligent follow-up are crucial for managing this rare condition.
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