Trichofolliculoma Workup

  • Author: Michael S Howard, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 13, 2012
 

Histologic Findings

Following surgical excision, these tumors are found to consist of a dilated primary follicle lined by infundibular, stratified squamous epithelium and opening to the skin surface.[4]

Low-power view of trichofolliculoma with a primaryLow-power view of trichofolliculoma with a primary follicle opening onto the skin surface.

From the central follicle outward, numerous secondary and tertiary follicles can be observed, presenting at various levels of hair-follicle differentiation. Hair structures may be observed within the hair follicle lumen; small sebaceous elements may be found within the follicular units.

Edge of the primary follicle with associated seconEdge of the primary follicle with associated secondary and tertiary budding follicular structures. Higher magnification of budding follicular structuHigher magnification of budding follicular structures.

Minimal lymphocytic or granulomatous inflammation may be present. An abundant connective tissue stroma is also present surrounding the follicular structures.

Low-power view of a section of trichofolliculoma dLow-power view of a section of trichofolliculoma demonstrating budding follicular structures and associated stroma. Higher magnification of budding follicular structuHigher magnification of budding follicular structures and associated stroma.

Abundant Merkel cells have been demonstrated within the follicular epithelium, supporting the concept that trichofolliculomas are hamartomas.[5]

A variant of the trichofolliculoma is the sebaceous trichofolliculoma, featuring similar histologic features, except for the presence of numerous well-differentiated sebaceous lobules emptying into the central, dilated primary follicle. Sebaceous trichofolliculoma demonstrates histologic overlap with folliculosebaceous cystic hamartoma.[6, 7] Some consider the latter tumor to be a sebaceous trichofolliculoma in telogen phase. A single case of trichofolliculoma with perineural invasion has been reported in the literature.[8]

Higher magnification of central primary follicle aHigher magnification of central primary follicle and associated sebaceous lobules.
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Contributor Information and Disclosures
Author

Michael S Howard, MD  Dermatopathologist and Laboratory Director, Georgia Dermatopathology Associates

Disclosure: Nothing to disclose.

Coauthor(s)

Bruce R Smoller, MD  Executive Vice President, United States and Canadian Academy of Pathology

Bruce R Smoller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society of Dermatopathology, and Arkansas Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

James W Patterson, MD  Professor of Pathology and Dermatology, Director of Dermatopathology, University of Virginia Medical Center

James W Patterson, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Society of Dermatopathology, Royal Society of Medicine, Society for Investigative Dermatology, and United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD  Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology

Disclosure: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Ishii N, Kawaguchi H, Takahashi K, Nakajima H. A case of congenital trichofolliculoma. J Dermatol. Mar 1992;19(3):195-6. [Medline].

  2. Cole P, Kaufman Y, Dishop M, Hatef DA, Hollier L. Giant, congenital folliculosebaceous cystic hamartoma: a case against a pathogenetic relationship with trichofolliculoma. Am J Dermatopathol. Oct 2008;30(5):500-3. [Medline].

  3. Wu YH. Folliculosebaceous cystic hamartoma or trichofolliculoma? A spectrum of hamartomatous changes inducted by perifollicular stroma in the follicular epithelium. J Cutan Pathol. Sep 2008;35(9):843-8. [Medline].

  4. Misago N, Kimura T, Toda S, Mori T, Narisawa Y. A revaluation of trichofolliculoma: the histopathological and immunohistochemical features. Am J Dermatopathol. Feb 2010;32(1):35-43. [Medline].

  5. Hartschuh W, Schulz T. Immunohistochemical investigation of the different developmental stages of trichofolliculoma with special reference to the Merkel cell. Am J Dermatopathol. Feb 1999;21(1):8-15. [Medline].

  6. Plewig G. Sebaceous trichofolliculoma. J Cutan Pathol. Dec 1980;7(6):394-403. [Medline].

  7. Tanimura S, Arita K, Iwao F, et al. Two cases of folliculosebaceous cystic hamartoma. Clin Exp Dermatol. Jan 2006;31(1):68-70. [Medline].

  8. Stern JB, Stout DA. Trichofolliculoma showing perineural invasion. Trichofolliculocarcinoma?. Arch Dermatol. Aug 1979;115(8):1003-4. [Medline].

  9. Gray HR, Helwig EB. Trichofolliculoma. Arch Dermatol. 1962;86:99-105.

  10. Headington JT. Tumors of hair follicle differentiation. In: Farmer E, Hood A, eds. Pathology of the Skin. New York, NY: McGraw-Hill; 1990:596-614.

  11. Kligman AM, Pinkus H. The histogenesis of nevoid tumors of the skin. The folliculoma--a hair-follicle tumor. Arch Dermatol. Jun 1960;81:922-30. [Medline].

  12. McKee P. Farmer E, Hood A, eds. Pathology of the Skin. 2nd ed. New York, NY: McGraw-Hill; 1996:15.25-15.28.

  13. Pinkus H, Sutton RL Jr. Trichofolliculoma. Arch Dermatol. Jan 1965;91:46-9. [Medline].

  14. Wick MR, Swanson PE, Barnhill RL. Sebaceous and pilar tumors. In: Barnhill R, ed. Textbook of Dermatopathology. New York, NY: McGraw-Hill; 1998:593-621.

 
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Low-power view of trichofolliculoma with a primary follicle opening onto the skin surface.
Edge of the primary follicle with associated secondary and tertiary budding follicular structures.
Higher magnification of budding follicular structures.
Low-power view of a section of trichofolliculoma demonstrating budding follicular structures and associated stroma.
Higher magnification of budding follicular structures and associated stroma.
Low-power view of sebaceous trichofolliculoma demonstrating dilated, primary follicle; budding follicular structures; and numerous associated sebaceous lobules.
Higher magnification of central primary follicle and associated sebaceous lobules.
Clinical appearance of trichofolliculoma.
 
 
 
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