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Trichofolliculoma Workup

  • Author: Michael S Howard, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Nov 13, 2015
 

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.[6]

Low-power view of trichofolliculoma with a primary Low-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 secon Edge of the primary follicle with associated secondary and tertiary budding follicular structures.
Higher magnification of budding follicular structu Higher 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 d Low-power view of a section of trichofolliculoma demonstrating budding follicular structures and associated stroma.
Higher magnification of budding follicular structu Higher 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.[7]

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.[8, 9] 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.[10]

Higher magnification of central primary follicle a Higher magnification of central primary follicle and associated sebaceous lobules.
 
 
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, Arkansas Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

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, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD Herman Beerman 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, American Medical Association, American Society of Dermatopathology, Pennsylvania Academy of Dermatology

Disclosure: Received royalty from Lippincott Williams Wilkins for textbook editor.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

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, United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

References
  1. Gokalp H, Gurer MA, Alan S. Trichofolliculoma: a rare variant of hair follicle hamartoma. Dermatol Online J. 2013 Aug 15. 19 (8):19264. [Medline].

  2. Abdou AG, Asaad NY. Sebaceous trichofolliculoma of the cheek in a 65-year-old man. Pol J Pathol. 2014 Oct. 65 (3):253-4. [Medline].

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

  4. 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. 2008 Oct. 30(5):500-3. [Medline].

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

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

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

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

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

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

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

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

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

 
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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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