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      The cytology of giant solitary trichoepithelioma

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          Giant solitary trichoepithelioma (GST) is a rare trichogenic tumor, which may present as a pigmented lesion. An 80-year-old man was diagnosed to have giant solitary trichoepithelioma on fine-needle aspiration cytology. The cytological findings represented the histological features. The recognition of GST is important because of its close resemblance to basal cell carcinoma and other skin adnexal tumors – clinically, cytologically and histologically.

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          Most cited references 8

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          Microcystic adnexal carcinoma: a distinct clinicopathologic entity.

          Microcystic adnexal carcinoma is an unusual locally aggressive neoplasm that is important to recognize since it may be confused with benign adnexal neoplasms, particularly desmoplastic trichoepithelioma, trichoadenoma, and syringoma. Six cases are described all of which displayed benign histological features on initial biopsy. Most often these neoplasms presented as solitary flesh-colored indurated plaques on the upper lip. All patients were white, five were women, and the average age was 44-years-old. Islands of basaloid keratinocytes, some of which contained horn cysts and abortive follicles, were embedded in a desmoplastic stroma. In other foci, ducts and gland-like structures lined by a two-cell layer predominated. In deep components individual and thin strands of cells dissected collagen bundles and skeletal muscle and invaded perineural spaces. Despite this, cytologic atypia and mitotic figures were rare. The cell of origin is considered to be a pluripotential adnexal keratinocyte which is capable of both follicular and sweat gland differentiation.
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            Trichoepithelioma: a 19-year clinicopathologic re-evaluation.

            Accurate histopathologic distinction between trichoepithelioma (TE) and basal cell carcinoma (BCC) may be challenging. From 97 cases diagnosed as TE during the period 1979-1997, 73 available cases were studied with regard to: 1) stroma; 2) retraction effect; 3) papillary-mesenchymal bodies (PMB); 4) amyloid; 5) mitotic figures; 6) apoptotic cells; 7) inflammation; 8) granuloma; and 9) calcification. A judgment was made regarding diagnosis. The patients' medical records were subsequently reviewed for clinical features and possible recurrence. The diagnosis of TE was confirmed histologically in 48 (65%) of 73 cases. Fifteen cases (21%) were reclassified as BCC (RC-BCC), eight other cases (11%) were reclassified as other lesions, and two additional cases (3%) could not be confidently classified as either TE or BCC. The most helpful differentiating features were the presence of retraction effect (in 100% of RC-BCC vs. 37% of TE), myxoid stroma (in 80% of RC-BCC vs. 12% of TE) and PMB (in 20% of RC-BCC vs. 81% of TE). Unexpected findings in TE were detection of amyloid in 33%, apoptotic cells in 100%, and mitotic figures in 46%. Five of the 15 RC-BCC have recurred (33%), whereas there have been no recurrences in the confirmed TE group. A constellation of histopathologic criteria may help to discriminate problematic examples of trichoepithelioma from basal cell carcinoma.
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              Giant solitary trichoepitheliomas located in the perianal area: a report of three cases.

              Very large solitary trichoepitheliomas which arose in the perianal region in three patients are described. Although these tumours showed a striking histological similarity to classical multiple or solitary trichoepitheliomas of the face, they differed in their massive size, unusual location and by their involvement of deeper tissue. We suggest that giant solitary trichoepitheliomas is a distinct variant of trichoepithelioma that may have a predilection for the perianal region. At this site this rare tumour must be distinguished from basal cell carcinoma of the perineum and from malignant basaloid (cloacogenic) carcinoma of the anal canal.

                Author and article information

                J Cytol
                Journal of Cytology / Indian Academy of Cytologists
                Medknow Publications (India )
                July 2010
                : 27
                : 3
                : 99-101
                Department of Pathology, Medical College (VIMS), Bellary, Karnataka, India
                Author notes
                Address for correspondence: Dr. Jayashree Krishnamurthy, Associate Professor, Department of Pathology, Medical College (VIMS), Bellary – 583 104, Karnataka, India. E-mail: bargavisaranga@ 123456gmail.com
                © Journal of Cytology

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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