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LETTER TO THE EDITOR
Year : 2013  |  Volume : 4  |  Issue : 3  |  Page : 251-252  

Verrucous trichoadenoma - presenting as discharging sinus on face


Department of Dermatology, S.G.R.D. Medical College, Amritsar, Punjab, India

Date of Web Publication24-Jul-2013

Correspondence Address:
Swati Arora
97, Inderjeet Colony, Opposite Mata Kaulan Hospital, 100 Feet Road, Amritsar, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5178.115540

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How to cite this article:
Arora S, Kaur J, Kaur H. Verrucous trichoadenoma - presenting as discharging sinus on face. Indian Dermatol Online J 2013;4:251-2

How to cite this URL:
Arora S, Kaur J, Kaur H. Verrucous trichoadenoma - presenting as discharging sinus on face. Indian Dermatol Online J [serial online] 2013 [cited 2019 Nov 22];4:251-2. Available from: http://www.idoj.in/text.asp?2013/4/3/251/115540

Sir,

Trichoadenoma is a slowly growing follicular tumor, which is rare, benign, well differentiated and solitary. It was first described by Nikolowski in 1958. [1] It occurs equally in men and women. The lesions present as a non-specific nodule. The commonest sites of appearance are face, buttocks. [2]

We want to discuss a case of 28-year-old female patient who presented with a swelling on right cheek with discharge since last 2 years [Figure 1]. Since then patient had been taking treatment for same in the form of antibiotics and anti-inflammatory drugs but there was no relief. She had even undergone incision and drainage few times for the same. On clinical examination there was a single nodular lesion measuring 2 cm × 1 cm with discharge on surface. Examination of buccal mucosa of same site did not reveal any lesion. We kept a differential diagnosis of lupus vulgaris, deep fungal granuloma.
Figure 1: Nodular lesion with scarring and discharge on right cheek

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Routine laboratory blood investigations were normal. Mantoux test was non-reactive. Pus culture and examination did not reveal any growth either bacterial or fungal. AFB staining of pus was negative. Punch biopsy was taken and sent for histopathological examination.

Histopathological examination of the tissue showed epidermis with hyperplasia and keratotic plugging [Figure 2]. In the dermis many horn cysts were present surrounded by eosinophillic cells. Fibrous tissue around cysts was increased at few sites [Figure 3]. Infiltration by chronic inflammatory cells consisting of lymphocytes and plasma cells was seen. At few sites sebaceous differentiation was also seen. Based on above histological findings, a diagnosis of verrucous trichoadenoma was made and the lesion was excised surgically.
Figure 2: 10X view of histopathological section showing hyperplastic 0epidermis and keratotic plugging [H & E, 10x]

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Figure 3: 40X view of section showing multiple horn cysts [H & E, 40x]

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Trichoadenoma is a benign tumor of hair follicle, presenting as a solitary nodule on face (58%) or buttocks (25%), size may vary from 3 to 50 mm in diameter. Rarely it can be present on neck, arms, thighs, shoulder, and shaft of penis. [3] It may arise any time during adult life in both sexes equally. [2],[3],[4],[5] Few case reports of childhood and congenital onset has also been described. [6]

Microscopic study of trichoadenoma reveals multiple horn cysts throughout dermis, surrounded by eosinophillic epithelial cells. The central cystic cavity shows epidermoid keratinization and looks like the cross section of infundibular portion of pilosebaceous canal without any evidence of hair follicle formation. Solid epithelial islands of eosinophillic epithelial cells without central keratinization can also be seen. [2],[5],[7]

In morphological differentiation trichoadenoma is believed to be in between trichoepithelioma and trichofolliculoma, differentiating toward infundibular portion of pilosebaceous canal.

Trichoepithelioma is an autosomal dominant disorder; histologically, it is characterized by the presence of islands of basaloid cells with peripheral palisading and surrounded by dense fibroblastic stroma. [2],[5]

At the other end, trichofolliculoma is a benign hamartomous lesion that can develop at any age. Histologically, trichofolliculomas consist of a centrally located, unilocular or multilocular keratin filled cystic cavity with hair shaft fragments, lined by infundibular squamous epithelium with prominent granular layer. [2],[5]

In our case the clinical appearance of lesion with discharge was very misleading. Histopathological examination proved to be very helpful in diagnosing this case. The lesion had been excised completely without any recurrence so far.

 
   References Top

1.Nikolowski W. Trichoadenom. Arch Klin Exp Dermatol 1958;207:34-5.  Back to cited text no. 1
[PUBMED]    
2.Brenn T, Mikee PH. Tumors of the hair follicle. In: Mckee PH, Calonje E, Granter SR, editors. Pathology of the skin with clinical correlations. 3 rd ed. Elsevier, Mosby; 2005. p. 1519-63.  Back to cited text no. 2
    
3.Yu HJ, Yang HY, Kim YS. A case of trichoadenoma. Korean J Dermatol 1998;36:372-5.  Back to cited text no. 3
    
4.Rebold R, Udeutsch W, Fleiner J. Trichoadenoma of Nikolwsky - Review of four ecades and seven new cases. Hautarzt 1998;49:925-8.  Back to cited text no. 4
    
5.Klein W, Chan E, Seykora JT. Tumors of the epidermal appendages. In: Elder DE, Elenitsas R, Johnson BL, Murphy GF, editors, Levers histopathology of the skin. 9 th ed. Lippincott: Williams & Wilkins; 2005. p. 877.  Back to cited text no. 5
    
6.Lee WS, Oh ST, Lee JY, Cho BK. Congenital trichoadenoma with an unusual clinical manifestation. J Am Acad Dermatol 2005;57:905-6.  Back to cited text no. 6
    
7.Yamaguchi J, Takino C. A case of trichoadenoma arising in the buttock. J Dermatol 1992;19:503-6.  Back to cited text no. 7
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  [Figure 1], [Figure 2], [Figure 3]



 

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